In the evolving discourse of public health and social equity, the intersection of reproductive coercion and medical mistrust emerges as a critical axis for understanding disparities affecting Black women in the United States. A pioneering study by Adekunle, published in the International Journal for Equity in Health, sheds profound light on how historical and systemic abuses have perpetuated health inequities stretching from the antebellum era to the present day. This incisive research navigates through centuries of oppression, unraveling the complex interplay of coercion, distrust, and the ongoing impacts on Black women’s reproductive health outcomes.
Reproductive coercion, broadly defined, involves subtle and overt pressures and restrictions limiting an individual’s autonomy over reproductive decisions. For Black women, this form of coercion is deeply rooted in a history marked by exploitation and control—beginning with the era of slavery when reproductive rights were commodified and manipulated. In the antebellum South, enslaved Black women were forced into reproductive servitude, their bodies subjected to enforced pregnancies to increase enslaved populations. These legacies have cascading effects that resonate into contemporary medical practices and policies.
One of the central themes explored in Adekunle’s work is medical mistrust, a phenomenon with deep roots in collective memory and lived experience. The cruel medical experiments of the past, such as those carried out by J. Marion Sims, known as the “father of modern gynecology,” who operated on enslaved women without anesthesia, have fostered generational wariness toward healthcare systems. This mistrust is not merely anecdotal; it has quantifiable impacts on healthcare engagement and outcomes. Black women, on average, exhibit higher rates of medical skepticism, which contributes to delayed prenatal care, reduced screening rates, and resistance to medical interventions that could improve health outcomes.
Adekunle’s research meticulously documents how such mistrust intertwines with contemporary forms of reproductive coercion, including healthcare provider bias, discriminatory practices, and implicit coercions embedded within institutional policies. The study positions these manifestations within a structural framework, recognizing that systemic racism infuses medical institutions and influences clinical interactions. Here, the author invokes critical race theory, emphasizing that structural determinants shape individual health behaviors and access.
Importantly, the study leverages extensive historical documentation alongside epidemiological data, blending qualitative and quantitative methodologies to provide a holistic view. This dual approach enables a nuanced understanding of how macro-level phenomena like structural racism manifest in micro-level experiences of coercion and mistrust. By contextualizing Black women’s health trajectories within these intersecting forces, the work reframes reproductive justice as inseparable from broader social justice movements.
A pivotal insight from the study is how reproductive coercion today transcends overt control and includes subtler, systemic pressures such as coercive contraception counseling or inadequate reproductive health education. The author highlights healthcare scenarios where Black women are disproportionately subjected to forms of coercion including pressured sterilization or limited contraceptive choices. These practices, often cloaked under the guise of public health initiatives, perpetuate paternalistic control and compromise informed consent.
The implications of sustained reproductive coercion and mistrust extend to disparities in maternal mortality and morbidity. Black women in the U.S. face maternal mortality rates two to three times higher than their white counterparts, a disparity inadequately explained by socioeconomic status alone. Adekunle interrogates how medical systems, influenced by biases and historic mistrust, contribute to these outcomes by failing to provide equitable, respectful, and culturally competent care.
One innovative dimension of the study is its engagement with patient narratives, spotlighting how personal stories reflect and resist systemic violences. These narratives reveal a paradox: while mistrust hampers engagement with healthcare, it also serves as a protective response against potential harm within a historically oppressive system. Recognizing this dynamic is essential for developing interventions that both rebuild trust and address structural inequities.
In the era of COVID-19 and rising awareness around systemic racial inequities, Adekunle’s findings gain urgent relevance. The pandemic underscored vulnerabilities in healthcare systems, disproportionately impacting Black communities and amplifying medical mistrust. The research calls for tailored public health strategies that prioritize trust-building and community empowerment to reduce reproductive health disparities.
Furthermore, the study advocates for policy reforms grounded in principles of reproductive justice—a framework that situates reproductive rights within the context of social, political, and economic freedoms. It critiques existing policies that inadequately consider historical trauma and calls for reparative approaches that actively dismantle structures perpetuating coercion and mistrust.
Healthcare provider education emerges as another critical area of focus. Adekunle underscores the need for training programs that confront implicit biases, incorporate historical contexts into curricula, and emphasize patient-centered care models. Such educational reforms could transform clinical environments from loci of mistrust to spaces of healing and empowerment.
Technology and digital health innovations also offer promising conduits for addressing these challenges. The study suggests that culturally congruent telehealth services and community-driven health information could improve access and trust, particularly in underserved urban and rural Black populations. These innovations must be designed with deep community involvement to ensure relevance and efficacy.
Ethical considerations permeate the analysis, especially regarding informed consent and autonomous decision-making in reproductive health. Adekunle calls on medical ethics to reckon with historical malpractices and foster frameworks that prioritize transparency, respect, and patient agency. Without this ethical reckoning, disparities and mistrust are likely to persist.
In essence, Adekunle’s research is a clarion call for integrating historical consciousness into contemporary health equity initiatives. It demonstrates that without addressing the deep-seated roots of reproductive coercion and medical mistrust, efforts to improve Black women’s health will remain superficial and ineffective. Comprehensive approaches must engage history, social justice, medical ethics, and community voices in a cohesive strategy to heal longstanding wounds.
The study’s broad interdisciplinary reach signals a paradigm shift, urging collaboration across fields—public health, history, ethics, sociology, and clinical medicine—to transform systems. It highlights that reproductive autonomy cannot be extricated from broader societal power relations and that true health equity requires systemic overhaul, not mere technical fixes.
As the healthcare community grapples with persistent inequities, this work offers a meticulously researched, historically grounded framework to guide future practice and policy. It challenges stakeholders to move beyond surface-level interventions and to embrace the complexity of reproductive justice as fundamental to achieving health equity for Black women and their communities.
Adekunle’s study stands as a monumental contribution to health equity literature, paving the way for new dialogues, research, and reforms that acknowledge and redress the multigenerational impacts of coercion and mistrust. Its resonance extends beyond academia into the realms of advocacy, clinical practice, and governance, charting a path forward in the quest for reproductive justice and dignified healthcare.
Subject of Research: Reproductive coercion, medical mistrust, and Black women’s health from historical and contemporary perspectives.
Article Title: Reproductive coercion, medical mistrust, and Black women’s health from the antebellum period to the 21st century.
Article References:
Adekunle, T. Reproductive coercion, medical mistrust, and Black women’s health from the antebellum period to the 21st century. Int J Equity Health 24, 302 (2025). https://doi.org/10.1186/s12939-025-02665-2
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