How Ignoring the Fundamental Causes of Maternal Morbidity/Mortality Impedes Progress Toward a Reproductive Justice Model of Contraceptive Counseling

Abstract

The American College of Obstetricians and Gynecologists recently published guidance promoting a reproductive justice model of contraceptive counseling that prioritizes patient preferences rather than centering effectiveness (American College of Obstetricians and Gynecologists, 2022c). However, practitioners may be hesitant to follow these new guidelines if they do not understand how maternal morbidity and mortality are rooted in fundamental causes like racism. If practitioners believe that pregnancy is innately dangerous, they may prioritize effectiveness in the name of patient safety. Taking a reproductive justice perspective, we assess how contraceptive counseling guidance portrays maternal morbidity/mortality by qualitatively examining 25 authoritative gynecology publications. Our abductive analysis shows that these documents describe maternal morbidity/mortality as rooted in biology and position highly effective contraception as the antidote. Ignoring fundamental causes of maternal morbidity/mortality impedes progress toward patient-centered contraceptive counseling and shifts the burden of addressing maternal morbidity/mortality away from public policy and toward individual contraceptive use.

Keywords:

• Contraception counseling
• fundamental causes
• maternal morbidity and mortality
• reproductive justice
• pregnancy

Acknowledgments

The authors extend their gratitude to Joely Hannan for her insightful feedback and to Sydney Baltuck for her meticulous assistance in preparing the manuscript for submission.

Disclosure Statement

No potential conflict of interest was reported by the authors.

Data Availability Statement

The data for this article consist of the ACOG publications, UpToDate articles, and gynecology textbooks listed in the Appendix. The ACOG documents are available online (https://www.acog.org/clinical), the UpToDate articles are available with a subscription, and the gynecology textbooks are available on Amazon or from other bookstores.

Notes

1 For this article, we use the gender-neutral terms patient, people, individual, and pregnant person to describe individuals who may become pregnant or use contraceptives. We also use woman and female as consistent with how research articles and our sampled documents describe this population. However, we recognize that some individuals who are able to become pregnant may self-identify differently.