More research should address problem
By Melinda Young
Family planning has been linked with racism for centuries, and this legacy impact on 21st-century patients needs to be addressed in family planning research, a new paper says.1
“The institution of slavery in and of itself profited from the reproduction of enslaved people,” says Nicole Quinones, MPH, a PhD student and graduate research assistant in the division of health policy and management at the University of Minnesota School of Public Health in Minneapolis.
“There was an inherent economic value tied to family planning and the racist institution of slavery, and that’s one of the origins we’re trying to highlight,” she says.
Gynecology research has a history of racism, including Dr. Simms, the father of gynecology, who experimented on enslaved women. The birth control pill was developed through experiments involving Puerto Rican women who were not told of the side effects, Quinones says.
“We can list numerous other instances of reproductive injustices in this country that are specifically targeted to people of color, marginalized communities,” she adds. “In this study, we address race and racism that even continues to this modern day.”
Past atrocities can affect current practices, and these need to be addressed and recognized when researchers are studying or addressing race or nationality in family planning studies, Quinones says.
“This paper is guidance to help people who are writing about these topics, specifically when we’re looking at quantitative research,” she explains. “This paper is a guidance, a set of recommendations, but it’s not an exhaustive list.”
It may not be possible for researchers and providers to be race neutral or colorblind. But every step of the research process can be improved by thinking about how biases and racism affect research design and the research question by considering these questions:
- How will I collect information on people’s race and ethnicity?
- How will I interpret my findings?
- How can I interpret my research question?
- How do I choose a theory or framework through which I can better understand what I’m trying to study?
“A lot of this has been done by scholars of color already, but we’re just not engaging sufficiently in that work,” Quinones says. “These are recommendations and things for researchers to think about as they go through each stage of the research process.”
The recommendations include having future researchers ensure that family planning research contributes to ensuring that all people have the resources, information, power, and safety they need to decide whether, when, and how to have children.1
The study also recommends that decisions about the inclusion of race in family planning research should be conceptually justified and incorporate considerations of the systems of social inequity, including structural racism and histories of exploitation.1
Qualitative and quantitative researchers need to engage in a dialogue with themselves as they go through the research process to think about what participants are saying and how this affects the research question, Quinones says.
“A lot of times, people think quantitative research is objective and, therefore, free from all these biases to a certain extent, and that’s simply not the case,” she adds.
Researchers’ biases can contribute to how the research question is designed and affect results.
“We need to look at mechanisms behind racism, and that explains health disparities and outcomes among marginalized populations,” she says.
The study’s investigators also found that the journal Contraception in a 2023 web search had only 50 articles that used the term “structural racism,” 13 that included “systemic racism,” and six that used the term “white supremacy.” This appears to suggest that the journal’s authors are not engaging with these concepts in their work and these perspectives are undervalued in academic publishing.1
“There is a lack of addressing the mechanisms through which white supremacy and structural racism give rise to racial health inequities,” Quinones explains.
When people attribute reproductive health inequities, such as adverse outcomes related to pregnancy, to a cultural or genetic issue, they lack understanding of why health inequities arise.
“Racism is engaged through policy and practice and can be addressed on structural societal levels. These are not individual characteristics,” she says.
For example, a woman’s weight is seen as an individual characteristic. A physician might believe that a pregnant woman would not be at high risk if she lost weight, but that is not necessarily the case.
“The case is the physician is not listening to the patient. That is structural. There are underlying biases behind that,” Quinones explains. “Why is it this doctor is not listening to this Black patient compared to a white patient?”
The paper seeks to get to the structural policy and practice level of understandings of how these racial health inequities come about because of structural racism.
“We hope people will take our recommendations and use this as a guide and start to engage in this type of thinking and be reflexive in our understanding of how these outcomes or phenomena come about,” Quinones says. “It takes a lot of internal thinking and reflection, and as scientists and researchers, that is our job — to think.”
REFERENCE
- Quinones N, Fuentes L, Hassan A, et al. Society of Family Planning Research Practice Support: Strategies and considerations for addressing race and racism in quantitative family planning studies. Contraception 2024;Jul 2:110534. Doi: 10.1016/j.contraception.2024.110534. [Online ahead of print].
