Reproductive Injustice at the Southern Border and Beyond: An Analysis of Current Events and Hope for the Future.

Abstract

Recent accounts of unconsented hysterectomies in detained immigrants give modern relevance to a history of government-sanctioned reproductive control in the United States. In September 2020, Dawn Wooten, a nurse at the Irwin County Detention Center (ICDC) in Georgia, reported reoccurring instances of medical neglect and medically unnecessary and unconsented sterilizing procedures in immigrant women in ICDC custody. The initial report included five women who reported hysterectomies between October and December 2019. The women held in U.S. Immigrations and Customs Enforcement (ICE) custody received inadequate and misleading information about the hysterectomy procedure in language that was not their own, invalidating informed consent (Cuffari et al., 2020Cuffari J.V. Quinn C. Giles T.P. Paulk D. Cuffari D. Lack of medical care, unsafe work practices, and absence of adequate protection against COVID-19 for detained immigrants and employees alike at the Irwin County Detention Center.https://projectsouth.org/wp-content/uploads/2020/09/OIG-ICDC-Complaint-1.pdfDate: 2020Date accessed: February 28, 2021Google Scholar). Since this initial report, dozens more women have come forward reporting medically aggressive and/or unconsented gynecological procedures. Investigation of these reports by U.S. Department of Homeland Security (DHS), and patient medical and psychological follow-up evaluations, have been compromised by deportation (McEvoy, 2020McEvoy J. Report: U.S. Is Deporting Women Who Alleged Surgical Abuse At Georgia Detention Center.www.forbes.com/sites/jemimamcevoy/2020/11/11/report-us-is-deporting-women-who-alleged-surgical-abuse-at-georgia-detention-center/?sh=15cce02810e7Date: 2020Date accessed: February 28, 2021Google Scholar). The events described by Ms. Wooten represent another manifestation of a disquieting historical narrative that immigrants, incarcerated, poor, mentally and physically disabled, and Black and Brown individuals are reproductively controllable and disposable. The founders of the Reproductive Justice (RJ) framework recognized that the reproductive rights movement was created largely by and for White women, some of whom were active in anti-immigration movements (Kulish and McIntire, 2019Kulish N. McIntire M. Why an heiress spent her fortune trying to keep immigrants out.www.nytimes.com/2019/08/14/us/anti-immigration-cordelia-scaife-may.htmlDate: 2019Date accessed: February 28, 2021Google Scholar). The RJ framework centers individuals who have been historically denied the full range of reproductive health services and protections, and recognizes the inextricable link between reproductive health, social justice, and the health systems’ role in maintaining inequity. The tenets of RJ detail the right to 1) maintain personal reproductive autonomy, 2) have children or to not have children as one desires, 3) parent those children with dignity in a safe environment, and 4) dissociate sex from reproduction (Parker, 2020Parker W.J. The moral imperative of reproductive rights, health, and justice.Best Practice and Research: Clinical Obstetrics and Gynaecology. 2020; 62: 3-10Crossref PubMed Scopus (4) Google Scholar). Our analysis outlines violations of the first three tenets. The unconsented hysterectomies at ICDC are only the most recent transgressions against immigrants’ personal reproductive autonomy by immigration authorities. In 2017, the American Civil Liberties Union (ACLU) filed lawsuits regarding multiple instances of unaccompanied immigrant minors in Office of Refugee Resettlement (ORR) custody being refused abortion services despite residing in a state that would otherwise allow them to exercise this request (American Civil Liberties Union (ACLU), 2018American Civil Liberties Union (ACLU)Court orders Trump administration to stop blocking abortion for young immigrant women in U.S. custody.www.aclu.org/press-releases/court-orders-trump-administration-stop-blocking-abortion-young-immigrant-women-usDate: 2018Date accessed: February 28, 2021Google Scholar). The ORR oversees the care of unaccompanied minors immigrating to the United States. Former federally appointed ORR Director Scott Lloyd upheld his reputation as an antiabortion activist over his tenure, using coercive techniques to deter abortion requests, even for pregnancies resulting from sexual assault (American Civil Liberties Union (ACLU), 2018American Civil Liberties Union (ACLU)Court orders Trump administration to stop blocking abortion for young immigrant women in U.S. custody.www.aclu.org/press-releases/court-orders-trump-administration-stop-blocking-abortion-young-immigrant-women-usDate: 2018Date accessed: February 28, 2021Google Scholar). ORR immigration staff were directed to refuse minors seeking judicial bypass for abortion laws, told to restrict access to meetings with attorneys (American Civil Liberties Union (ACLU), 2021American Civil Liberties Union (ACLU)J.D. v. Azar (formerly Garza v. Azar and Garza v. Hargan) - Challenging Trump administration’s refusal to permit teenage immigration detainees to access abortion services.www.acludc.org/en/cases/jd-v-azar-formerly-garza-v-azar-and-garza-v-hargan-challenging-trump-administrations-refusalDate: 2021Date accessed: February 28, 2021Google Scholar), and instructed that they “should not be supporting abortion pre- or post-release; only pregnancy services and life-affirming options counseling” (Messing et al., 2020Messing A.J. Rosen J.D. Fabi R.E. Reproductive injustice at the US Border.American Journal of Public Health. 2020; 110: 339-344Crossref PubMed Scopus (6) Google Scholar). Previous protections under the Obama Administration allowed a pregnant minor in ORR custody to receive abortion services, although federal funds could only pay for services when the pregnancy resulted from a rape or cases of medical emergency. However, the Trump Administration granted additional privileges to the ORR Director to personally decide whether abortions were in the best interest of the teens, leading to the denial of abortion services (S. Ehrlich, JD, Interview, July 1, 2020; American Civil Liberties Union (ACLU), 2018American Civil Liberties Union (ACLU)Court orders Trump administration to stop blocking abortion for young immigrant women in U.S. custody.www.aclu.org/press-releases/court-orders-trump-administration-stop-blocking-abortion-young-immigrant-women-usDate: 2018Date accessed: February 28, 2021Google Scholar). Deplorable holding conditions and a lack of access to comprehensive obstetric and gynecological services directly undermine migrants' reproductive rights. Detained asylum seekers frequently experience shackling during labor and inadequate health care, resulting in poor maternal and neonatal health outcomes (Messing et al., 2020Messing A.J. Rosen J.D. Fabi R.E. Reproductive injustice at the US Border.American Journal of Public Health. 2020; 110: 339-344Crossref PubMed Scopus (6) Google Scholar). The Obama Administration's “presumption of release” policy ordered detention centers to release, or undertake expedited removal of, pregnant women from federal custody except under extraordinary circumstances (Ellmann, 2019Ellmann N. Immigration detention is dangerous for women’s health and rights.www.americanprogress.org/issues/women/reports/2019/10/21/475997/immigration-detention-dangerous-womens-health-rights/Date: 2019Date accessed: February 28, 2021Google Scholar). However, this protective regulation was revised under the Trump Administration's new policy, which took effect in December 2017. Under the new directive, pregnant women were no longer exempt from detention, and reporting guidelines that mandated timely centralized tracking of all people in detention by ICE Health Services Corps Headquarters, the overseer of health care in detention facilities, were removed (Ellmann, 2019Ellmann N. Immigration detention is dangerous for women’s health and rights.www.americanprogress.org/issues/women/reports/2019/10/21/475997/immigration-detention-dangerous-womens-health-rights/Date: 2019Date accessed: February 28, 2021Google Scholar). The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Academy of Family Physicians voiced their opposition to the policy change, arguing that “all pregnant women and adolescents held in federal custody, regardless of immigration status, should have access to adequate, timely, evidence-based, and comprehensive health care” (American Immigration Lawyers Association (AILA), 2018American Immigration Lawyers Association (AILA)Letter from medical professionals to ICE against inhumane detention policies for pregnant women.www.aila.org/infonet/medic-professionals-against-ice-deten-policies?utm_source=aila.org&utm_medium=InfoNet SearchDate: 2018Date accessed: February 28, 2021Google Scholar). Policies designed to protect detained migrants are continuously underused or distorted. The ICE Performance-Based National Detention Standards (PBNDS) (2016) (U.S. Immigration and Customs Enforcement (ICE), 2016U.S. Immigration and Customs Enforcement (ICE)Performance-based national detention standards 2011.www.ice.gov/doclib/detention-standards/2011/pbnds2011r2016.pdfDate: 2016Date accessed: February 28, 2021Google Scholar) and the ORR Guide: Children Entering the United States Unaccompanied (2015) (Office of Refugee Resettlement (ORR), 2015Office of Refugee Resettlement (ORR)Children entering the United States unaccompanied.www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompaniedDate: 2015Date accessed: February 28, 2021Google Scholar) were established under the Obama Administration. The updated 2019 standards require adherence to more comprehensive medical care (U.S. Immigration and Customs Enforcement (ICE), 2019U.S. Immigration and Customs Enforcement (ICE)National detention standards for non-dedicated facilities.www.ice.gov/doclib/detention-standards/2019/nds2019.pdfDate: 2019Date accessed: February 28, 2021Google Scholar). However, more than 70% of ICE detainees reside in subcontracted detention centers such as ICDC, leading to inevitable gaps in effecting these policies. Eighty percent of facilities use outdated guidance lacking critical information on women's health and comprehensive care (Ellmann, 2019Ellmann N. Immigration detention is dangerous for women’s health and rights.www.americanprogress.org/issues/women/reports/2019/10/21/475997/immigration-detention-dangerous-womens-health-rights/Date: 2019Date accessed: February 28, 2021Google Scholar). This lack of standardization causes the quality and availability of care to vary greatly by location, and makes it extraordinarily challenging to monitor care across facilities. Families seeking asylum navigate the risks of physical and sexual violence, and psychological trauma, in an effort to escape precarious conditions in their home countries. Women and gender minorities seeking asylum are particularly vulnerable to gender-based violence during migration. A study conducted by Doctors without Borders (Médecins Sans Frontieres [MSF]) found that 68.3% of migrants and refugee populations reported being victims of violence during migration, and nearly one-third of women had been sexually abused during their journeys (Médecins Sans Frontieres, 2017Médecins Sans FrontieresForded to flee Central America’s Northern Triangle: A neglected humanitarian crisis.www.msf.org/sites/msf.org/files/msf_forced-to-flee-central-americas-northern-triangle_e.pdfDate: 2017Date accessed: February 28, 2021Google Scholar). Many migrants continue to experience sexual violence and harassment within detention centers, with the majority of perpetrators reported to be guards and detention officials (Ellmann, 2019Ellmann N. Immigration detention is dangerous for women’s health and rights.www.americanprogress.org/issues/women/reports/2019/10/21/475997/immigration-detention-dangerous-womens-health-rights/Date: 2019Date accessed: February 28, 2021Google Scholar). From January 2010 to September 2017, there were 1,224 complaints of sexual abuse reported in DHS custody, including in ICE and U.S. Customs and Border Protection facilities (Ellmann, 2019Ellmann N. Immigration detention is dangerous for women’s health and rights.www.americanprogress.org/issues/women/reports/2019/10/21/475997/immigration-detention-dangerous-womens-health-rights/Date: 2019Date accessed: February 28, 2021Google Scholar). Only 43 of these complaints were investigated. LGBTQ immigrants, particularly transgender women, experience sexual violence and assault at even higher rates (Ellmann, 2019Ellmann N. Immigration detention is dangerous for women’s health and rights.www.americanprogress.org/issues/women/reports/2019/10/21/475997/immigration-detention-dangerous-womens-health-rights/Date: 2019Date accessed: February 28, 2021Google Scholar). Although two-thirds of assaults on transgender women are perpetrated by guards, transgender women also face further risk of assault by being housed with men in detention (Ellmann, 2019Ellmann N. Immigration detention is dangerous for women’s health and rights.www.americanprogress.org/issues/women/reports/2019/10/21/475997/immigration-detention-dangerous-womens-health-rights/Date: 2019Date accessed: February 28, 2021Google Scholar). The Prison Rape Elimination Act aims to prevent, identify, and respond to reports of sexual assault and harassment (National PREA Resource Center, 2003National PREA Resource CenterPrison Rape Elimination Act.https://www.prearesourcecenter.org/about/prison-rape-elimination-actDate: 2003Date accessed: February 28, 2021Google Scholar). However, these standards have been inadequate in ensuring the safety of detained migrants owing in part to loopholes that undermine their efficacy, such as a religious exemption allowing providers to deny care to LGBTQ survivors or comprehensive reproductive care (Ellmann, 2019Ellmann N. Immigration detention is dangerous for women’s health and rights.www.americanprogress.org/issues/women/reports/2019/10/21/475997/immigration-detention-dangerous-womens-health-rights/Date: 2019Date accessed: February 28, 2021Google Scholar). The bottlenecks in the processing of asylum seekers at the southern border as a result of “metering” and the Trump administration's Migrant Protections Protocol (MPP) program—which forced over 68,000 asylum seekers to “remain in Mexico” pending their asylum court hearings—have left dozens of thousands of asylum seekers exposed to violence and limited access to health services, including abortion, in Mexican border towns (Totenberg, 2021Totenberg N. Supreme Court cancels arguments in Trump-era immigration cases.www.npr.org/2021/02/01/962997274/biden-administration-asks-supreme-court-to-delay-considering-2-key-trump-policieDate: 2021Date accessed: February 28, 2021Google Scholar). In addition to these experiences of violence, rates of gender-based homicides have been rising in Mexico, with more than 41,000 women victims of gender-based homicide in Mexico from 1985 to 2014 (Centro para el Desarrollo Integral de la Muger, A.C. (CEDIMAC), & Robert F. Kennedy Human Rights, 2018Centro para el Desarrollo Integral de la Mujer, A.C. (CEDIMAC), & Robert F. Kennedy Human RightsAlternative report on violence against women in Ciudad Juarez, Chihuahua, Mexico ninth periodic report of Mexico Committee on the Elimination of Discrimination against Women seventieth session.https://observatoriofeminicidio.files.wordpress.com/2018/05/enviando-informeDate: 2018Date accessed: February 28, 2021Google Scholar). In 2019, there were reportedly 1,006 femicides, although this is felt to reflect only one-quarter of all women murdered that year, because many of the victims' bodies were never found (Vivanco, 2020Vivanco J.M.V. Mexican government paralyzed in the face of a wave of femicides.www.hrw.org/news/2020/03/03/mexican-government-paralyzed-face-wave-femicides#Date: 2020Date accessed: February 28, 2021Google Scholar). Thirty-one of the documented femicides were women located in the Chihuahua State of Ciudad Juarez, a prominent border city near El Paso, Texas (Chin and Schultz, 2020Chin C. Schultz E. Disappearing daughters. Mothers search for justice and embrace fragile memories.https://projects.seattletimes.com/2020/femicide-juarez-mexico-border/Date: 2020Date accessed: February 28, 2021Google Scholar). The fear of physical violence is compounded by the emotional and psychological trauma of family separation. Under the Trump Administration's Zero Tolerance Policy, thousands of immigrant families were separated when the program was implemented in 2017. During this period, immigration authorities forcibly removed children from their families or separated children while parents were occupied receiving medical care or in court (Camaj et al., 2020Camaj L. Habbach H. Hampton K. “You will never see your child again.” The persistent psychological effects of family separation.https://phr.org/wp-content/uploads/2020/02/PHR-Report-2020-Family-Separation-Full-Report.pdfDate: 2020Date accessed: February 28, 2021Google Scholar). In a sample of psychological evaluations conducted by Physicians for Human Rights, nearly all children and parents who were separated showed symptoms and behavior associated with major trauma and met the diagnostic criteria for at least one mental health condition, including post-traumatic stress disorder, major depressive disorder, and/or generalized anxiety disorder. Children in particular exhibited developmental delays and regression in age-appropriate behavior (Camaj et al., 2020Camaj L. Habbach H. Hampton K. “You will never see your child again.” The persistent psychological effects of family separation.https://phr.org/wp-content/uploads/2020/02/PHR-Report-2020-Family-Separation-Full-Report.pdfDate: 2020Date accessed: February 28, 2021Google Scholar). The experience of family separation likely exacerbated preexisting trauma exposures from migrants' countries of origin and the perilous journey seeking asylum. Four years later the parents of 628 children who were separated at the border still cannot be found; many are believed to have been returned to their home countries (MS. L vs. U.S. Immigration and Customs Enforcement, 2020MS. L vs. U.S. Immigration and Customs Enforcementhttp://cdn.cnn.com/cnn/2020/images/12/02/ms.l.ice.joint.status.report.pdfDate: 2020Date accessed: February 28, 2021Google Scholar). Reunification efforts have been stalled owing to the coronavirus pandemic and left many children in limbo, continuing to have to endure the physical, emotional, and psychological impacts of forced separation. President Biden has created a task force committed to family reunification; however, the timeline and legal procedures to decrease the risk of reseparation for undocumented parents remain undetermined (Sieff, 2021Sieff K. Trump family separations: Biden executive order task force to reunite migrants.www.washingtonpost.com/world/the_americas/family-separation-migrant-biden-executive-order/2021/02/01/ebb6ada8-64bf-11eb-8c64-9595888caa15_story.htmlDate: 2021Date accessed: February 28, 2021Google Scholar). Meanwhile, even since the formal end of the Zero Tolerance Policy on June 20, 2018, family separations have continued, because many parents have felt compelled to make the impossible decision to allow children to cross the border alone to be processed as unaccompanied minors as perhaps their only real chance to escape the deplorable conditions in the border towns (Congressional Research Service, 2021Congressional Research ServiceThe Trump Administration’s “Zero Tolerance” Immigration Enforcement Policy.https://crsreports.congress.govDate: 2021Date accessed: February 28, 2021Google Scholar). The Biden Administration, including Alejandro Mayorkas as Secretary of Homeland Security, has a critical window of opportunity to reevaluate policies that violate immigrants' reproductive rights and to reinstate standards and processes that promote RJ. Clear protocols for evaluation, accountability, and policy enforcement are essential to promote justice at the border. Gaps in accountability and policy enforcement exacerbate opportunities for medical neglect and abuse. Findings from a 2019 investigation by DHS found that ICE does not have standards in place to adequately hold contracted detention centers accountable and inconsistently includes the agencies’ quality assurance surveillance plan in contract terms (U.S. Department of Homeland Security (DHS), 2019U.S. Department of Homeland Security (DHS)OIG-19-18 - ICE does not fully use contracting tools to hold detention facility contractors accountable for failing to meet performance standards.www.oig.dhs.govDate: 2019Date accessed: February 28, 2021Google Scholar). Quality assurance surveillance plans should be included in all contracts, with clear financial penalties outlined for facilities that are noncompliant. Mandatory data reporting is also essential to monitoring progress and targeting areas for further intervention. The Biden Administration has already begun to dismantle the MPP. DHS began the first phase of rectifying pending cases on February 19, 2021. Migrants with pending asylum cases are required to register with international organizations and undergo coronavirus testing before their hearings. Those who enter through the program may not be placed in detention centers but may still be under security monitoring (U.S. Department of Homeland Security (DHS), 2021U.S. Department of Homeland Security (DHS)DHS announces process to address individuals in Mexico with active MPP cases.www.dhs.gov/news/2021/02/11/dhs-announces-process-address-individuals-mexico-active-mpp-casesDate: 2021Date accessed: February 28, 2021Google Scholar; Hesson and Dwyer, 2021Hesson T. Dwyer M. Biden to bring in asylum seekers forced to wait in Mexico under Trump program.www.reuters.com/article/us-usa-biden-immigration-asylum/biden-to-bring-in-asylum-seekers-forced-to-wait-in-mexico-under-trump-program-idUSKBN2AC113Date: 2021Date accessed: February 28, 2021Google Scholar). In addition to repealing MPP, the Biden Administration should end the so-called Safe Third Country Agreements negotiated by the outgoing Trump Administration with El Salvador, Guatemala, and Honduras (Gil-Bazo, 2015Gil-Bazo M.T. The safe third country concept in international agreements on refugee protection assessing state practice.Netherlands Quarterly of Human Rights. 2015; 33: 42-77Crossref Scopus (5) Google Scholar). These Northern Triangle countries constitute three of the top five countries of origin for asylum seekers to the United States. With some of highest femicide rates in the world, these countries do not provide adequate protection or legal processes for those seeking asylum, particularly women fleeing intimate partner violence and gang-related sexual violence (World Vision, 2020World VisionNorthern Triangle: terrifying to live in, dangerous to leave.www.worldvision.ca/stories/child-protection/northern-triangleDate: 2020Date accessed: February 28, 2021Google Scholar). Furthermore, we recommend the reinstatement of the “presumption of release,” ordering release or expedited removal of pregnant women from custody to reduce their exposure to physical and psychological trauma. Likewise, providing access, referral, and linkage to care grants the opportunity to receive appropriate medical services. Reconsideration of this policy along with other ratified international human rights protocols that are committed to reducing undue exposure to harm of migrants, providing comprehensive reproductive health education, maternal health care, contraception and abortion access, and reporting procedures for gender-based violence are essential to achieving RJ (International Justice Resource Center (IJRC), 2020International Justice Resource Center (IJRC)Immigration & migrants’ rights.https://ijrcenter.org/thematic-research-guides/immigration-migrants-rights/#Protection_against_Torture_or_Inhuman_TreatmentDate: 2020Date accessed: November 1, 2020Google Scholar). Many existing organizations already fight for RJ and human rights of asylum seekers through the provision of health services and litigation. In addition to advocacy efforts, qualified volunteers can provide clinical support, conduct telephone evaluations, review medical records for detained families, or provide virtual or in-person forensic medical examinations for detainees. Several organizations provide health and legal resources for migrants including the Refugee Health Alliance, 2019Refugee Health AllianceRefugee Health Alliance.www.refugeehealthalliance.orgDate: 2019Date accessed: February 28, 2021Google Scholar, RAICES, 2020RAICESTake action. RAICES.https://www.raicestexas.org/take-action/Date: 2020Date accessed: February 28, 2021Google Scholar, Medecins Sans Frontieres, 2020Medecins Sans FrontieresDoctors Without Borders - USA.www.doctorswithoutborders.org/takeactionDate: 2020Date accessed: November 1, 2020Google Scholar, Doctors For Camp Closure, 2019Doctors For Camp ClosureWhat’s next? Three things you can do.https://d4cc.nationbuilder.com/take_actionDate: 2019Google Scholar, Al Otro Lado, 2020Al Otro LadoGet involved.https://alotrolado.org/get-involvedDate: 2020Date accessed: February 28, 2021Google Scholar, Families Belong Together, 2021Families Belong TogetherTake action.https://www.familiesbelongtogether.org/take-action/Date: 2021Date accessed: February 28, 2021Google Scholar, Border Angels, 2020Border AngelsVolunteer..www.borderangels.org/volunteer.htmlDate: 2020Date accessed: November 1, 2020Google Scholar, Catholic Legal Immigration Network, Inc. (CLINIC), 2019Catholic Legal Immigration Network, Inc. (CLINIC)The Estamos Unidos Asylum Project offers legal guidance to migrants waiting to ask for protection.https://cliniclegal.org/issues/estamos-unidosDate: 2019Date accessed: February 28, 2021Google Scholar, and Global Response Management, 2019Global Response ManagementVolunteer.www.global-response.org/volunteerDate: 2019Date accessed: February 28, 2021Google Scholar. Strong advocacy efforts and on-the-ground and virtual participation coupled with U.S. government enforcement of immigration policies and procedures that protect migrants’ rights are critical steps to empowering individuals to make reproductive decisions for themselves. All people, regardless of citizenship, who flee to the U.S. deserve comprehensive reproductive care free from coercion and with respect of full bodily autonomy. Medical and public health professionals must remain informed about the current events in reproductive health for asylum seekers to prevent further violations of RJ for our most vulnerable communities. The authors thank Katherine Peeler, MD, Medical Director of Harvard Medical School's Asylum Clinic, pediatrician at Boston Children's Hospital, as well as Shoshanna Ehrlich, JD, Professor of Women, Gender, and Sexuality Studies at University of Massachusetts, for their contributions to the preliminary development of this work. Kalifa J. Wright, MPH, is a research analyst at the Center for Health Information and Analysis, and former Connors Center for Women's Health & Gender Biology affiliate with professional expertise in health policy, global health, and reproductive health for adolescents and young women. Lydia E. Pace, MD, MPH, is the Director of Women's Health Policy & Advocacy at the Connors Center for Women's Health & Gender Biology, Associate Physician in the Brigham and Women's Hospital Division of Women's Health, and Assistant Professor of Medicine, Harvard Medical School. C. Nicholas Cuneo, MD, MPH, is Assistant Professor in Pediatrics, Johns Hopkins University School of Medicine, with a joint appointment at the Bloomberg School of Public Health's Center for Public Health and Human Rights and expertise in migrant health, human rights, and global health research. Deborah Bartz, MD, MPH, is the Director of Education at the Connors Center for Women's Health and Gender Biology. She is an obstetrician-gynecologist at Brigham and Women's Hospital and an Associate Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School.