SRHR and systemic racism: Examining inequities faced by BIPOC communities in Canadian health care

Understanding the sexual and reproductive health (SRH) experiences and outcomes of Black, Indigenous and People of Color (BIPOC) communities in Canada requires a deep examination of intersecting factors rooted in oppressive colonial policies and institutional structures. Reproductive Justice, as outlined by various scholars and organizations, emphasizes the importance of considering multiple intersecting factors such as class, race, gender, sexuality, and access to healthcare in shaping individuals’ reproductive experiences. Elizabeth McGibbon, a Canadian scholar, underscores how intersectionality and existing systemic power structures contribute to poor health outcomes for BIPOC communities by linking racism to social determinants of health.

Despite established literature highlighting negative SRHR experiences among BIPOC women, systemic racism continues to pervade healthcare institutions. This leads to inadequate awareness, discrimination, and implicit biases among healthcare providers. Implicit biases, defined as unconscious and uncontrollable associations influencing thoughts and actions, contribute to disparities in healthcare delivery. For instance, racial implicit biases among healthcare professionals can result in the dismissal or inappropriate treatment of patients from specific racial groups, exacerbating SRHR inequities.

Recent studies  in Canada have identified recurring instances of racism experienced by racialized populations seeking and receiving healthcare , leading to feelings of discrimination and dehumanization. Shocking examples of medical racism, such as the case of Joyce Echaquan, highlight the dire consequences of systemic biases within the healthcare system. Black and Indigenous women in Canada, in particular, have historically faced mistreatment, neglect, and discrimination in their SRHR experiences, resulting in poor health outcomes.

The relationship between Black women and the healthcare system in Canada is complex, characterized by a history of racism and medical experimentation, leading to mistrust and negative SRHR experiences. Similarly, Indigenous women continue to experience reproductive injustice, including coerced sterilizations and limited access to SRHR services. Federally incarcerated women, a significant and over-represented portion of whom are Indigenous, also face unconstitutional barriers to SRHR services, perpetuating intergenerational trauma and health disparities.

Addressing these systemic failures requires anti-racist policies that go beyond cultural competence training and acknowledge the role of unequal power dynamics and everyday racism in healthcare. A Reproductive Justice Framework, initiated and informed by women of color, provides a comprehensive approach to addressing disparities in SRHR by considering intersecting oppressions and advocating for resources and social justice. Healthcare providers must also recognize the historical and ongoing impacts of colonization, racism, and social exclusion on the health status of Indigenous populations  in Canada.

Building trust in the Canadian healthcare system among BIPOC communities necessitates culturally appropriate healthcare delivery and programs addressing socioeconomic determinants affecting SRHR. Increasing the representation of Indigenous, Black, and racialized healthcare professionals in SRHR studies and healthcare roles is crucial for advancing equitable SRHR outcomes for BIPOC communities. These individuals can drive meaningful change within the healthcare system, ensuring that all patients receive respectful, inclusive and equitable SRHR care.

Trust in the Canadian healthcare system hinges upon several crucial factors. These include ensuring healthcare providers are well-informed, delivering culturally appropriate care and implementing prioritized programs aimed at addressing socioeconomic determinants affecting sexual and reproductive health and rights. Recognizing the historical contexts of slavery for Black womxn, colonialism of Indigenous womxn, and ongoing racism for Indigenous, Black, and People of Color womxn, along with their intersections with social determinants of health, is paramount in understanding the inequities leading to poor SRHR outcomes. 

To advance reproductive health studies effectively, it is imperative to increase representation of Indigenous, Black, and racialized midwives, nurses, physicians, and researchers who comprehend the potential health impacts of systemic racism on individual and population-level health outcomes. By advocating for change within and across the healthcare system, they can champion equitable SRHR for BIPOC communities, thus fostering greater trust in the Canadian healthcare system.

About the author:
Leisha Toory is the founder of the Period Priority Project, the Sexual and Reproductive Health and Rights Director with the Young Canadians Roundtable on Health, and an Honors in Political Science undergraduate at the University of Ottawa.