Three Scenarios

In November 2015, the International Federation of Gynecology and Obstetrics (FIGO) issued a statement and immediate call to action on environmental justice, summarized in the following abstract:

Exposure to toxic environmental chemicals during pregnancy and breastfeeding is ubiquitous and is a threat to healthy human reproduction. There are tens of thousands of chemicals in global commerce, and even small exposures to toxic chemicals during pregnancy can trigger adverse health consequences. Exposure to toxic environmental chemicals and related health outcomes are inequitably distributed within and between countries; universally, the consequences of exposure are disproportionately borne by people with low incomes. Discrimination, other social factors, economic factors, and occupation impact risk of exposure and harm. Documented links between prenatal exposure to environmental chemicals and adverse health outcomes span the life course and include impacts on fertility and pregnancy, neurodevelopment, and cancer. The global health and economic burden related to toxic environmental chemicals is in excess of millions of deaths and billions of dollars every year. On the basis of accumulating robust evidence of exposures and adverse health impacts related to toxic environmental chemicals, the International Federation of Gynecology and Obstetrics (FIGO) joins other leading reproductive health professional societies in calling for timely action to prevent harm. FIGO recommends that reproductive and other health professionals advocate for policies to prevent exposure to toxic environmental chemicals, work to ensure a healthy food system for all, make environmental health part of health care, and champion environmental justice.

The American College of Obstetricians and Gynecologists issued a Committee Opinion containing similar statements two years prior.

Both statements expound upon the environmental factors threatening reproductive health and explain the role social, economic, and occupational factors play in determining an individual’s risk of exposure to toxic environmental chemicals and in turn to reproductive harm.

In recent years, Appalachia has seen a surge in the most severe form of black lung . The disease causes chronic shortness of breath and can result in death. As a result, affected individuals (often young men who are the primary breadwinners for their families) may suffer ailments so severe they cannot work and that require high levels of care and medical attention.

Tuesday, the CDC confirmed the first sexually-transmitted case of Zika virus on U.S. soil in Dallas, TX and dozens of U.S. citizens have contracted the disease by mosquito bite while traveling. Zika is suspected to be responsible for microcephaly in over 4,000 infants across the Americas so far. Concern about the virus has caused U.S. officials to recommend pregnant women not travel to countries where Zika is of high concern, and El Salvador has issued a statement that the country’s women should not get pregnant for the next two years.

Applying a Reproductive Justice Lens to Environmental Concerns and Applying an Environmental Justice Lens to Reproductive Rights

The above scenarios are just three examples demonstrating the intersection of environmental justice and reproductive justice. They demonstrate the unique way our environment impacts our reproductive health and the impact that has on our ability to plan and provide for our families. They demonstrate the way an individual’s ability to exercise their reproductive rights and gain access to reproductive healthcare can contribute to how successfully that individual navigates the environmental concerns they may be facing. They also demonstrate the way economic and social factors impact an individual’s exposure to harm and access to justice.

Looking at environmental concerns through a reproductive justice lens (and looking at reproductive concerns through an environmental justice lens) can help attorneys articulate needs that might otherwise go unaddressed and unnoticed in conversations about legal concerns and potentially available remedies.

Take for example, the mineworker suffering from black lung. He has government benefits systems to navigate as well as a host of legal concerns. As an attorney, applying a reproductive justice lens to his case might mean being aware of the needs of his family and the injury they have suffered as the result of their father’s and husband’s injury. It might mean asking pointed questions about children in the household and ways they may have been exposed to toxins brought home on their father’s clothes, hair, and skin from his place of work. It might mean making a family feel comfortable to talk about issues of infertility and miscarriage that might not immediately come to mind when talking to a mineworker about the harm he has suffered.

Unfortunately the Zika virus easily provides a number of examples of how these fields intersect and what legal concerns might be at issue. Let’s take a woman who has recently begun a new job, her benefits have yet to begin, she is not yet eligible for maternity leave, and her job requires significant travel to developing nations. She may be concerned about her legal rights to refuse to travel or disclosing her pregnancy to her employer. Or let’s take a woman whose boyfriend recently moved from El Salvador; she is on Medicaid and 23 weeks pregnant; she contracts Zika through him. What are her options given her Medicaid status and the stage of her pregnancy? What are her options if she is also in this country without the requisite documentation? Similar questions arise for a woman who discovers she has been exposed to extremely elevated lead levels (or any number of other environmental toxins) throughout her pregnancy.

As another example, lets take a group of midwives in a state that does not provide a licensing system for their professional work. Reading FIGO’s statement on the urgency of addressing the environmental factors affecting pregnant and breastfeeding women, they might respond with an understanding that these are issues already at the heart of their practice. Perhaps they provide weekly guidance to clients regarding their eating habits, guiding them on how to eat organic on a budget, educating them on potential environmental toxin exposure pathways, even conducting home visits where they make note of potential risk factors in the home. Attending only to births in the home, these midwives notice their clients have significantly lower rates of hospital intervention, thereby reducing exposure to particular environmental risks more likely to be present in a hospital setting. Comparing themselves to a hospital’s gynecologic and obstetric care, they feel the services they provide are important in the education and attention required to reduce pregnant and breastfeeding women’s exposure to environmental harm. However, they also find their services prohibitively expensive for many individuals because they cannot currently take insurance and are not currently covered by Medicaid in their state. Thus, they feel their care continues a cycle of environmental injustice. They might seek assistance in navigating insurance systems, arguing for Medicaid coverage, organizing as a formal advocacy group, or proposing or advocating for particular regulatory or licensing systems.

Why this matters

A fellow attorney once told me that what I am saying boils down to “nothing happens in a vacuum.” However, I think working at the intersection of environmental and reproductive justice means much more than that. As an attorney committed to serving modest-means clients and an attorney committed to addressing the environmental legal concerns of women and families in particular, using these lenses to tackle a legal problem brings unique counseling and fact-gathering skills and provides an opportunity for novel approaches to legal action. If you are interested in the subject matter or have legal concerns that you think might benefit from this perspective, I can be contacted by email at: mhunter@fairshake-els.org.