Everyone is impacted by environmental toxicity and global warming, albeit to vastly different degrees. From the air we breathe, to the products we use, to weather extremes such as heavy rain or harsh drought, we are constantly impacted by an increasingly changing climate and polluted environment. Current environmental inequities are driven by legacies of colonialism and racial capitalism - a term coined by Cedric Robinson in 1983 to describe the interconnected and reiterating nature of racial hierarchy and the accumulation of global capital.1, 2, 3 Decades of activism and research have documented the disproportionate impacts of both environmental harm on BIPOC (Black, Indigenous, and people of color) communities and low-income individuals, the consequences of which include adverse health outcomes.4 Advocacy efforts such as the environmental justice movement and the reproductive justice movement have arisen in response to these disparities. Although both movements address fundamentally different social justice issues, they were both founded by Black community leaders, share core values of justice, and place an emphasis on intersectionality - the consideration of how individuals possess multiple marginalized identities, which can lead to overlapping forms of discrimination.5 The term reproductive justice was coined in 1994 by members of a Black feminist caucus, who wanted to expand the pro-choice movement beyond the right to abortion and include the rights of individuals to have children and raise them in a safe and healthy environment.6,7 Similarly, the environmental justice movement has its roots in Black activist projects: originally conceptualized as environmental racism, legal scholars such as Dr. Robert Bullard observed clear disparities in environmental quality and urban planning for Black communities when compared to their white counterparts. Eventually the environmental justice movement expanded to address intersectional discrimination, defending the right of all communities to “equal protection of environmental and public health laws and regulations.”8 Climate justice is considered to be a sub-movement of environmental justice that specifically addresses the role of class and race in determining the severity of global warming consequences, particularly for “frontline” or “fenceline” communities, who bear the most extreme ecological burdens.9 In healthcare contexts, climate justice can be defined as “the social, racial, economic, environmental, and multispecies justice issues of the climate crisis through centering the experiences and ways of knowing in frontline and fenceline communities and safeguarding the rights of Nature to achieve planetary health.”9 Under this framework, the lived experience of the patient and consideration of intersectionality is critical to providing care (Fig. 1).

While activists and researchers often explore the respective role of race and class in populations disproportionately impacted by environmental harm, there has been less attention to how environmental, climate, and reproductive justice intersect and amplify each other, particularly since environmental factors and climate impacts can disrupt reproductive health and autonomy.10 As climate change worsens, it acts as a threat multiplier to existing forms of racial and socio-economic discrimination;9 because of this amplification, it is important to work at the intersection of environmental and reproductive justice to identify and prevent the risk to pregnant individuals.

Pregnancy increases patients’ engagement with medical systems. For example, while the average adult attends 3.2 medical appointments annually,11 pregnant individuals are advised to have 12-14 visits for perinatal care.12 This heightened scale of surveillance allows for the identification of health issues that affect both the pregnant individual and developing fetus; however, this increased awareness can turn into scrutiny for patients who experience medical bias due to race, class, age, linguistic isolation, and other social and structural factors.13 Prenatal care often focuses on individual actions that pregnant individuals can take to avoid adverse health outcomes, such as abstaining from tobacco, alcohol, and drug usage, limiting the consumption of certain foods, or adding certain dietary supplements to one's daily intake. Khiara Bridges describes how the prenatal care structure often posits poor women as “possessors of unruly bodies” through this attempt to mediate risk at the individual level.14 In other words, while a myriad of social and environmental factors can be responsible for adverse birth outcomes, focusing on individual action implies that the pregnant person bears sole responsibility for fetal health. This paradoxically positions the pregnant person as both the perpetuator and arbitrator of risk, rather than placing responsibility on corporations and legal systems for ensuring products are safe to use and public spaces are safe to occupy.15,16 Placing the responsibility for birth outcomes on pregnant individuals can lead to patient maltreatment, particularly when considering biases of medical practitioners; researchers have documented that BIPOC and poor women often report negative experiences with healthcare systems, which can subsequently lead to an aversion to seeking out care or contact with legal systems.17, 18, 19

As climate change worsens both environmental and reproductive health outcomes, it is important that research examines the nexus of reproductive and environmental justice. Through the following case studies, we will discuss ecological issues related to climate change that impact pregnancy health both for pregnant people and their children. We will also discuss the feedback loops that perpetuate environmental and reproductive health inequities: how environmental pollution can exacerbate greenhouse gas emissions, and in turn, how climate events and adaptation can worsen pollutant exposures and associated health outcomes. First, we will examine the connection between traffic-related air pollution and preterm birth. Next, we look at connections between fossil fuels, plastics in beauty products, and impacts on fecundability and preterm birth. Lastly, we posit that increasingly frequent natural disasters will impact reproductive rights and access to healthcare. We conclude with recommendations for practitioners working with reproductive-age patients on incorporating climate consciousness and intersectionality into their work.