Racism in contraceptive care: ‘that trust barrier is really hard to build back up, rightfully so’

Research has shown that Black and Latinx patients in the USA have poorer outcomes in sexual and reproductive health due to systemic racism. While the harm against Black and Latinx communities has been documented, gaps exist in understanding how modern racial dynamics in contraceptive care perpetuate inequity. The objective of this study was to assess how racism manifests in contraceptive care by exploring healthcare providers' experiences of racism and discrimination. Between August 2022 to August 2024, we conducted in-depth interviews with 41 providers delivering contraceptive care across the USA. We engaged in a thematic analysis drawing upon Public Health Critical Race Praxis. We found several providers were able to recognise racism in healthcare, but there were mixed findings regarding their own race consciousness and cultural humility amidst systemic inaction. Providers described evidence among their colleagues of obstetric harms through informed consent violations, medical concealment, and paternalism. Providers also displayed prejudiced beliefs by attributing their patients' sexual behaviours and contraceptive decision making to race. Contemporary racism in contraceptive care is perpetuated by both healthcare providers and the systems they work within. While some providers exemplified anti-racism, our results largely reveal the complicity of healthcare professionals in perpetuating systemic racial injustice.