Navigating fetal conditions through a Reproductive Justice lens: lessons from composite cases in the United States

Every day, pregnant people get the news that the futures they imagined for their families are at risk due to a fetal condition. It may be something relatively minor, like a small benign growth on a lung, or something major, like a life-threatening heart or developmental problem. These fetal conditions sit at the intersection of maternity care, high-risk pregnancy services, fetal therapy, family planning, pediatric specialty care, community supports, insurance structures, and policy environments. Despite the profound inequities embedded in these systems, Reproductive Justice has rarely been applied to this area of care. A Reproductive Justice lens centers bodily autonomy, the right to have children, the right not to have children, and the right to parent in safe and sustainable communities. Applying this lens can clarify how structural power shapes the experiences of those navigating fetal conditions. This Comment uses four composite cases from the United States to highlight how restrictive abortion policies, ableist assumptions, limited access to perinatal palliative care, and exclusion from specialized maternal-fetal interventions influence care and outcomes. These examples underscore that the challenges individuals and families face are not isolated clinical issues, but predictable outcomes of systems built around idealized patient profiles and shaped by racism, classism, ableism, and geographic and economic inequities. Viewing fetal conditions through a Reproductive Justice lens reveals the structural forces that constrain autonomy, narrow options, and produce inequitable outcomes. Centering Reproductive Justice in this context can help reduce harm, deepen attunement to patients’ lived realities, and support meaningful reproductive agency throughout the course of care.