Unlearning Ableism in Abortion Care

We live in a society that caters to the able-bodied, where people with invisible and externally apparent disabilities have historically faced marginalization, exclusion, and oppression. Abortion spaces have not been exempt from these dynamics, and in Canada we have a long shameful history of perpetuating them.   

“Bigotry is the goal, ableism and eugenics is the tool kit.” – Imani Barbarin  

In reproductive health these systemic inequalities are exacerbated when race and other marginalized identities come into play. Today healthcare providers still enact racist, colonizing practices upon Black and Indigenous populations, such as misdiagnosing health conditions, forced sterilization and contraceptive coercion.  Additionally, studies show that doctors treat pain differently depending on race, spend less time with patients with obesity, discriminate against trans patients, and exhibit unexamined bias that negatively impacts health outcomes.  

The reproductive justice movement was created as an intersectional response to uplift the voices of marginalized people who can get pregnant and is defined by SisterSong as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” The term was originally coined by the Women of African Descent for Reproductive Justice in 1994, who identified that the privileged leaders of the women’s rights movement did not represent the needs of Indigenous women, women of color, and trans people. 

Recognizing the legacy of work that has come before us, at Choice in Health we know that disability justice and reproductive justice are intertwined. Ableism has been used to uphold white supremacy, embedding the erasure of bodies into societal structures, policies and practices.  We recognize that abortions were forced upon Indigenous communities as a form of institutionalized eugenics, trans folks still face prejudice, patients labelled with obesity encounter obstacles to healthcare access, and in response we strive to improve quality of care for those who have systematically had their choices extinguished.  

The decision is yours  

One change we have made to prioritize client agency was updating our birth control counselling policy. Historically birth control has been used as a form of population control against marginalized groups, stripping the right to parent or not parent safely. 

At Choice in Health we reflected on our past birth control counselling policy, which included a session with a counsellor in every appointment, and arrived at a place that centers client decision making above prescriptive care.  We do not require clients to discuss birth control and know that pushing these conversations is a form of contraceptive coercion that can impact reproductive health choices.  

Ableist narratives around what is best for people with disabilities are infantilizing and racist assumptions about which bodies need long-acting reversible contraceptives (LARC) are harmful. We will not assume what you need, and we will not speak for you.  

Your appointment, your conversation 

We recognize the power dynamics that exist in healthcare spaces when clients are in a room with a healthcare provider. We intentionally removed the pressure of deciding whether to discuss birth control while you are at our clinic. What we do instead: you get to make that decision in the comfort of your home and you can change your mind.   

People seeking abortion care still face stigma. The stereotype that those who have abortions are “unresponsible” and need contraception contributes to shame around abortion and dismisses client autonomy. This can be especially damaging for BIPOC clients or clients with disabilities who have historically been forced into birth control decisions.  

If you choose to talk about birth control during your appointment, we consider your individual needs, lifestyle and health history. Our staff have expert knowledge that can support you in making a decision that best fits you. 

At Choice we know that your reproductive health decisions are your own and are committed to providing abortion care that centers autonomy and self-determination. Our Disability Justice statement outlines our dedication to this work, though we acknowledge that we have more work to do. We know you’re the expert and we’ll keep working to make sure access and agency are prioritized at every step of your care.