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Discussing reproductive justice with attorney and advocate Stephanie Kraft Sheley

Published on January 7, 2021

The following is a transcript of an episode of From the Front Row: Student Voices in Public Health, the University of Iowa College of Public Health’s student podcast. Alex and Steve talk about the issues surrounding reproductive justice with attorney, advocate, and University of Iowa alumna Stephanie Kraft Sheley (16JD/MHA). They touch on the maternal mortality crisis, reproductive rights, abortion, and issues of race and poverty.

Steve Sonnier:

Hi all, this is Steve jumping in briefly before our episode starts. This episode about reproductive justice includes discussions about heavy subjects, including maternal mortality crisis and abortion. If you feel at any time you need support, please contact your local crisis center.

Alex Murra:

Hello everyone, welcome back to From the Front Row brought to you by the University of Iowa College of Public Health. My name is Alex Murra, and I’m joined by Steve Sonnier. And if this is your first time with us, welcome. We are a student run podcast that talks about major issues in public health and how they are relevant to anyone, both in and out of the field of public health.

Alex Murra:

Today, we’ll be chatting with Stephanie Kraft Sheley, an attorney and advocate for reproductive justice in Missouri and Illinois. As a consultant for Cambridge Reproductive Health Consultants, she focuses on developing full spectrum legal and practical supports for young pregnant people. She earned her JD and MHA from the University of Iowa. Welcome to the show, Stephanie.

Stephanie Sheley:

Hi, thank you for having me.

Steve Sonnier:

To start us off, how is reproductive justice different from reproductive rights? The two areas sound very similar, but I imagine that there’s some nuance there when you’re going about it.

Stephanie Sheley:

Yeah, so reproductive rights is really concerned with the legal right to abortion and contraception and it’s really more confined to those issues, whereas reproductive justice is a framework that’s been created and championed by black women that really focuses more on the rights to have or not have children and to parent the children that you have in a safe and healthy environment. And so that does encompass the legal right to abortion and to contraception, but it also acknowledges the unique reproductive oppressions that are visited upon particularly communities of color and poor people. And also the social and economic factors, in addition to the legal factors that are involved.

Steve Sonnier:

Can you talk more real quick about the oppression side of things in there? What dimensions does that kind of take on when you’re looking at the issues as a whole?

Stephanie Sheley:

So when you’re talking about reproductive oppression, there has been a lot of attention paid to the ways in which the right to abortion has been restricted, and it has. It’s been heavily restricted in many states. For example, in the state that I work in, in Missouri, there’s one abortion clinic in the entire state. And there are many additional restrictions that make it very difficult to access abortion.

Stephanie Sheley:

But beyond abortion, there is a long history in this country of people facing barriers to actually having children. There have been examples of forced sterilizations and pushes to prevent people in certain communities from becoming pregnant at all. And then there have been numerous really broad ways in which parenting children and raising them to adulthood is made unsafe for people. I mean, we can look at that through the lens of where people’s neighborhoods are located and the unsafe environment that might be involved there. And then also around police brutality and parents fearing that their children can be hurt or killed just going about their business in the world.

Stephanie Sheley:

So it’s very broad and it also encompasses the healthcare needs that people have, certainly. And of course there’s a staggering maternal mortality crisis in this country that falls tremendously disproportionately on black women and black people giving birth, but it’s much broader than that. It’s looking at someone’s entire reproductive life.

Alex Murra:

So this kind of ties into what we have been talking about with black maternal health. Recently, we discussed a black women’s maternal health conference that was held in Iowa. How does your work intersect with the choices that are made during pregnancy, any reproductive needs and any issues of significant risk?

Stephanie Sheley:

Yeah, so my work kind of intersects in every way with those issues. Part of my work is around abortion and the right to access that care. And like I said, access in various parts of the country is super, super difficult. But then I also work around birth justice and birth rights. And so that’s helping people understand that they have the right to bodily autonomy, that they have the right as the legal authority over their pregnancy and their body to make decisions about what happens to them during their pregnancy and during birth, what type of birth attendant or provider they would like to see, what their birth setting might be, what interventions they want or don’t want, which can include C-sections, labor augmentation, epidurals, different pain management techniques. All of these things that if you really get to understand more about how obstetrical care and prenatal and birth care is delivered, aren’t really always framed as choices in the healthcare context when you’re actually there in labor.

Stephanie Sheley:

And so a lot of my work is just helping people understand that they actually are in the position to make the decisions. And it’s the doctor that works for them and not the other way around, if they choose to have a doctor and not a different type of birth attendant.

Stephanie Sheley:

And then if there is a harm that happens, if there’s mistreatment during birth, if there’s a forced or coerced intervention or an act of what we call obstetric violence, which would be a forced C-section or something, that they do have the right to complain. And that there are mechanisms that exist and we’re working to strengthen so that people can work through the healthcare system and also through the legal system to get justice for that harm and prevent it from happening again.

Stephanie Sheley:

And I would say that those two issues of abortion and birth justice cannot be disentangled from one another. Because of the really challenging maternal landscape where people are dying at really unacceptable rates in childbirth, abortion has to be available as an option. It’s not acceptable that someone wouldn’t be able to end a pregnancy and then we would force them into a system where they could be facing preventable harm or death. And that particularly needs to be said about the risks that black people and people of color are facing.

Stephanie Sheley:

And the other area that this really comes up is that because abortion is so difficult to access, people have turned to self-management, which is they obtain pills that are the same bills that they would obtain from a physician, but they obtain them outside of the formal healthcare system. They take those pills and largely that’s done safely and in privacy, but there are times where there are complications and people need to seek health care from likely emergency rooms or urgent cares. And they’re exhibiting bleeding and things like that that need to be addressed.

Stephanie Sheley:

When that happens, we have seen that if you are poor or you are a person of color, you are much more likely for the healthcare system to flag you for criminal enforcement. So we’ve seen doctors and healthcare providers in the emergency room actually calling the police on their patients and allowing the police to take them away under the often mistaken belief that a crime has been committed. And a lot of times the legal situation does sort itself out. Sometimes it doesn’t, but not before that person has been mistreated by their healthcare providers, taken to jail, possibly their picture has been printed in the paper and details about their circumstances have been put out there.

Stephanie Sheley:

And so it’s really important for the healthcare community to understand why people are doing this, that it isn’t some criminal act so much as it’s an evidence of a really deep healthcare need, and that issues of race and issues of poverty are very much intersecting here.

Steve Sonnier:

I really appreciate the notion of the understanding the difficulties that go into obstetric care. When we recently had our kiddo, one of the things I felt really empowered by was one of our practitioners saying, if you don’t like how someone in the room is behaving you can say, “I don’t want you to be here for attending on my care.” And I really appreciated that because it’s such a difficult, strenuous situation. Labor is a very trying time, and so I want to hear more about that when that. When you’re looking at that situation where you’re trying to educate these folks from an MHA and a JD perspective coming into this, how does that look when you’re trying to communicate that this situation might not be as ideal as you pictured when you first go into it?

Stephanie Sheley:

I don’t have a really wonderful answer for this. And it’s because it’s so challenging. But I mean, I will share. You shared a little bit of your personal story and I’ll share a little of mine.

Stephanie Sheley:

I am the parent of twins, one of which was breached right up until delivery. And I faced a situation where late in my pregnancy, my provider changed her position about whether she would be willing to attend an attempt at a vaginal delivery versus a C-section. And I live in a large metro area, and yet I spent literally weeks calling and trying to navigate my network to try to find a provider who would do this. And I had in hand all of the guidelines from the American College of Obstetricians and Gynecologists and all of the data that showed that my situation was highly appropriate, but I could not find a provider who was comfortable or willing to provide this care.

Stephanie Sheley:

And I have to say that I sat there and I just had to reflect on the fact that with my education and my deep experience in this area and all of my connections, I was yet struggling to find this because I was in a situation that required being in the hospital. It really would not have been safe to forego hospital care. And what was that going to look like if I showed up? And what kind of fight were are we going to have over my birth in the middle of labor?

Stephanie Sheley:

And luckily I was able to find a provider and I was able to accomplish my goal of delivering my baby, including a breech second baby, but it’s super challenging. It’s one thing to tell people that you have the right, and it’s another thing to help them practically get access.

Stephanie Sheley:

So one of the things that’s really important is to build up the knowledge base among providers and to build up alternatives for people. If they’re wanting to have out of hospital birth or lower intervention birth, where are those providers that can help them do that safely? And in a lot of communities, they aren’t there. And so it’s really thinking about how we can invest in that and making sure that the full range of choices is available for people and that people have an alternative to the super hyper medicalized birth.

Steve Sonnier:

I think this is a really good thing to hit on too, is that folks have that choice but they’re not always informed about it. And so figuring out the supports is really, really critical. And I really appreciate you sharing your experiences too, as well. Because it does show the variety of things that can happen unexpectedly when it comes to something as important as going through labor, going through this very critical experience that is life defining, I would say. Did these experiences that you had in your own birth experience as it were, did that help catalyze your interest in going into this practice area of reproductive justice? Or was that already kind of a path that you were exploring as a whole?

Stephanie Sheley:

That was a path that I was already very much on. That started during my JD MHA education and I had been really focused on becoming a healthcare attorney and working inside of a hospital. And I spent a couple of summers doing that, working in a hospital legal department. And I just saw the ways in which corporate healthcare and my job as an attorney would be to mitigate corporate risks and maximize corporate gain. And that being the superseding goal over top of really providing healthcare benefit to the community.

Stephanie Sheley:

And I mean, we commonly frame this as this notion of no margin, no mission. The corporation has to come first. And I mean, this is the reality we live in. We deliver health care via corporations in this country. And that’s the truth, but it wasn’t really the helping career that I had envisioned going into. So I was kind of thinking through what my next steps were when I got really interested in these ideas around the beginnings and ends of life and bodily autonomy and informed decision making. And how those medical and legal concepts are super clear until you get to this muddled area of beginnings or potential beginnings of life.

Stephanie Sheley:

And so through that exploration, I just became more aware of abortion restrictions and just the practical barriers in the way of people getting access and how super common it is. I mean, one in four women, and I say that with an asterisk, because of course, people of different gender identities can become pregnant. But this is how the statistics are relayed. So one in four women has an abortion throughout their reproductive life. And the majority of those people that have abortions are already parents. And so it just became super interesting to me that there was this kind of whole thing that I hadn’t even been exposed to in my healthcare education going on.

Stephanie Sheley:

And I was like, “This is where I need to be. This reproductive rights thing is what I need to be doing.” And then I got an offer to do an internship with National Advocates for Pregnant Women. And that’s where I got my education in reproductive justice because that organization focuses really broadly on the different ways that people are oppressed through pregnancy, are criminalized for pregnancy outcomes or are forced into unwanted interventions.

Stephanie Sheley:

And I mean, even to the extent of one of the cases I worked on, the person had gotten in a car accident while pregnant and there was an allegation that maybe that person was the cause of the accident, or maybe she hadn’t been wearing her seatbelt. And maybe that contributed to the demise of her baby. And this was a wanted pregnancy that she was very excited about. And so just got just really excited about this kind of whole world where that is often overlooked, I guess, in healthcare.

Alex Murra:

I think it’s really interesting that you talked about how you started learning about reproductive justice. I think as a student myself, and there’s other people that I know who are interested in maternal child health issues, you may not know a lot coming into your public health education. And for people outside who are trying to learn about reproductive justice or abortion rights, one of your ways of communicating this was through your piece in [Comics for Choice 00:00:15:26]. What was the impetus for helping with that, your creative background and what was your aim and developing your specific comic?

Stephanie Sheley:

Myself. I love graphic novels and I was drawing a lot at the time. I had time for that back then. And also I have to say my identical twin sister is a professional artist. So there’s that in our DNA as well. So I’ve always had this little kind of creative side, but Comics for Choice is it’s an anthology of comics about abortion. And it’s coming from people talking about their personal stories, experts in the field. Some of them were paired up with professional artists that drew the comic. I actually wrote and drew my own and that’s why it’s probably one of the least professional looking ones in the anthology.

Stephanie Sheley:

But it talks about just this segregation of abortion from mainstream healthcare and why and how that’s happened. It kind of goes into the rise of the Catholic healthcare institution and in the ways that that intersects with abortion and reproductive health care and other reasons why there has been a move away from including abortion among the range of reproductive healthcare offerings of just mainstream healthcare clinics. And kind of siloed into free standing special clinics and service providers, and the harms that that can cause. And also a little bit of the benefits, because there’s also been a movement among some to say that we shouldn’t be hyper medicalizing that process either. And much like there’s a place for midwifery and out of hospital birth, there’s a place for out of hospital and out of formal healthcare system abortion.

Steve Sonnier:

When you’re talking about the hyper medicalization side of things, I think it’s really important to hit on because a lot of our training, at least in the JD MHA side of things too, definitely focuses on understanding the intricacies of the health administration system and how that operates as a whole. You touched on it a little bit earlier, but it kind of want to go back to that idea of when you’re at the College of Public Health and exploring these ideas, was there something instrumental that changed your focus to go into this area specifically? Were there skills that you got along the way that you said, “Oh my goodness, this is what everyone should be focusing on. This is the elephant in the room and we’re not paying attention to it right now.”

Stephanie Sheley:

Yeah. So, I mean, there’s no doubt that I got just a tremendous education that I use in my everyday practice and work from the College of Public Health. I mean, just learning about healthcare systems, how they operate, how healthcare is financed and delivered and all of those things that really do come up when I’m trying to think through how can you help a person navigate through the system and get what they need out of it. It’s been super helpful.

Stephanie Sheley:

And I will also say there were some challenges that I faced at the college that particularly in the Master of Healthcare Administration program that’s very focused on the business side and the leadership side, that really have informed my work, but weren’t necessarily in the curriculum.

Stephanie Sheley:

So one of the first things is that we talked a lot about healthcare disparities and equity, but we also know that making sure that people of color are in leadership positions is one of the ways to address that. And yet when I looked around, I was not being trained alongside a diverse group of people. And so thinking about who was in the pipeline and how we do know these things, but we don’t always for complicated reasons live up to those values or are able to do the things we know need to be done to get where we need to go and achieve better equity.

Stephanie Sheley:

So that was something that I just kind of had to wrestle with while I was there. I had a couple experiences there. First of all, my experience trying to talk about reproductive rights and reproductive justice within the MHA curriculum was very, very mixed. I mean, saying the word abortion out loud often sent a chill around the room. People were very, very uncomfortable with this idea or kind of wanted to get into a debate over the political controversy or the morality and their personal views on it. And I think it’s really important that we acknowledge it as a healthcare reality. And it doesn’t really even need to be a conversation about our personal feelings about it, because it’s a reality for the communities that are seeking healthcare.

Stephanie Sheley:

And so that was kind of something that I had to also grapple with because I realized I’m not getting educated in this, nor are my classmates, who are going to go on to more traditional roles and be in leadership positions, getting educated on this in a way that really informs them about the community that they’re serving.

Stephanie Sheley:

And actually, I think kind of the greatest extent of this was I was in the room listening in one of my classes while two officials at UIHC describe the steps that they would take if there was a person who was in labor and resisting a C-section that was being offered and the physician thought was medically necessary. And their kind of framework for that included going so far as calling the police and calling the district attorney and kind of talking through, “Well, what would it look like if the police came in and held the person down while the surgery was performed?” And I mean, that is a description of a human rights violation. And that was somehow unclear to the people in the room.

Stephanie Sheley:

And through those experiences, I sat back and I said, “Wow, this is so real. We have so much work to do here. The problem is very close to home.” And that’s not to say that that’s actually how that scenario would have played out. It was more of a description of a thorny problem that they thought might occur and the farthest end that it might lead to. But that was the conversation. And so that made me say, “Okay, so this is what people are up against when they go to seek reproductive health care.” The very well-regarded program and very well-regarded people are still unclear about whether or not this is how we should approach these issues. So that also informed in a real way, just kind of the way that I’ve approached this problem and understanding healthcare administration and leadership views these issues.

Alex Murra:

I really appreciate you sharing some of maybe just even your struggles with realizing that the system is stacked against a lot of women. And I think there’s a lot of listeners too that are hearing all these stories, there’s these issues of systemic racism in health care that are coming up and they’re wondering how they can actually help out. How can they become an advocate for reproductive justice? And how would you suggest that our listeners could get involved and actually make a difference?

Stephanie Sheley:

I think first and foremost is uplifting black leaders, funding black work, funding black education and initiatives in the community. That just has to be number one. We already know that communities have the answer to the issues that exist for them. And I think making sure that we’re supporting and listening to black women and black leaders on these issues is what we need to do and just really amplify that. I mean, I just can’t say that enough.

Stephanie Sheley:

And then I would say number two is look at the kind of anti-racism and reproductive justice lens you might bring to the work you’re already doing. Chances are, you have people listening here who are involved in creating and implementing policies that do affect how people can have children, not have children or raise children safely. That’s a pretty broad issue and I think that there are often ways we can see that we’re doing things that can either help or harm. So make sure you’re helping.

Stephanie Sheley:

I would also say donate to an abortion fund or practical support fund. Lots of people do not have insurance coverage and need to travel great distances, pay for lodging, childcare, all of these things just to access this basic bit of healthcare. And so you can go to the National Network of Abortion Funds and you can find a local fund and you can really make a difference in someone’s life by just making sure they can get that care.

Stephanie Sheley:

The other thing I would say is start saying abortion out loud and talk about it, about what it is, which is healthcare and not an optional topic if you’re going to be delivering healthcare, particularly maternal healthcare.

Steve Sonnier:

I think those are all really good points. And it’s a very, I think, difficult conversation for walks to have, but it’s a very necessary one in healthcare. It’s a public health issue at the forefront of a lot of folks’ lives and it’s something that’s not going to disappear overnight or anything along those lines. This is a reality that a lot of folks need to have assistance with and have empathy and compassion when we’re navigating something like this.

Steve Sonnier:

When you’re talking about these issues and reflecting on them, is there something that sticks out to you that you within your career want to solve or do something that you could really make your mark on the field with?

Stephanie Sheley:

I don’t know what the public knows about this. I suspect it’s not enough, but I mean the greatest crisis is the black maternal mortality crisis. There is no question about that. People, families, communities are losing loved ones from preventable causes. And so that is where the biggest crisis is. I can’t sit here and say that I feel like that’s where I will have made my mark necessarily, or take any responsibility for the solving of that. If I had a magic wand, that is the first problem that I would go after, but I will always advocate for policies that enhance maternal safety and maternal health, and that are particularly focused around the black community. And just knowing that racism is literally killing people, particularly people trying to give birth.

Stephanie Sheley:

And also to that end, I would continue to advocate for abortion access because like I said, it’s the height of cruelty to force someone to remain pregnant and then force them into a system that might kill them. So making sure that that remains a safe option for people is the other really pressing issue.

Alex Murra:

One question kind of just to wrap everything up that we like to ask people is, what’s one thing that you thought you knew, but were later wrong about?

Stephanie Sheley:

I’ve thought a lot about this and I’ve done a lot of learning and growing over time. So it’s hard to actually in this field think of one particular thing. But one thing that I’ve been sitting with a lot lately is issues around young parenthood. I think that, well, I should back up and say that I work a lot around youth and pregnancy. I’m actually developing a text line for young people in Missouri to access not only abortion care, but if they’re seeking access to birth or parenting support, adoption, any of those things to make sure that they have that access. So that’s kind of what I’m sitting with right now.

Stephanie Sheley:

And I realized along the way that I’ve had this kind of bias, I guess, in the back of my mind around young parenthood and thinking, because I do represent young people in court who are seeking to terminate pregnancies without involving their parents in that process for lots of really complicated reasons. I’ve kind of developed the sense that for the majority of young people, it probably is the best thing for their life that they have access to abortion because it might ruin their life if they don’t.

Stephanie Sheley:

But with my work, as it has evolved, I’ve had to really realize that it’s much more complicated than that. And actually young people, given the right support, does not ruin their life. It’s just another in the range of valid choices. And so if you legitimize that, it actually in no way needs to make their life worse or make their children less well off. And so that’s just been a real evolution for me and I think that’s something that is culturally a challenge for us to get our minds around, but it is something that we need to continue to just think about as we kind of evolve and progress.

Steve Sonnier:

And those are all very good points, especially giving folks the support. And I think that’s what it comes back to, is this idea of we want to look out for our fellow person. We want to do right by other folks and your efforts are clearly doing so, developing these supports, focusing on reproductive justice, helping out folks who need it in their time of need. It sounds like an amazing career and I’m so glad that you got to come on the podcast today and chat with us about it. It’s been really insightful.

Stephanie Sheley:

Well thank you so much again for having me.

Steve Sonnier:

That’s it for this week’s episode of From the Front Row. Huge, thanks to our guest, Stephanie Kraft Sheley, for coming on today. This episode was hosted and written by Steve Sonnier and Alex Murra. This episode was edited and produced by Steve Sonnier. You could find more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts and SoundCloud as the University of Iowa College of Public Health.

Steve Sonnier:

If you enjoyed this episode, please share it with your colleagues. Our team can be reached at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Keep on keeping on out there, and here’s to 2021.