Health Equity Hub

The National Family Planning & Reproductive Health Association (NFPRHA) believes that the principles of reproductive justice are an essential component of ensuring the administration and delivery of comprehensive reproductive health. As SisterSong defines it, reproductive justice is the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities. Reproductive justice prioritizes equity, access, and quality of care for all people seeking family planning services, regardless of their race, ethnicity, age, socio-economic status, gender or sexual identity, immigration status, employer, insurance status, and cultural and religious beliefs. Reproductive justice goes beyond the scope of traditional reproductive rights, acknowledging the intersectionality of various social, economic, and cultural factors that influence individuals' ability to make their own informed decisions about their reproductive lives and health.

NFPRHA recognizes that the history and present-day experiences of systemic racism, inhumane treatment, and inequitable access to resources and services have negatively affected the health and well[1]being of Black, Indigenous, and other people of color, LGBTQ+, undocumented, and other marginalized populations. US family planning policy, as well as broader health policy, is rooted in white supremacy, which enables a fundamental disregard for the bodily autonomy of individuals from these marginalized populations and has led to countless examples of reproductive coercion.

NFPRHA, as a membership organization representing publicly funded family planning providers and administrators and recognizing that the organization has been historically white-led, is committed to advancing the work of the reproductive justice movement and the tireless advocacy efforts led by Black women and gender-expansive leaders by committing to the following work:

NFPRHA seeks to address distrust in family planning settings by promoting the principles of voluntarism and free choice in family planning.

NFPRHA supports policies and practices that acknowledge and counteract explicit and implicit systemic oppression and individual biases that have been shown to limit patient choice and result in patients’ needs and preferences not being assessed or met fully.

NFPRHA condemns policies and practices designed to control people’s fertility and/or reproductive health. NFPRHA believes that safeguarding access to voluntary family planning and sexual health is critical to improving public health and the overall social and economic well-being of all people.

NFPRHA acknowledges and respects the longstanding leadership and work of reproductive justice organizations. It commits to act with integrity when aligning with and/or amplifying the work of reproductive justice leaders and organizations, crediting those who do the work and demonstrating accountability both internally and with partners when NFPRHA’s words or actions create harm in relationship to reproductive justice leaders, organizations, and other partners. 

NFPRHA's Work: NFPRHA hosted a five-part series on racism and its impact on public health to its membership. We hope these conversations inspire our collective work toward creating a more just and equitable health care system.

The National Family Planning & Reproductive Health Association (NFPRHA) recognizes and condemns racial and ethnic disparities in pregnancy-related mortality and morbidity in the US. Such disparities, rooted in systemic racism and sexism, are persistent and unacceptable. While other social and structural inequities have an impact on pregnancy-related health care – including prenatal and obstetric care, interpregnancy care, abortion care, management of miscarriage and stillbirth, and postpartum care (regardless of the outcome of the pregnancy) – often preventing individuals from accessing the care, potentially even lifesaving, that they need, the significance of race is indisputable. According to the Centers for Disease Control and Prevention (CDC), Black and Indigenous people experience, respectively, three and two times the rates of pregnancy-related deaths than white women in the US, in part due to the implicit and explicit bias of their health care providers and service delivery systems. These alarming disparities in pregnancy-related health outcomes persist across income and education levels. NFPRHA believes it is imperative to educate health care providers on systemic racism, implicit and explicit bias, and evidence-based and emerging prevention strategies to address maternal mortality and morbidity; and implores health care providers to do better at listening to their patients and their loved ones when they express concerns about their health, recognizing and responding to urgent maternal warning signs, providing timely treatment, and ultimately delivering the respectful and quality care needed to end racial disparities in pregnancy and pregnancy-related care.

NFPRHA believes that all people should have access to the high-quality, confidential, and affordable health services they need to thrive during and after pregnancy, including prenatal, obstetric, and postpartum care that supports an individual’s autonomy and decision-making. People who are pregnant or postpartum also have the right to care that addresses their mental health, behavioral health, and social service needs. A person’s relationship with the health care system during pregnancy (regardless of the outcome of that pregnancy), childbirth, and the postpartum period is vitally important, as these encounters are the vehicle for essential and sometimes lifesaving health services. During this potentially vulnerable time, no person should be subject to inequitable treatment from health care providers. Instead, they have the right to care – and health care coverage – that promotes healthy pregnancy; safe birth, management of miscarriage or stillbirth, or abortion care; and ongoing health through the postpartum period – regardless of the pregnancy outcome – and beyond. Historically, the highest income eligibility in most states for Medicaid coverage available during pregnancy ends 60 days postpartum. NFPRHA believes that states should be required to extend Medicaid coverage to beneficiaries 12 months postpartum no matter the pregnancy outcome. No one should face a loss of health insurance coverage after childbirth, pregnancy loss, or abortion care, particularly people with low or no incomes who experience a variety of barriers to accessing care. .

The National Family Planning & Reproductive Health Association (NFPRHA) believes that all people— regardless of race, ethnicity, age, sexual orientation, gender identity, immigration status, employer, insurance status, or any other demographic—should have timely and convenient access to high-quality, confidential, and affordable health care, including family planning and sexual health services, supplies and information. An individual's right to access the care they need should never be contingent upon the possession of legal status documentation.

There are people, regardless of their ability to provide proof of citizenship, who continue to face barriers accessing government documents, including, but not limited, to the following:

• Adolescents and young adults.

• Adolescents and young adults who are currently or have been in child services systems.
• Individuals experiencing intimate partner violence (IPV) or trafficking.
• Individuals who are currently or have been in government custody.
• Older adults.
• People who experience homelessness.
• People who are transgender.
• People who fear interacting with law enforcement or governmental systems of enforcement.
• People with low incomes.
• People with physical or developmental disabilities.

NFPRHA believes that federal and state governments should prioritize expanding health care access for these communities— each of which faces systemic inequities in accessing services— rather than imposing any documentation requirements as a condition to receiving care. NFPRHA believes that health care providers should adhere to nationally recognized guidelines for IPV, trafficking and/or sexual assault screening when caring for these communities. Health care providers should also provide care that is responsive and culturally informed which will help patients feel more comfortable to disclose IPV, trafficking, and/or sexual assault without fear of judgment.

NFPRHA further believes that immigrants should have equal access to public health insurance and public health programs, regardless of their legal status.

Improving Access and Quality for All Resource Guide and Assessment Tool

The National Family Planning & Reproductive Health Association (NFPRHA) believes that efforts to improved access and quality of care can only be achieved by recognizing and responding to systemic racism and all forms of oppression, including the unequal distribution of resources, which have created persistent health disparities. To support this work, NFPRHA has created the Improving Access and Quality for All Resource Guide and Assessment Tool which aims to assist family planning providers in identifying the work that is needed within their agency to address systemic barriers to care and improve access to high-quality health care. By applying the resource guide and assessment tool, health care organizations can strengthen their efforts to improve sexual and reproductive health outcomes.  

The National Family Planning & Reproductive Health Association (NFPRHA) believes that all people should have the right to engage in happy and healthy relationships without fear of violence or discrimination. Patients who are or are perceived to be lesbian, gay, bisexual, transgender, queer, intersex or asexual (LGBTQIA+), as well as people who have sex with people of the same sex and do not identify as LGBTQIA+, may have different sexual and reproductive health needs than patients who identify as cisgender and/or heterosexual. All people have a right to have their full health care needs met when seeking education, counseling and/or clinical serves which includes having access to high-quality, confidential, and affordable family planning and sexual health services and supplies, regardless of their sexual orientation or gender identity and expression.

According to the Centers for Disease Control and Prevention (CDC), LGTBQIA+ people and people who have sex with members of the same sex are more likely to experience bullying and harassment, substance use disorders, depression, or suicidal thoughts. LGBTQIA+ people may also face a significantly heightened risk of certain negative health outcomes, including sexually transmitted infections (STIs) and interpersonal violence. It is important to make explicit that these increased risks are not because of a person’s sexual orientation or gender identity, but rather due to cultural attitudes and forces of systemic oppressions including misogyny, racism, homophobia, and transphobia. Because of the unacceptable stigma, discrimination, and violence that members of the LGBTQIA+ community face—and the contributions of such discrimination to adverse health outcomes—it is especially important to assure these patients’ rights to be treated in a culturally relevant and responsive way when accessing health services. NFPRHA believes that LGBTQIA+ patients have the right to receive sexual and reproductive health services and counseling in supportive environments that are respectful, responsive, actively affirming, and nondirective. NFPRHA also opposes laws that allow providers to refuse to provide health care to LGBTQIA+ and gender-diverse people and the criminalization of providers who deliver gender-affirming care.

As a nonprofit organization based in Washington, DC, NFPRHA supports and complies with nondiscrimination laws that prohibit discrimination on the basis of gender identity, sexual orientation, and sex, in addition but not limited to race, national origin, religion, disability, employment, housing, credit, education, public spaces and services, federally funded programs, and jury service. .

Family planning providers play a critical role in ensuring that all community members, regardless of sexual orientation, gender identity, or gender expression, receive appropriate, timely, and affordable health care services.

The National Family Planning & Reproductive Health Association (NFPRHA) believes that adolescents and young adults have a fundamental right to the knowledge, services, and supplies that support their personal autonomy and sexual and reproductive health. NFPRHA believes that adolescents and young adults should have access to high-quality, confidential, and affordable sexual and reproductive health services from health centers that are welcoming and respectful of young people.

NFPRHA also supports efforts to promote a positive, healthy view of sexuality through high-quality, comprehensive sexuality education that is age and developmentally appropriate, medically accurate, responsive to the diverse needs and inclusive of the lived experience of adolescents and young adults across the sex, gender, and sexual orientation spectra, and that identifies sexuality as a part of the human experience. NFPRHA believes that these efforts to support adolescent and young adults’ family planning and sexual health will equip young people to make decisions that align with their own goals and values. These efforts are essential to foster their healthy development and support their emotional and physical well-being. NFPRHA supports approaches that encourage voluntary, supportive communication between parents/trusted adults and adolescents and young adults about matters of sexual health.

Not all adolescents and young adults have a relationship with a parent or guardian in which they feel safe to disclose or discuss these issues. It is important to recognize the role of other trusted adults who may provide this support. Evidence shows that mandates for parental notification and/or consent do not deter sexual activity; rather, they can create barriers that discourage adolescents and young adults from seeking necessary medical care. For this reason, NFPRHA believes that parental/trusted adult/care provider involvement, such as sexuality education opt-in or opt-out policies, should never be forced or required for adolescents and young adults to receive family planning and sexual and reproductive health services or information, including abortion information.

The National Family Planning & Reproductive Health Association (NFPRHA) believes that efforts to improved access and quality of care can only be achieved by recognizing and responding to systemic racism and all forms of oppression, including the unequal distribution of resources, which have created persistent health disparities. To support this work, NFPRHA has created the Improving Access and Quality for All Resource Guide and Assessment Tool which aims to assist family planning providers in identifying the work that is needed within their agency to address systemic barriers to care and improve access to high-quality health care. By applying the resource guide and assessment tool, health care organizations can strengthen their efforts to improve sexual and reproductive health outcomes.