Decommodifying Reproductive Health: A Rights-based Approach

A woman’s reproductive system is perhaps the single most valuable thing for society’s productivity, for it enables the continuation of the labor force. Throughout history, reproductive health has followed the needs of labor capital as opposed to a steady progression towards reproductive autonomy. Indian famine conditions energized the neo-Malthusian birth control movement across the British Empire (Sreenivas, 2015); in the 1960s, the “population bomb” thesis led to various aggressive birth control policies (Felitti, 2022). Most recently, against the backdrop of demographic decline, Hungary introduced a tax exemption scheme for mothers — temporary for one child, and lifelong for two or more — to “encourage family growth” and foster a "family-centered economy.” (Anadolu Ajansı, 2025) Hungary’s literal equation of reproductive labor with monetary value demonstrates that the goal of reproductive policies is often not to advance autonomy, but to keep capitalism on its feet.

Given that “the maintenance … of the working class [is] a necessary condition for the reproduction of capital” (Humphries, 1977), the health of women’s bodies became a necessity for perpetuating oppression. On one hand, investing in the health of women’s reproductive system is necessary to ensure the continuation of reproductive labor; on the other hand, there must be sufficient oppressive pressure to hinder female empowerment. In turn, far from being an enshrined right, reproductive healthcare, from the beginning, has largely been designed to be a tool towards socio-political ends. Yet, as long as it is considered a commodity rather than a fundamental right, it will be susceptible to market forces and to efforts to maximize profits.” (Pavlakis, 2021) Such structural instabilities heighten its vulnerability to systematic destruction, as starkly demonstrated by the swiftness and ease of the Trump administration’s onslaught on the reproductive care system.

Undoubtedly, progressive social values and feminist advocacy have made considerable strides toward reproductive autonomy. However, historically, advocacy sprang from a variety of motivations — Malthusian, eugenics, sexual radicalism, anti-patriarchical thought, and socialism (Hodgson, 1997; Gordon, 1975). In turn, while these discrete strands of advocacy have advanced reproductive care in critical areas, their often conflicting priorities have resulted in fragmented, often stand-alone, gains. The absence of a cohesive and comprehensive framework to safeguard the right to reproductive care, as a result, has left it vulnerable to recurrent political retrenchment.

Path Forward

A unified, rights-based approach to reproductive health is critical in building resilience against political and ideological shifts. Using international law’s Availability, Accessibility, Acceptability, and Quality (AAAQ) framework as a blueprint for tackling barriers to services, implementing a rights-based approach requires restructuring along three axes: bottom-up solutions tailored to local realities, participatory governance, and renewed public-private partnership.

First, bottom-up solutions tailored to local realities are critical in ensuring the equitable access and acceptability of reproductive care. While policies apply with equal force to all women in theory, their impact is by no means uniform. Instead, structural inequalities shape how, whether, and under what conditions individuals have access to reproductive care. For example, modern policies such as the Hyde Amendment, which prohibit federal Medicaid funding for abortion services, reveal a continuing pattern wherein reproductive choices are stratified by race and class, treating access to care as a privilege rather than a right (Harris, 2014). Community-driven initiatives essentially created a microcosm of a decommodified medical system for populations that are often neglected by the formal system. For example, in the 1960s, against a cascade of medical discrimination and disparities, the Black Panthers established community clinics in over a dozen major cities, ​​providing free reproductive health care to Black and low-income communities otherwise denied adequate treatment within mainstream healthcare (Nelson, 2011 p.51). These clinics not only filled critical service gaps left by the healthcare system’s racialized exclusion, but their understanding of local history and context enabled them to respond to the specific social, cultural, and material needs of diverse populations (Olaniran, 2017). This is critical in addressing distrust of the medical system and increasing the acceptability of care.

Second, shifting from a top-down decision-making body to one rooted in participatory governance is crucial for reducing inequities and increasing accessibility. Historically, marginalized women (who are often the most disproportionately affected) have largely been excluded from formal healthcare decision-making. (Soriano, 2024) Yet, engagement of those most affected is crucial in ensuring that the service of care remains accountable, responsive, and resistant to top-down political rollbacks. (Snow, 2018) For example, in Brazil, the Sistema Único de Saúde (SUS) engages over 5,500 local health councils, involving more than 100,000 citizen participants. Decision-making is, in turn, democratized through community health boards, patient advisory councils, and participatory budgeting processes. (Barnes, 2009) While the expansion of the system has revealed funding and oversight challenges, Brazil has seen a reduction in inequalities in the inter‐regional distribution of public health resources, as well as a reduction in disparity. (Barnes, 2009)

Lastly, public-private partnerships provide essential top-down institutional support and regulatory frameworks to sustain bottom-up solutions. While current partnerships under neoliberal paradigms largely prioritize market efficiency (Singh, 2022), a rights-based approach calls for a transition to a framework grounded in universality and public ownership. In 2010, Vermont’s legislature adopted Act 48, which enshrined healthcare as a “public good” and established a framework for a public-private, single-payer system of healthcare based on five human rights principles (universality, equity, accountability, transparency, and participation), which mirror the AAAQ framework. The adoption of these principles into Vermont law allowed them to be “internalized by legislatures.” (MacNaughton? , 2015) While Vermont’s efforts to adopt a single-payer system ultimately failed, it reflects a core paradox of America’s healthcare system: the failure to control costs fortifies the status quo, as private profiteers extinguish efforts to reallocate financing in the current system. (Kliff, 2014) To this end, the problem wasn't the single-payer itself, but the starting point — Vermont was building a public system on top of an extremely expensive private one. As such, for a rights center public-private partnership to take root, innovation incentives should be realigned to address unmet needs (Hoffman, 2011), and financing mechanisms must shift toward more publicly accountable structures. (Esping-Anderson, 1990 p.95)

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