Dorothy Roberts and the Reproductive Truths Medicine Must Confront

How a legal scholar reshaped our understanding of race, power, and the ethics of reproductive care.

Dorothy Roberts, born in 1956, is an American legal scholar, sociologist, and ethicist whose work has transformed the way we think about reproduction, race, and state power. She is best known for her books Killing the Black Body, Shattered Bonds, and Torn Apart, which expose how medical, legal, and social systems regulate and punish the reproduction of marginalized women. Roberts has become one of the most influential voices in reproductive justice. Her central claim is that reproductive freedom is not only about individual choice. It is also about dismantling the structures that control whose pregnancies are valued and whose are treated as risky, irresponsible, or unworthy. Her insights challenge obstetrics to examine its own assumptions and to confront the systemic inequities embedded within modern maternal care.

1. The Myth of Neutral Medicine

Roberts argues that medicine often presents itself as objective while operating within racialized and gendered assumptions. In obstetrics, this appears when Black women’s pain is underestimated, when their symptoms are dismissed, or when their bodies are described as riskier without considering the role of social conditions. Roberts teaches that disparities are not biological facts. They are consequences of unequal treatment, environmental exposure, economic conditions, and institutional bias. She compels clinicians to question the assumption that outcomes reflect intrinsic maternal traits rather than the structures surrounding care. Obstetrics cannot improve disparities if it begins with the wrong explanations.

2. Reproductive Autonomy as a Social Right

For Roberts, reproductive autonomy requires more than formal legal protection. It requires the conditions that make pregnancy safe and desired. She argues that many women do not control their reproductive lives because poverty, surveillance, and systemic racism limit their choices. Obstetrics often encounters the downstream effects of these barriers. Women may delay prenatal care because they fear judgment. They may avoid hospitals because past encounters were disrespectful. Roberts’s perspective expands the clinician’s ethical horizon. Supporting autonomy means understanding the real social constraints women face. It means recognizing that freedom is impaired when systems punish rather than support pregnant women.

3. The Punitive Gaze on Pregnant Women

Roberts documents how the United States has increasingly criminalized pregnancy, especially among poor women and women of color. Cases involving substance use in pregnancy illustrate this pattern. Instead of receiving treatment, many women face incarceration, child removal, or mandatory reporting. Obstetrics exists within this punitive environment. Clinicians must navigate the tension between public health responsibilities and the risk of contributing to surveillance. Roberts urges clinicians to understand that punitive responses worsen outcomes, drive women away from care, and perpetuate trauma. The ethical imperative is to treat pregnant women as patients, not suspects.

4. The Historical Roots of Modern Disparities

Roberts highlights how contemporary inequities are tied to a long history of reproductive control, from slavery to forced sterilization to discriminatory welfare policies. These histories influence how women interpret modern medical encounters. A woman who hesitates to trust a physician may not be responding only to the present. She may be carrying generational memory of exploitation. Obstetricians often see themselves outside of this history, but Roberts insists that history shapes perception and experience. Understanding this lineage helps clinicians respond with humility rather than defensiveness. It also reinforces that trust must be intentionally cultivated.

5. The Family Policing System and Its Obstetric Implications

Roberts describes the child welfare system as a “family policing system” that disproportionately targets Black and low income mothers. Obstetricians intersect with this system when they report concerns to child protection agencies. Roberts challenges clinicians to distinguish between risk and poverty, between neglect and lack of resources. Many referrals arise not from true danger but from systemic inequities. Clinicians must ensure that reporting is based on genuine harm, not on assumptions rooted in bias. Her work pushes obstetrics to consider how referral patterns may replicate broader injustices and to advocate for supportive services rather than punitive interventions.

6. Reframing Maternal Mortality Through Structural Analysis

Roberts’s framework offers clarity on the United States maternal mortality crisis. She argues that the disparities are not mysterious. They arise from structural racism that affects where women live, how they are treated, and whether their concerns are believed. When Black women report feeling ignored during labor, they reflect the same systemic patterns Roberts describes in legal contexts. Obstetrics must shift from individual-level explanations to structural ones. This reframing helps identify solutions that address communication practices, bias training, staffing ratios, and access to high quality care rather than focusing on presumed biological differences.

7. Ethical Care as Social Transformation

Roberts teaches that ethical practice must extend beyond the clinical encounter. Clinicians have a role in transforming the systems that harm the women they serve. This does not require political activism in the traditional sense. It requires acknowledging the social realities that shape pregnancy and advocating for institutional reforms that improve safety, dignity, and trust. Obstetricians who listen more carefully, challenge biased assumptions, and promote equitable policies advance reproductive justice through everyday actions. Roberts’s thinking challenges clinicians to see themselves as agents of change within a broader moral landscape.

Reflection

Dorothy Roberts reminds obstetrics that caring for pregnant women means caring about the systems that govern their lives. She exposes how power operates quietly within clinical routines and how reproductive freedom is shaped by forces far beyond the clinic walls. Her work presses clinicians to examine not only what they do but the assumptions underlying each decision. The question she leaves us is simple. Does obstetric care reinforce inequity or actively dismantle it. Answering that question honestly is part of the responsibility the profession must embrace.