For Black History Month Lady Parts Justice League is interviewing modern day reproductive justice heroes. Today we talk to Monica R. McLemore (PhD, MPH, RN) a research superstar who we think should be in charge of everything!
LPJL: So let’s start at the beginning… what motivated you towards your current career? And how has your activism evolved from before and after you started research?
Whew. The beginning? I was born a preemie in 1969. All the work I do is personal. I had a really hard go of it as a child, leg braces, glasses, braces on teeth, psoriasis, eczema, sickly child and spent lots of time sick. I believe I was 8 years old when I announced I would become a nurse. Despite no one in my family even being remotely engaged in healthcare. Now, I’m a professor of nursing at a public university after receiving a bachelor’s degree in nursing in 1993, master’s in public health in 2002 and a PhD in 2010. I received them all at public institutions and emerged from school with no debt because we used to invest in education and our future. I was lucky enough to take a course called power and politics in nursing from Dr. Susan Boughn, my first faculty mentor, colleague and friend. She introduced me to Faye Wattleton (the first Black and youngest president of Planned Parenthood). I live as a Black American woman. The personal is always political and to believe that activism is separate from the core tenets of nursing and public health is to be both inaccurate and ahistorical. I have only gotten more progressive as I have gotten older.
LPJL: I think you’ve really laid out here why reproductive justice isn’t just used in your work, it IS your work. Can you walk us through how you conducted a specific study through the lens of reproductive justice?
Reproductive justice is both a theory and a praxis that was born out of advocacy work. It has yet to be adapted to clinical research, which I why I joined the advisory board for Black Mamas Matter Alliance and agreed to support the research working group. The operationalization of reproductive justice has not yet been defined and so what you end up with is a lot of folks co-opting the term but not aligning with reproductive justice principles. For example, when I launched the Saving Our Ladies from early births And Reducing Stress (SOLARS) study, it was intentionally designed using RJ principles. First, it is a woman of color designed, woman of color led research team. I often tell colleagues if you have an all-white research team, you are not aligned with reproductive justice or research justice principles. It is impossible for a racially discordant team to be able to generate the appropriate research questions necessary to answer vexing questions about health outcomes and effective interventions. Next, reproductive justice centers oppressed Black, Indigenous and people of color – thus, SOLARS has no white woman control group. I often have to tell colleagues that there are no default humans and particularly white women don’t serve as some standard for all others, particularly when their health outcomes are not the best we can hope for. Finally, the SOLARS measures were carefully selected to measure assets as well as stressors. I have always thought to design my work from the perspective that, “how different would the scientific enterprise be if we began with the question why aren’t Black people extinct, given all that’s happened to us and the shameful health disparities that exist?”
Another study I conducted that designed and tested if doula work could serve as both a vocational job program and a mitigation strategy for recidivism (cycling in and out of jail or prison) for formerly incarcerated Black and Brown women was predicated upon the reproductive justice principle that Black Lives Matter. That gainful employment and meaningful work supporting other Black people could serve as a model to not only transform those who became doulas, but also the people they support through abortion and birth. Reproductive and research justice posits that centering the most oppressed people with everything they need to be successful unleashes the full creativity of humanity. I believe this with my entire being.
LPJL: The thing we really love about your job and what you do is that the FACTS ARE ON YOUR SIDE! That being said, do you still get a lot of hate from people saying you’ve interpreted the facts wrong?
I fight with people a great deal of my time trying to get them to see the lies that racism has taught them and the biggest one of those lies is that health disparities exist because as my good friend Dr. Kemi Doll says: it’s not that Black women are a broken group of women, it’s because of a broken racist system. It amazes me that researchers and policy makers don’t understand that the people we serve are experts in their own lives. As clinicians we take a history and physical from someone and deem them competent to report symptoms and how they feel, but not solutions and how to address their health needs in the context of their own existence. Somewhere along the health professions lost our way and think we know better than the people we serve, when their lived experience probably is more important than our population-based knowledge.
The other thing that drives me up a tree about this is that people think that facts are malleable. They’ve somehow been convinced that personal opinion and preference are just as important as empirical evidence and research. It feels like many people wish for the pre-enlightenment days and it is fundamentally scary and makes me angry.
LPJL: OK so we get called out all the time by anti-abortion people who think they have science on their side. Could you maybe school them on why they’re wrong? That’s too vague, we’ll be more specific…. Why are heartbeat bills and “fetal pain” bills not scientifically sound?
For me, this is a fundamental existentialist issue. Who gets to decide about what happens in another human’s body should be the decision of the pregnant person. If science is centered on the people we serve, fetuses aren’t people. However, to address more specific issue, heartbeat bills are not science based for many reasons; they do not improve abortion safety and they don’t change people’s minds who are certain in their abortion decisions. But there is a more insidious problem with these arguments which is the false equivalence that a fetus is just as valuable as a grown adult pregnant person who has full capability to determine their destiny and future. Most anti-abortion people believe their opinion about what another person – who has bodily autonomy – does with their body, matters more than what the pregnant person thinks. Anti-abortion people want to opine about what risks pregnant people should be forced to take (given that pregnancy is riskier than abortion); which is extremely problematic in the context of our current maternal morbidity and mortality crisis which is borne by reproductively oppressed Black and Indigenous people of color.
LPJL: Why is this latest “infanticide” nonsense not scientifically sound? This is definitely pretty heavy stuff, but we are also talking a lot about how anti-choicers don’t like, want to acknowledge all the ways your body betray you late in pregnancy. So, can you talk a little about that?
I have worked clinically in abortion care provision my entire career. I have been a nurse for 27 years. For people who seek or need abortions later in pregnancy, it is important for people to make those decisions with their clinical team and the people involved with the pregnancy. It is both cruel and rude to believe that some families and clinicians would take these decisions lightly, and would not have the moral clarity to protect the life of the pregnant person, nor ease the suffering a fetus who is not developing or is likely to die at birth. I would caution that these principles be considered about all pregnancies, but specifically for the 1% of abortions that are later in pregnancy that there be a semblance of grace and privacy afforded the people who make these decisions. I have talked with and been a nurse for so many families in this situation and the one thing I would tell anti-abortion people who think they know best what these families need, you are wrong and you need to mind your own business.
LPJL: What are some of the worst ways you’ve seen anti-abortion people interpret research?
The frame of safety is an important one, but I also think it is insufficient. Anti-abortion people talk about how abortion harms women, without acknowledging their mean and cruel perspectives, tactics and other perpetuation of stigma is the actual harm. The most recent inaccurate interpretation drove me to appear on billboards last year as part of the #EndAbortionDeception campaign with the Abortion Care Network. The so-called medication abortion reversal treatment. To be clear, as a reproductive justice person, I would support someone wanting to reverse their abortion in the same way I do as a charge nurse to coordinate dilator removal if/when patients request. At least for dilator removal, we have some data we can apply and counsel about risk for premature rupture, preterm birth and other outcomes. However, the science behind so-called medication abortion reversal is shoddy and we should not be legislating based on an untested and unproven treatment.
LPJL: And I guess I also should ask is there a way that we as pro-choicers interpret research that could be better?
I wouldn’t use the word pro-choicers. I believe people should have the information, capacity, and tools to make the reproductive decisions they need to make. For some people abortion isn’t a choice if they don’t have access. With that caveat, I would argue that we don’t know what the people we serve as part of their abortion care experience. I spend a lot of my research understanding how can we improve people’s experiences of their care including the physical space and organization of how services are provided to pain management and comfort. I truly believe that we need to study the desire (or lack thereof) for people to seek care across the reproductive spectrum from the same team of individuals. We know from published studies, including some of my own, that people are frustrated when they meet an obstetrician or midwife at the time of their birth who had not seen them across their pregnancy, I am curious if this is true when people seek out abortion providers. I’m curious about team-based approaches taking a reproductive life course approach to determine how we could better provide care. How to be more transparent about roles and expectations in the care setting. The ethics of physicians being visible provider of abortion procedures but all the counseling, ultrasound, blood work, pain management and other skills that nurses, counselors, technicians and other paraprofessionals perform. The implications for the future workforce. There are many things I could list.
LPJL: What do you wish that we had funding to research more? Like, pipe dream.
See above. I’d also like to have co-located birth, abortion, contraception and reproductive life course services all in one community, central location.
LPJL: What are your 2019 reproductive justice goals?
The House of Representatives is now dominated by Democrats and its way past time for a reproductive justice new deal. I hope to make some headway on achieving a reproductive justice agenda that I usually provide Letterman style like a top 10 list (video here):
- Universal Coverage, Single Payer, Medicare for all;
- That a basic minimum income is provided to citizens – I worry we are becoming a country where poor people are unable to parent with dignity;
- That paid family leave becomes the norm in the United States;
- That immigrant children are not separated from their families, we [Nurses] fought for years for dyadic and couplet care within our hospital walls, to say nothing outside of them speaks volumes about why communities don’t trust us and while I’m on this subject; we figure out how to stop incarcerating pregnant people – it is unethical to have babies begin their lives in jail as innocent citizens because their parent or parents may have committed a crime.
- That maternity coverage not continue to be discussed as “optional” on healthcare exchanges in discussions about the Affordable Care Act.
- That Title X be fully funded to provide access to contraception, abortion, and comprehensive family planning including infertility services and fertility awareness-based methods.
- We need to Be Bold and Repeal the Hyde Amendment; that we understand and can dialog about the need for abortion not only as a tenet of reproductive justice but also in order to maintain its quality and safety as outlined by the recent National Academies of Science, Engineering and Medicine report, we need to continue to train the current and future workforce to provide them safely.
- We know in states that expanded Medi-caid that pregnant people and babies have better short-term health outcomes – thus it becomes an ethical argument to deny coverage when we know this intervention alone improves population health; and we need to call this out as unethical.
- That culturally and racially relevant midwives and doulas should be provided to all Black and Brown women during birth until we fix our broken labor, delivery and birthing units; that a midwifery model of care be provided to those who seek it and that group care (which we know affords superior outcomes for even the most high-risk patients be readily accessible and sustainable)
- That we view our patients and communities we work in as our current and future workforce; and that we finally stop making pipeline excuses and realize that the pipeline we have is gummed up because we don’t have the courage or the political will to disrupt how we train the future healthcare workforce.
LPJL: What do you need to see MORE of from co-conspirators and activists when busting abortion stigma and promoting RR/RH/RJ?, Especially white cis women and privileged folx?
I think all white people need to figure out what role they have to play in justice work and seek accountability in doing that work. I’m am resentful of having to teach white people what their work is and I’m done with the performative concentration of their attention on what people of color are or are not doing and their disassociation from doing the real work – getting their people. I also am seriously irritated by people who have power and have no idea when, where or how to wield it.
I recently posted on social media that Anti-Racist > Co-conspirator > Accomplice > Ally. I think everyone is aspirational and doesn’t really want to admit they aren’t doing anything substantial to dismantle racism or understand how this could all be different. For example, folx with an agenda would have already figured out how to build infrastructure with marginalized communities in stealth mode to amplify justice stances. I posted last week that if every non-Black individual wanting to work with me and my team found a non-profit or community organization that they could adopt – they could write up template grants, press releases, create databases and other data visualization infographics, and important tools such that these orgs can get the important work done. They could run interference around structural racism that keeps essential resources of time, money, and humans from being heard.
Small, scrappy women of color led organizations need infrastructure and resources, not good intentions. If every person with skills all lined up around a shared long-term agenda, this could all be different. This kind of foundational supports nimbleness – to not miss out on opportunities because they never have bandwidth to apply for grants and awards because they are DOING THE WORK. But, this requires a commitment to change as opposed to commitment to structures as they currently exist. Which gets back to my basic point – this could all be different and I’m planning to make it so.