Historical Context

Past and ongoing reproductive mistreatment of people belonging to communities that have been marginalized is of clinical relevance because it has shaped many present-day health inequities and contributes to ongoing mistrust of the health care system.

Twentieth-century violations of reproductive autonomy include the testing of the oral contraceptive pill on women in Puerto Rico without appropriate informed consent; coercive sterilization of people with physical and intellectual disabilities, those living in poverty, and from marginalized racial and ethnic groups; and the Tuskegee experiment, in which hundreds of Black men were deprived of treatment for syphilis.11, 17, 18, 19, 20, 21  Coercive sterilization practices continue into the 21st century, including among women in carceral settings.

Public health prerogatives to advance science and improve the gene pool were used to justify many of the actions now recognized as unjust.22 These past actions serve as a reminder to providers to interrogate programs and practices, and to engage patients and communities in program development and system redesign to avoid neglecting or misunderstanding community needs and to reduce the risk of additional harm.