Historical, cultural, social, and political elements play a role in the discrepancies in reproductive health, rendering it a complex and deeply entrenched issue within the United States’ framework. Historically, the remnants of slavery and the American eugenics movements fostered race-specific medical practices, systems, and stereotypes that still impact provider bias and patient distrust, perpetuating the continuing inequalities in reproductive health. Culturally, enduring stereotypes, especially against Black women, have resulted in unequal treatment for pain symptoms, worse maternal outcomes, and diminished rates of patient-inclusive care. Policies at the state level and systemic racism have erected obstacles to care, encompassing abortion accessibility, restrictions on insurance coverage, and variable enforcement of reproductive health services. These hurdles have resulted in unequal care for individuals of color, economically disadvantaged families, and those in rural areas.

The historical abuse of Black birthing individuals in the United States has left a persistent legacy of trauma, distrust, and systemic inequity. Throughout slavery, Black women were stripped of bodily autonomy and regarded chiefly as reproductive workers vital to maintaining chattel slavery, particularly after the transatlantic slave trade was banned. Their value was assessed not by their humanity but by their ability to generate more enslaved individuals. Medical institutions capitalized on this arrangement. In the antebellum South, doctors and medical schools frequently worked with slave owners to perform reproductive experiments without consent. Gynecological techniques such as cesarean sections and the excision of infected ovaries were developed and honed through repeated surgeries on enslaved Black women without anesthesia. These horrors were rationalized by the unfounded belief that Black individuals do not experience pain in the same manner as White individuals. This misconception, rooted in slavery, still impacts medical practices today. Research has indicated that some healthcare providers persist in holding erroneous beliefs about biological disparities between Black and White patients. These biases lead to insufficient pain management, the dismissal of symptoms, and delayed interventions in obstetrics. Post-emancipation, reproductive control over Black individuals persisted through government-funded sterilization initiatives and welfare policies. In the 1930s, federally funded birth control clinics aimed to limit Black reproduction. In the 1980s and 1990s, certain physicians and public assistance officials coerced low-income Black women into sterilization by threatening to revoke welfare benefits. Presently, Black birthing individuals are still three to four times more likely to succumb to pregnancy-related complications compared to White women.

Structural competency represents a framework in healthcare that aims to confront and comprehend the political, economic, and social influences impacting an individual’s health. When applied to reproductive health, this notion allows us to recognize the extensive health disparities, particularly for minorities and low-income individuals, that emerge from existing political and socioeconomic trends. Recent Medicaid cutbacks have led to over 17 million Americans losing access to healthcare, including reproductive services. The U.S. Supreme Court’s 2022 decision to overturn Roe v. Wade resulted in numerous states altering their abortion laws, compelling individuals to either continue unwanted pregnancies or travel significant distances to obtain abortion care. In February 2025, Adriana Smith, a 31-year-old woman from Georgia, was declared brain dead after multiple blood clots were detected in her brain. At the time, she was 9 weeks pregnant, and due to Georgia’s stringent abortion regulations prohibiting the procedure after 6 weeks, Adriana Smith was maintained on life support contrary to her family’s wishes. In June 2025, she was taken off life support only after the baby was delivered prematurely, creating profound distress for her family. This case illustrates the real-time consequences of our current political and socioeconomic environment, highlighting its potential to inflict genuine harm. Physicians and healthcare providers are now confronted with more ethical dilemmas while attempting to care for their patients and adhere to the four foundational principles of medical ethics: autonomy, beneficence, non-maleficence, and justice.

It is crucial for healthcare providers to remain knowledgeable about their state’s reproductive healthcare regulations and actively advocate for the safeguarding and enhancement of access to these essential services. This call to action is particularly pertinent following the June 2025 Supreme Court ruling on Medina v. Planned Parenthood, which affirmed South Carolina’s authority to deny Planned Parenthood Medicaid reimbursement for healthcare services. This ruling was further influenced by the passing of H.R. 1 a week later. H.R. 1 is a federal statute that prohibits Medicaid payments to organizations receiving over $800,000 in federal reimbursements if they provide abortion services. Given that Planned Parenthood caters to low-income and rural individuals, this ruling represents a significant loss of access to critical reproductive health services such as birth control, Pap smears, HPV testing, and STI screening. The availability of reproductive healthcare is jeopardized, along with the dissemination of information regarding these services and their significance. Due to Executive Order 14168, thousands of Centers for Disease Control and Prevention webpages on reproductive health