Proceedings of a Workshop—in Brief

Convened November 21, 2024

Understanding the Barriers and Opportunities to Conducting Reproductive Health Research

The current legislative, political, and cultural context surrounding reproductive health in the United States is changing rapidly and influences both the ability to conduct research and the delivery of care—with disparate impacts among marginalized populations. To help address the research needs in this area, the Standing Committee on Reproductive Health, Equity, and Society of the National Academies of Sciences, Engineering, and Medicine hosted a public workshop on November 21, 2024.

Claire Brindis, University of California, San Francisco, opened the workshop by emphasizing the challenges of studying human behavior and decision making. She noted the importance of how health equity is measured; who is involved in conducting research; and who builds on that information to shape practices, programs, policies, and people’s lives. Brindis said the workshop would identify methodological challenges in conducting research on reproductive health, explore best practices for overcoming them, and discuss opportunities to strengthen data infrastructure and validation across the reproductive lifespan.

Tracy Weitz, Center for American Progress, explained that since the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization on June 24, 2022, which eliminated the federal right to abortion, many states have implemented policy changes, including banning abortion, protecting data, expanding insurance coverage, and more. The workshop explored recent advances and challenges in measuring reproductive health equity, including the impact of the Dobbs decision in this area. It featured discussions related to maternal morbidity and mortality, interdisciplinary research opportunities, and the application of reproductive justice and public health frameworks in guiding research design and implementation.

Advances in Measuring Reproductive health Equity

“We cannot optimize health unless we do it for everyone,” stated Andrew Anderson, Johns Hopkins Bloomberg School of Public Health. “Equity is not just a side thing,” he said, “it is a part of population health improvement.” Asha Hassan, University of Minnesota Medical School, explained that health equity research acknowledges the structures based in oppression at the root of health disparities. She identified three phases of health equity research: (1) detecting inequities, (2) understanding their context and driving forces, and (3) developing interventions to alleviate them. Hassan and several other panelists emphasized the importance of appropriate outcomes, stating that access and quality are more appropriate measures for future abortion-related research over safety and efficacy

measures because there is already an immense amount of literature finding it to be safe and effective. This differs from birth-research where there is still a need to develop measures on safety and efficacy in light of the crisis of maternal and infant morbidity and mortality in the United States. However, Anderson added that it took a lot of advocacy to get data on maternal mortality collected routinely, and he suggested focusing on the data that are available currently.

Heidi Moseson, Ibis Reproductive Health, discussed her research on access to abortion care for transgender and nonbinary people. She asked who “we assume reproductive health is for,” noting that those writing research questions may not even think of trans or nonbinary people. Studies that use clinical data are limited because electronic health records (EHRs) rely on binary sex, often not clearly distinguished from gender. Moseson highlighted a critical limitation in many clinical and research practices: eligibility for care or study participation is often based on binary sex or gender categories, rather than the presence or absence of specific organs. She advocated for the use of organ inventories—that is, determining eligibility or clinical need based on anatomy (e.g., having a cervix) rather than gender markers. For example, relying on gender to determine cervical cancer screening can result in missed care for transgender men and over-screening for individuals without a cervix.

Moseson went on to name an issue in research practice: a scarcity mindset, stating, “We fought so hard for women’s inclusion in research…some are worried that if we make space for transgender men and nonbinary people in the spheres of pregnancy research, what does that mean for cisgender women? And I think we have to move away from that. Including all genders advances science and health care for all people.”

May Sudhinaraset, University of California, Los Angeles, discussed measuring access to abortion care for immigrant populations. Sudhinaraset explained that current research methods inadequately account for the heterogeneity and dynamic status of immigrant populations. “We are not just talking about one population, but a heterogenous population across national origins, immigration statuses, languages people speak, and time they have been here,” she explained. According to Sudhinaraset, researchers are not asking the right questions to get disaggregated data, and they often misunderstand immigration status as a binary variable (e.g., U.S.- or foreign-born). "Research has shown that if you have had an experience of being undocumented in the past, even if you are naturalized now or have a green card, you’re more likely to delay care … [and] to have increased psychological distress. … we have to be thinking about the dynamics to be able to get a comprehensive picture,” she explained.

In the context of researching inequities in the health care system, data quality is a major challenge, Anderson said. Researchers use data from claims, EHRs, and the Census to understand disparities, but when disaggregating for smaller groups, the sample sizes can compromise statistical power, reliability, and validity. In addition, he said, people have a constellation of attributes—social markers, social identities—that impact one another to exacerbate or mitigate the causes of health disparities. Researchers tend to disaggregate to one social category, he continued, and when trying to look at multiple categories, such as the intersection between poverty and race, sample sizes become very small. Weighting and oversampling can help, but these difficulties remain. Several panelists later described the importance of mixed-methods research, adding qualitative data collection such as patient interviews, to supplement quantitative methods.

As an example of using large datasets to study how the intersection of multiple marginalized identities (e.g., race and gender) can affect health outcomes, Sudhinaraset mentioned that the California Maternal Quality Care Collaborative is linking EHR data to birth certificate data to get a more comprehensive perspective of subpopulations. However, Anderson pointed out that a trade-off for using linked datasets (and the related integration of large language models) may be data privacy. While people have been working to address this, he said, “We need to be careful that we don’t inadvertently harm people or make it worse . . . if data fall into the wrong hands.” Moseson said that researchers need to be “airtight on what’s possible with subpoenas and what isn’t.”

Several panelists throughout the workshop discussed the benefit of using person-centered and/or patient-reported

outcome measures. These give more insight into what is important to patients, from access to contraceptives to care post-delivery. Sudhinaraset is part of a team developing person-centered abortion care measures, asking questions about patient experiences, such as what is the length of time to get an appointment, to what extent patients are involved in care, and how to ensure there is clear communication. She said that because abortion is stigmatized, patients tend to report very high satisfaction (i.e., they are less likely to complain about care received because expectations on quality of care received may be lower due to abortion stigma).

Community-based participatory research emerged as another topic throughout the workshop. Sudhinaraset said involving the community extensively takes more time but is critical post-Dobbs. Moseson emphasized that community members need to be included in every step, including writing grant applications and defining the research question and methodology. Diverse teams can improve linguistic capabilities and cultural understanding, added Sudhinaraset, and can highlight things such as the impact of immigration status or ethnicities. Marginalized communities may feel threatened, so participatory approaches are important. Additionally, Hassan described increasing pressures and fear of criminalization associated with abortion care. In this context, Sudhinaraset urged deidentifying data.

Moseson said researchers need to be asking questions responsibly using community engagement so people will trust and participate in the research. Moderator Anitra Beasley, Baylor College of Medicine, emphasized the importance of both designing and advertising studies appropriately to ensure “that we’re capturing the populations that we want and need to study…what we’re seeing here is this theme of missingness.” Throughout the discussion, she echoed several panelists’ calls for inclusive measures and intentional outreach strategies, noting that the populations most affected by structural inequities— such as unequal access to health care, education, or economic opportunity—are often those least likely to be represented in research unless studies are explicitly built to include them. Moseson added that a historical lack of trust stemming from a lack of community engagement has precluded people from participating in studies.

UNDERSTANDING THE EFFECTS OF DOBBS: THE EVIDENCE TO DATE

Presenting a literature review, Jennifer O’Donnell, Society of Family Planning, stated, “Attempts to use science to understand this moment rest on many years of scholarship.” She declared that abortion is safe in that it has lower risks than childbirth and, in many cases, does not require medical supervision. Denying abortion care, on the other hand, has negative health and social implications, including physical violence and economic insecurity. Additionally, she continued, deep inequities in reproductive health care precluded the Dobbs decision, especially along the lines of race, ethnicity, and age, with young people representing a particularly vulnerable population. The Dobbs decision was a “shock to the system,” she said, which researchers expect will which further exacerbate a number of long-standing challenges in reproductive health care.. Evidence on those effects is still emerging, O’Donnell stated.

Legislative and other policy changes post-Dobbs have included total abortion bans and severe gestation limits, O’Donnell continued, as well as “flickering effects” in states such as Wisconsin and Ohio, where the application and interpretation of policies has been vacillating. On the other hand, some states have taken measures to increase access to abortion care, such as insurance coverage for abortions, public awareness campaigns, and shield laws, which are designed to protect clinicians and patients from sharing information about abortions across states. Additionally, she stated, individuals, philanthropies, and states are mobilizing financial resources to blunt the immediate impact of Dobbs.

O’Donnell reported on evidence pertaining to access to and use of abortion care. Inequities for in-person care are increasing, she said, related to facilities closing and longer travel times. For instance, “Black and American Indian and Alaska Native women ages 18–49 are more likely than other groups to live in states with abortion bans and restrictions” (Hill et al., 2024). However, surprisingly, total abortions in the United States have increased post-Dobbs, as of June 2024.¹ There is also early evidence of increased births (Dench et al., 2024).

Service delivery is shifting, O’Donnell stated; while most abortions still take place in person, remote delivery is increasing in proportion to in-person delivery. Remote distribution has become a pathway to care for those living in states with no legal abortion, she said. Additionally, remote dispensing makes lower-cost options available—the median price of medication abortion offered by virtual clinics decreased from $239 in 2021 to $150 in 2023 (Upadhyay et al., 2024). She also noted that self-managed abortions, which occur outside of a clinical setting and without direct supervision from health care providers, make it more difficult for researchers to understand the full universe of care.

Factors that remain unknown include how changes in access and use are affecting people’s trajectory to care, people’s preferences and awareness of options for care, and the cost of in-person care, explained O’Donnell. Also unanswered, she said, is how many people are unable to receive a wanted abortion.

Researchers are also studying the health and economic impacts of being denied abortion care, O’Donnell continued. Models have been created for maternal and neonatal mortality, infant and neonatal morbidity, and economic ripple effects. What remains unknown is how the number of abortions might translate into access and economic well-being, she said.

The reproductive health care workforce is often used as a proxy for abortion access, noted O’Donnell. She reported that evidence on the impacts of the Dobbs decision on the health workforce include obstetricians and gynecologists expressing hesitancy and moral distress, and a decline in residency applications for obstetrics and gynecology. She noted that researchers do not know how these challenges will shift the preparedness of the workforce in the next 10 to 15 years.

Next, O’Donnell discussed evidence on contraceptive use patterns with an immediate spike after moments of policy-related insecurity and an overall downward trend except in vasectomies (Strasser et al., 2024). In several states, sexual activity declined following the Dobbs decision, barriers to accessing contraception increased, condom use increased, and reports of receiving high-quality contraceptive care decreased (Kavanaugh and Friedrich-Karnik, 2024). Factors that remain opaque, said O’Donnell, are how shifts in contraceptive use may have changed needs for abortion and whether the shifts are aligned with patients’ preferences.

O’Donnell pointed out that disentangling the direct effects of Dobbs is challenging because of other shifts in the environment. Comparing outcomes before and after Dobbs for a population of interest will lead to a “really distorted signal,” she said. Significant research is in progress, she added, with results anticipated in 2025.

CHALLENGES IN MEASURING MATERNAL MORTALITY, MORBIDITY, AND RELATED REPRODUCTIVE HEALTH OUTCOMES

Caitlin Myers, Middlebury College, stated that the increased number of births reported since Dobbs suggests that about 20,000 to 30,000 people per year who want an abortion cannot access care. Myers’ team has begun using Medicaid claims data to measure the effects of increased distance on women’s health outcomes. These data provide rich information on health care utilization and diagnoses, and the population of Medicaid beneficiaries is low income and particularly likely to be affected by increased distance to abortion providers. However, she said, it takes a long time to get access to files. Thus, they have not yet been able to look at claims data post-Dobbs. The Centers for Medicare and Medicaid Services (CMS) proposed a change to how people access these data—using cloud storage at CMS rather than universities, which may increase cost. Time and cost for accessing Medicaid claims data are significant barriers, particularly for young researchers, she continued.

Time lags and high costs are also barriers for using vital statistics data, stated Alison Gemmill, Johns Hopkins Bloomberg School of Public Health. She urged monitoring issues in real time so they can be addressed quickly. To bridge the lag times and collect data on patient-centered outcomes, Cynthia Lebron, University of Miami, suggested eliciting the help of promotores de salud or other community health workers. Gemill agreed and gave the example of universities in California that partnered with hospitals to gather data. Additionally, she added, better training people who fill out birth certificates can improve validity.

Gemmill discussed the difficulty of measuring maternal morbidity and mortality in high-income countries, partly because it is very rare (e.g., 1–2% have severe maternal morbidity). This makes it hard to measure inequities because, for instance, cell counts of less than 10 are suppressed in certain datasets. However, she said, when her team receives 2023 vital statistics data, she hopes to start modeling joint probabilities for those who hold multiple marginalized identities (e.g., disabled women). Participant Rita Kaur Kuwahara, Association of Asian Pacific Community Health Organizations, pointed out that while rates vary over time, sometimes maternal morbidity and mortality rates are very high for Native Hawaiian and Pacific Islander populations. However, she continued, small data samples preclude statistical significance for most data analysis, and these populations are therefore left out of the conversation. She added that this is also an issue in the American Indian and Alaska Native community. Gemmill said, and several other panelists agreed, that aggregating across years can help to show magnitude, but this method will be tricky because of the changes since Dobbs.

Lebron pointed to the effect of immigration status and context on access to care and resources, especially among mixed-status families. In Florida and Texas, she noted, “Health care providers are forced to ask you about your immigration status.” She urged that researchers need to move beyond documentation status to explore the intersection of ethnicity, country of birth, and heritage country (e.g., Afro-Latina identity).

Justin Lappen, Cleveland Clinic, asked how researchers could use the wealth of data available in EHRs to study the impact of social determinants of health on maternal morbidity and mortality. Myers commented on the tension between wanting to track everything against the “very real concerns…of regulating data availability.” She promoted using privately deployed (on premises) systems when using large language models, otherwise “you’re feeding the data into some company’s large data.” Artificial intelligence models that process confidential data entirely within an organization’s secure environment, without sending any information to external servers, could analyze health records for themes such as breastfeeding with potentially reliable results, she said.

Lappen stated that a national medical record could harness the power of the EHR to have appropriately extracted data fields; researchers could then collect the data that are salient for understanding obstetric and perinatal morbidity, as well as other diseases. As it is, he continued, EHRs are underutilized silos, and data privacy concerns exacerbate the challenge. He added that there are the resources and technology available to establish a national medical record to serve both clinical and research purposes but not the collective buy-in or willingness as a society.

Wietz reported that on the day of the workshop, the state of Georgia disbanded the 32 members of its maternal mortality review committee, ostensibly because of their recommendation that two of the most recent deaths that they reviewed were due to the state abortion ban.

applying a Reproductive Justice lens

The reproductive justice movement has roots in Black feminist theory, intersectionality, and human rights (Luna and Luker, 2013; Ross and Solinger, 2017) stated Anu Manchikanti Gómez, University of California, Berkeley. The concept, formalized by 12 Black women in 1994, can serve as a lens for research, ensuring that it is assets-based, equity-driven, community-focused, and person-centered, Gómez explained. Noting that "Many current issues are old issues," she said it attends to historyand structures and is action oriented with real-world significance and applications.

Reproductive justice can inform research questions, the interpretation of results, and their implications, Gómez said. For instance, when looking at unintended pregnancy by income, instead of focusing on access to contraception alone, researchers can seek to understand “the host of issues that create a gap between what someone wants for themselves and their realities.” For example, studies using this lens have explored structural inequities that affect people’s ability to choose “when to parent, when desired" (Gómez et al., 2021).

Gómez pointed out that research sometimes falls into the trap of admiring the problem. For instance, she said, repeatedly using birth certificates to identify disparities does not identify what action is needed to bring change.

In the service of applying reproductive justice to research, Gómez echoed earlier comments on the benefits of the community-based participatory research (CBPR). CBPR uses an ecological perspective to address multiple social and structural determinants of health, she said. Core principles include sharing power; building trusting relationships, community resources and strength, and research capacity; and identifying and addressing issues that are important to the community.

Other approaches, Gómez continued, include the Research Prioritization with Affected Communities approach, which helps identify research topics based on community consensus.² Additionally, the Community Research Model, which is used in a project she co-leads, seeks to combine lived experience with research experience. It delegates power to community researchers, making academic researchers accountable to them. Goméz and her colleagues are developing a curriculum to support training traditional and community researchers in this approach.

Gómez concluded by discussing the challenges and some best practices involved in applying these approaches. Traditional knowledge production sometimes upends processes that center on researchers and their universities (e.g., peer review). Gómez stated that community-based research should not be “delegated.” In her remarks, she stressed that researchers themselves must be directly involved in the work with communities: “It is up to me to show up and do the work and set the tone.” She cautioned against passing this responsibility onto others, reinforcing that authentic community engagement must be rooted in trust and accountability, and that delegating such work undermines both the process and the intent of reproductive justice frameworks. She also acknowledged that funders may not be aware how time-intensive this process can be. “Of course,” she added, “we need money to pay the people who are participating in the research…It’s not something you can do with a scarcity mindset.”

Data on Abortion Care access

Laura Lindberg, Rutgers School of Public Health, described three data sources for understanding who, how, and why individuals can and cannot access abortion care: (1) data from clinics and health departments, which is usually state mandated and sent to the Centers for Disease Control and Prevention (not all states participate, and Lindberg estimates that only about two-thirds of abortions are counted); (2) household surveys of people who did and did not have abortion (about half of people are unwilling to talk about their abortion in surveys); (3) data collected in waiting rooms (i.e., asking questions at the time of abortion). Because of the changing legislation, Lindberg added, waiting room data will become increasingly insufficient.

Jane Seymour, University of Wisconsin–Madison, reiterated that while researchers rely on data gathered in abortion clinics, those patients who face the greatest barriers are not reflected in those samples. To address this, she suggested a two-pronged approach: The first is recruiting from prenatal care clinics. For example, her group is recruiting people presenting for prenatal care to participate in a longitudinal survey study to understand their experiences. The second aspect, she continued, is using Google ads and data gathered through abortion funds to understand the experience of people who report having considered abortion for even 1 second. Seymour added that using Google ads in prior studies was much more successful than in their current study; now that there is more activity around abortion online, more entities are vying for ad space than previously, and people are warned to protect their information from Google. Additionally, she noted, using the internet to recruit participants increases vulnerability of the work to fraud; her team has received thousands of fraudulent surveys.

Tiffany Green, University of Wisconsin–Madison, emphasized the importance of a person-centered approach, explaining that the premise of this approach is about “having the kinds of care that you want to have.” Green is co-leading the Reproductive Health Experiences and Access Survey, which is working to survey 48,000 people in select states to understand contraception and abortion access. Seymour commented that these studies define abortion access not just as “not being pregnant anymore,” but as people having the experience that they want. “If somebody has to pay thousands of dollars out of pocket and has to wait weeks beyond what they wanted, that’s poor access to care,” she said. Green stated that more experience-oriented

data are needed, and she suggested asking whether a participant used the type of contraceptive they want. When writing survey questions, Green and her team began with the end in mind: They wanted to center certain populations such as Black, disabled, and noncisgendered. Additionally, Green shared that she has members on her technical expert panel with both lived experience and scholarly expertise in the area of disability.

Building on previous comments about community-based research, Caitlin Gerdts, Ibis Reproductive Health, talked about the importance of engaging people who have had abortions, especially in contexts where abortion is legally restricted or banned all together. She suggested that working with communities as equal partners in the research process is the best way to ensure that research meets the needs of people and communities. Engaging communities is not only about increasing participation, she added; it is ensuring that those who are facing the greatest risks and potential impacts from policy changes help to make the research better and more relevant. Gerdts acknowledged that trust-building is slow work, does not follow a straight line, and requires human and financial resources.

Fully self-managed abortion care has moved from the margins and is becoming a primary source of abortion access, said Gerdts. She noted that the population characteristics of those who seek care from abortion clinics are vastly different from those who have self-managed abortions. Gerdts urged that researchers be painstakingly clear about what they are measuring; for example, is a medication abortion fully self-managed or aided by telehealth? If it was aided by telehealth, was it asynchronous, by phone, or by video? She said that “Terminology is a very live issue and is evolving incredibly quickly.” For example, she noted, self-managed abortion includes all ways people have ended unwanted pregnancy, including traditional methods; self-managed medication abortion, on the other hand, indicates no involvement with a clinician. Individuals themselves may think of their abortion experiences in ways that may not align with terminology that researchers use, and Gerdts encouraged researchers to be extremely clear about what methods and models of abortion care they are studying, rather than attempting to define them, so that their results can lead to impact where they are most relevant. Several panelists throughout the workshop emphasized that when reporting data, researchers need to be clear about what research models and participant characteristics and questions were used and to acknowledge the study’s limitations.

Difficulties Collecting Data on Reproductive Health Equity Post-Dobbs

In opening the final panel, Lisa Simpson, University of California, Berkeley, noted that the workshop had not yet included discussion about the mental health needs of those seeking abortion care. The relevant structural factors are myriad, complex, interconnecting, and interacting, she said, and geography, policy changes, and life course are all important considerations.

“What abortion is has changed” in the United States since its decriminalization in the mid century, pointed out Amanda Stevenson, University of Colorado Boulder. Specifically, it is available much earlier in pregnancy, and the delivery method is now primarily via medication, she continued. The incidence of abortion was increasing before Dobbs and continues after, she asserted, as has the fraction of pregnancies not lost to miscarriage. This may be because a pregnancy that is terminated at 6 weeks cannot then result in a miscarriage later. On the other hand, she explained, if collecting data on abortion completed at 12 weeks, part of the cohort of people will have miscarried in that time. This may be one of the ways that the changing timing and methodology of abortion is influencing the abortion counts, she concluded. Stevenson also noted that WeCount and the Guttmacher Institute have provided abortion enumerations, but these numbers do not explain anything about who is getting abortions. Additionally, she said, the most recent racial and ethnic data are mainly from 2014.

Lee Hasselbacher, University of Chicago, said researchers need to consider human subjects protections, which are influenced by both institutional policies, such as those enforced by institutional review boards (IRBs), and federal regulations, including those from agencies like the National Institutes of Health (NIH). These frameworks are intended to protect participant privacy and safety—especially in sensitive areas like abortion research—but can also introduce challenges. Researchers need to balance mitigating risks to research participation while also

preserving rigorous research. In a survey of researchers conducted at CONVERGE at the University of Pittsburgh, she related, researchers reported experiencing increased scrutiny from IRBs when proposing studies on abortion care compared with research on other topics. Hasselbacher noted that because the landscape is volatile, people are not always aware of the laws in place. Researchers may need to give an overview of current laws to IRBs so they have the full picture, she suggested.

Certificates of confidentiality (CoCs), which are granted by NIH and used to protect sensitive research data from being disclosed in court proceedings, are somewhat untested, Hasselbacher explained. CoCs may offer important protections, but non-NIH-funded studies on abortion-related topics have faced difficulties getting the certificates approved. While additional risks need to be considered, in some cases these dynamics have stymied research.

Strategies for addressing these challenges, said Hasselbacher, include working with IRBs, with experts in internal and external digital security, and with legal experts. Researchers also need to collaborate with and educate federal and state leaders and colleagues at supportive institutions, she said.

Jake Laperruque, Center for Democracy and Technology, discussed shield laws, which he said have been implemented in almost every state where abortion remains legal. Shield laws, he explained, make it illegal to share data even if required by other states. The laws apply to various entities and vary in how broadly they apply. However, Laperruque noted, it remains unclear whether shield laws will hold up in court.

Family doctors can provide abortions too, said Angad Singh, University of Washington. He said that EHRs should include more granular opt-out options for data sharing, allowing patients an exception for having their abortion records shared by default. He pointed out that telling EHR vendors what is the “right thing to do” has not been successful, so legal changes are likely needed at the state level to address data privacy, community inclusion and transparency, and patient-driven data-sharing choices.

Myers asked about entities that sell information to data brokers and the associated risks. Laperruque responded that there are huge risks across multiple areas, including location data, which is one of the types sold most often. Additionally, he said, as shield laws do not typically apply to data brokers, law enforcement will sometimes use the “data broker loophole” to skip the process of going to court for a subpoena or warrant. He noted that a bill, called the Not for Sale Act, has been introduced to close this loophole. It passed the House of Representatives this year, he reported, but has not yet passed the Senate.

A participant asked about menstrual cycle–tracking apps, wondering whether users’ data could be exploited. Lapperque affirmed that these questions came up a lot right after Dobbs, increasing public awareness about what these apps reveal. The data they collect are not protected by the Health Insurance Portability and Accountability Act and thus do not have the limits on data-sharing that a doctor would have.

CLOSING REMARKS

Michele Bratcher Goodwin, Georgetown Law, gave the final presentation, saying the Dobbs decision imparted a new sense of urgency around reproductive health equity; yet, “If we peer more deeply . . . we would know that there are communities that have been complaining about a lack of independence, autonomy, respect, and constitutionalism associated with their reproductive bodies that dates back centuries.”

Black women were experiencing criminalization and policing in the 1980s and 1990s, Goodwin continued, and, like canaries in a coal mine, they asked why the “reproductive health” conversation paid attention to abortion only, in spite of the dangers and injustices surrounding Black communities. Among many examples from that era, she expressed that Black women were “being dragged out of hospitals in shackles and in chains to awaiting police cars” because their medical providers reported them to child protective services. Having given the same type of information to medical providers, Black women were ten times more likely than their White counterparts to be reported, Goodwin said. She also said Black women were asking, “Can your children actually

survive to the ages of 7 . . . or 18 without being gunned down by law enforcement?”

In addition to patients, continued Goodwin, criminalization now also threatens medical providers and now targets not only Black women: Everybody is at risk. If our society had paid attention to the call of Black women in the last century, it would better understand racial disparities, the atmosphere of fear that has intensified in recent weeks, coercion in the reproduction space, and how a government can impose abuse, she said. For instance, she said, in 1927, the Supreme Court ushered in an era of eugenics with Buck v. Bell. Eugenics has not always been about Black people, Goodwin asserted; poor White people were the first targets for forced sterilization because they were considered unfit: Carrie Buck was a poor White woman from Virginia. Like the subjects of Nazi eugenics, said Goodwin, poor White people were perceived as having no use.

“Why is it so very difficult for us to have our own truth and reconciliation within these spaces?” Goodwin asked. Such work is long overdue.

Brindis thanked the planning committee and participants, encouraging all to continue thinking about how to advance data collection, data-sharing, and collecting stories and legacies as well as quantitative data “so that we can continue the work.”

References

Dench, D., M. Pineda-Torres, and C. Myers. 2024. The effects of post-Dobbs abortion bans on fertility. Journal of Public Economics 234:105124.

Gómez, A., S. Arteaga, and B. Freihart. 2021. Structural inequity and pregnancy desires in emerging adulthood. Archives of Sexual Behavior 50(6):2447–2458. https://doi.org/10.1007/s10508-020-01854-0.

Hill, L., S. Artiga, U. Ranji, I. Gomez, and N. Ndugga. 2024. What are the implications of the Dobbs ruling for racial disparities? KFF. https://www.kff.org/womens-health-policy/issue-brief/what-are-the-implications-of-the-dobbs-ruling-for-racial-disparities/ (accessed December 18, 2024).

Kavanaugh, M. L., and A. Friedrich-Karnik. 2024. Has the fall of Roe changed contraceptive access and use? New research from four US states offers critical insights. Health Affairs Scholar 2(2):qxae016. https://doi.org/10.1093/haschl/qxae016.

Luna, Z., and K. Luker. 2013. Reproductive justice. Annual Review of Law and Social Science 9(1):327–352. https://doi.org/10.1146/annurev-lawsocsci-102612-134037.

Ross, L., and R. Solinger. 2017. Reproductive justice: An introduction. University of California Press. https://www.ucpress.edu/books/reproductive-justice/paper (accessed February 1, 2025).

Strasser, J., E. Schenk, Q. Luo, M. Bodas, M. Murray, and C. Chen. 2024. Contraception usage and workforce trends through 2022. JAMA Network Open 7(4):e246044. https://doi.org/10.1001/jamanetworkopen.2024.6044.

Upadhyay, U. D., R. Schroeder, S. Kaller, C. Stewart, and N. F. Berglas. 2024. Pricing of medication abortion in the United States, 2021–2023. Perspectives on Sexual and Reproductive Health 56(3):282–294. https://doi.org/10.1111/psrh.12280.

DISCLAIMER: This Proceedings of a Workshop—in Brief was prepared by Allie Boman as a factual summary of what occurred at the workshop.The statements made are those of the rapporteur or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

PLANNING COMMITTEE MEMBERS: Claire Brindis (Chair), University of California, San Francisco; Andreia Alexander, Indiana University ; Elizabeth Ananat, Barnard College, Columbia University and National Bureau of Economic Research; Wanda Barfield (Ex Officio Member), Centers for Disease Control and Prevention; Alison N. Cernich (Ex Officio Member), Eunice Kennedy Shriver National Institute of Child Health and Human Development; Bruce N. Calonge, University of Coloradoh; Judy Chang, University of Pittsburgh ; Ellen Wright Clayton, Vanderbilt University; Cat Dymond, Atlanta Birth Center; Michelle Bratcher Goodwin, Georgetown University; Barbara J. Grosz, Harvard University; Vincent Guilamo-Ramos, Johns Hopkins University; Lisa Harris, University of Michigan; Justin R. Lappen, Cleveland Clinic and Case Western Reserve University; Monica McLemore, University of Washington; Rebecca R. Richards-Kortum, Rice University; Sara Rosenbaum, George Washington University; Yvette Roubideaux, University of Colorado; Alina Salganicoff, KFF; Susan C. Scrimshaw, University of Illinois at Chicago; LeKara Simmons, AMAZE; Melissa Simon, Northwestern University; Lisa Simpson, University of South Floridaand George Washington University; Tracy A. Weitz, American University and Center for American Progress; Katherine L. Wisner, Children’s National Hospital and George Washington University

REVIEWERS: To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by Karen Trister Grace, George Mason University, and Timothy Wend, University of California, San Diego. Leslie Sim, National Academies of Sciences, Engineering, and Medicine. served as the review coordinator

SPONSORS: This activity was supported by the National Academy of Sciences W. K. Kellogg Foundation Fund. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

STAFF: Julie Pavlin, Senior Board Director; Ashley Bear, Board Director; Natacha Blain, Senior Board Director; Priyanka Nalamada, Program Officer; Laura DeStefano, Director of Strategic Communications & Engagement; Melissa Laitner, Senior Program Officer, Special Assistant to the President; Adaeze Okoroajuzie, Senior Program Assistant; Kavita Shah Arora, Consultant

SUGGESTED CITATION: National Academies of Sciences, Engineering, and Medicine. 2025. Understanding the Barriers and Opportunities to Conducting Reproductive Health Research: Proceedings of a Workshop—in Brief. Washington, DC: National Academies Press. https://doi.org/10.17226/29131.

For additional information regarding the workshop, visit https://www.nationalacademies.org/event/43944_11-2024_a-workshop-why-is-it-challenging-to-measure-reproductive-health-equity-and-what-are-promising-practices.
Health and Medicine Division; Division of Behavioral and Social Sciences and Education; National Academy of Medicine; Policy and Global Affairs

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