Reproductive Justice,Bodily Autonomy,and State Violence

Abstract

Media stories have highlighted some devastating consequences of attacks on bodily autonomy (i.e., the fundamental right to make decisions about one's own body without constraints or violence), such as the surging maternal mortality rates among Black, Indigenous, and People of Color), a 10-year-old rape victim’s travel out of state for an abortion, families’ exodus from Texas to avoid child maltreatment charges in response to their children’s gender-affirming care, and the dangerous effects of Missouri’s ban of gender-affirming care for children and adults. To successfully fight attacks on bodily autonomy, social workers would benefit from applying an intersectional and rights-based, reproductive justice theoretical framework that blends under-explored theories of state violence: biopolitics, necropolitics, and debility. Our resulting framework elucidates the role white supremacy plays in state violence. After providing the theoretical framework, we connect the framework to the modern political landscape's rapidly spreading efforts to limit the sovereignty of People of Color, women, and transgender and non-binary communities in the latest iterations of state violence. Our article provides a necessary lens to understand and address the complex web of implications that emerge from attacks on bodily autonomy.

The recent attacks on bodily sovereignty coming from US state legislatures and the courts serve as a form of state violence that is antithetical to social work's mandate of social justice and self-determination (NASW, 2021). For example, by August 2023, 25 states ended, severely curtailed, or criminalized abortion (Baden & Driver, 2023) and 23 states have passed 83 bills that are dangerous to transgender and non-binary (TNB) individuals’ health, well-being, education, human rights, and autonomy (Trans Legislation Tracker, 2023). In response, the National Association of Social Workers (NASW, 2022) and the Council on Social Work Education (CSWE, 2022) have each issued clarion calls for social workers to advocate for bodily autonomy. In support of these calls, Goldblatt Hyatt et al. (2022) and Liddell (2018) argue that social work needs to embrace reproductive justice (RJ), which Black women developed as an intersectional rights-based framework and social movement (Goldblatt Hyatt et al. 2022; Liddell, 2018; Ross and Solinger, 2017). The RJ movement supports the belief that everyone has “(1) the right to have a child, (2) the right not to have a child, (3) the right to parent in safe and healthy environments” (Ross & Solinger, 2017 p. 65). As can be seen in RJ, reproduction is directly linked to other social justice issues that disproportionately harm Black, Indigenous, People of Color (BIPOC), and other oppressed communities.

This article posits that the laws and judicial decisions against bodily autonomy constitute a form of state-sanctioned violence, determining who lives and who dies. To respond effectively, social work needs to embrace RJ and develop a more nuanced understanding of state violence and its relationship to patriarchy and white supremacy in teaching, research, and practice. Here we draw from Black feminist scholar Dorothy Roberts’ work in which she argues that curtailment of bodily autonomy serves systems of white supremacy and cisheteropatriarchy. Cisheteropatriarchy refers to the belief that sex and gender are binary, based only in biology, and that society is organized and racialized in ways that support patriarchy and heteronormativity (Alim et al., 2020).

We begin our article with a literature review introducing theories of state violence that are meaningful to but often not highlighted in social work: biopolitics, necropolitics, and debility. Next, we explore state legislation and its impact on life and death. We then look to RJ as a response and explore what social workers can do to support bodily autonomy and why doing so from an understanding of state violence and RJ matters.

Literature Review: Theorizing Life, Death, and State Violence

State violence occurs when the state itself, enabled by the populace, becomes a social problem by eroding democratic norms and using its institutions, structures, or actions to harm wide swaths of people (Torres, 2018). Analyses of state violence include who is targeted; the breadth, nature, and lethality of the violence; and who or what benefits from this violence. To explore these questions, we highlight to the work of Michel Foucault (2003; 2008), Achille Mbembé (2003; 2019), and Jasbir Puar (2007, 2017), as each author centers how the state enacts power through both visible and invisible modes of control and governance of human life and death and lethality in their analysis of state violence. Foucault, began the conversation with a new approach to investigating modernity, in which he argues that modern values required a more nuanced determination of life and death than the premodern state's “right to kill” (Foucault, 2003, p. 239).

Biopolitics

Foucault developed the term biopower to describe the state's mechanisms used to sort citizens into “bad” subjects to be regulated, controlled, disciplined, and punished and “may be let to die,” or “good citizens” who have autonomy and are “made to live” (Foucault, 2003, p. 239). Specific sites of biopower that he explored included race, reproduction, and sexuality, and it was through his analysis of the state's as well as psychiatry's problematizing of the non-normative homosexual body that Foucault developed some of his most important theories. While Foucault saw power as a potentially life-giving force, he also understood that it can subjugate non-normative, gendered, and racialized bodies and control populations not by killing, but more simply, by letting die. For example, pregnant people who live in poverty are not overtly killed by the state; rather, their lack of access to health care and proximity to precarity is an enactment of biopower so that some may be let to die. Foucault then uses the term biopolitics to describe the rationality that the state uses to administer life in ways that it is either fostered or disallowed through the sorting of citizens into good and bad subjects (Foucault, 2008). This sorting works to produce an ascendency toward a form of citizenship in which mastery over self and others is the ideal and one most obtainable to white, middle-class, heterosexual, Christian, cisgender men. When one does not meet the normative criteria that support the notion of a good citizen, one's body can then become a site for regulation and biopolitical punishment.

In her theorizing of biopolitics and queerness, Puar (2007) adds another dimension to biopolitics as she asks, “Which queers live and which queers die?” (p. xx). In her book Terrorist Assemblages: Homonationalism in Queer Times, she analyzes societal changes toward LGBTQIA+ lives. To exemplify, she points to the early 1980s HIV/AIDS epidemic, reminding readers that from 1981 to 1986 the U.S. federal government refused to support people with HIV/AIDS and indeed even mocked or dismissed their deaths. That is until heterosexual citizens were impacted, and only then were federal dollars released (Puar, 2007; Shulman, 2021). Over the next few decades, a societal shift happened in which LGBTQIA+ people who presented in homonormative ways gained greater acceptance. Puar reads this progress as tied to biopolitics, as citizens historically cast as pathological were re-sorted into good subjects and a new category of undesirable that queerness created. In the United States, the normative LBGTQIA+ individuals were largely allowed to live, and queer lives—especially those of color, those without resources, or those visibly denying a gender binary—were allowed to let die (Puar, 2007).

Biopolitical Arsenal: Necropower and Necropolitics

da Silva (2011) adds to this conversation with the term biopolitical arsenal to describe how race acts as an efficient tool for sorting humanity into “good” and “bad” subjects. Here, race determines who has access to a productive life, while also allowing the state to deem a population dangerous. In the latter case, mechanisms of control and regulation are often deployed. It is this racialized proximity to death that leads us to Mbembé's (2003) concepts of necropower and necropolitics. Like da Silva (2011), Mbembé forefronts race as a mechanism for sorting good vs. bad state-subjects and life vs. death. Necropower is the process that sorts people into “who may live and who must die,” and necropolitics is the framework that governments use to assign human life value (Mbembé, 2003, p. 12). Necropower is more active and sinister than biopower, even as the tactics of both overlap and merge. For example, in her discussion of reproduction and race, Roberts (1997) demonstrates that even when abortion was legal, the biopolitical arsenal of race was deployed in reproductive health as evidenced by the higher mortality rate of Black people who were pregnant as opposed to whites.

Butler (2004) evokes necropower in their discussion of gender and a livable life, arguing that the lack of categories that allows one to be recognized and the creation of categories that constrain life creates an unlivable life. They then advocate then advocates for the need to distinguish “among the norms and conventions that permit people to breathe, to desire, to love, and to live, and those norms and conventions that restrict or eviscerate the conditions of life itself” (Butler 2004, p. 8). In this discussion, Butler evokes both necropower and the idea of unliving. Here Butler is invoking Mbembe's (2019) necropolitics, explaining that if a person cannot determine what they can do, where they can go, and their proximity to death, they are not fully alive—rather they are the living dead: hopeless and devoid of joy or pleasure (Mbembé, 2019).

This view of state violence can be seen as similar to Puar's (2017) debility. While Puar's analysis of debility is much larger, she conceptualizes it not as a consequence of a disabling event (i.e., a noun), but as a “a slow wearing down of populations” (2017, xiv). In her framework, debility is a verb and response to deliberate state-sanctioned practice that both sorts and harms in relationship to one's access to resources. Debility includes the ways that capitalism wears down bodies, and excludes people from health care. Thus, access to resources can determine who lives and who dies, while lack of access both kills and slowly wears the body down (Puar, 2017). As we turn our attention from theorizing to examining contemporary legislative assaults on bodily autonomy, we are reminded of Verghese's (2021) assertion that “Once you see how the logics of necropolitics structure our society, you won’t be able to unsee it.”

Legislating Bodily Autonomy and its Impact

Reproduction

Efforts to overturn Roe v. Wade (Roe) began quickly after its passage in 1973 that affirmed the constitutionality of abortion within the first trimester of pregnancy. These efforts included seeding anti-abortion lawmakers at all levels of government, building popular support against abortion, and passing laws weakening access. Four years after Roe, the Hyde Amendment was passed in 1976 prohibiting the use of federal funds, including Medicaid, for abortion, except in the case of incest or life of the mother (Hyde Amendment (Pub. L. No. 105-119, § 617 111 Stat. 2519, 1997)). The decision disproportionately affected Black women who comprise about half of those receiving Medicaid (Roberts, 1997). Following the Hyde amendment, additional court proceedings weakened access to abortion by imposing a 24-h waiting period between the initial appointment with a medical professional and an abortion, the requirement of parental consent for minors seeking to obtain an abortion, and the regulations of clinics in ways that negatively impacted their ability to provide services (Planned Parenthood of Southeastern Pennsylvania v Casey, 1991).

Because Dobbs v. the Jackson Women's Health Organization (hereafter Dobbs), the ruling that overturned abortion, was a Mississippi-based lawsuit, we provide some background on that state's legislative and legal activities leading to the Supreme Court (Dobbs v. Jackson Women's Health Organization, 597 U.S., 2022). In 2007, in preparation for the possibility that the Supreme Court would overturn Roe, the Mississippi legislature passed what is called a trigger law, dictating that if the constitutional right to abortion were to end, abortion would immediately become illegal except when needed to save the life of the mother or in the case of reported rape or incest (House Bill 1510, 2023). In 2018, Mississippi passed another law that made abortion in the state illegal after 15 weeks of pregnancy, which is about 2 months shy of a full second trimester (Mississippi Code Title 41. Public Health § 41-41-45). When Mississippi tried to implement the ruling, the Jackson Women's Health Organization began legal proceedings against Thomas E. Dobbs, the State Health Officer for the Mississippi Department of Health, which ultimately resulted in the Dobbs decision.

Prior to Dobbs, the cost of an abortion was already prohibitive with the average cost of medical abortions being $580 and the average cost of a clinic-based abortion being $800 (Planned Parenthood, 2023). Traveling out of state may increase these expenses significantly. Post-Dobbs, there has been a seismic shift in the exception of abortion, as identified in the Hyde amendment—in order to save the life of a mother or when a pregnancy results from rape or incest—as many of the recent laws have removed the latter as an exception. While nearly every state allows for saving the life of the mother, post-Dobbs some states have created statutes designed to criminalize physicians for performing an abortion even when the life of the child or mother may be at risk, or in Texas, even when the child has been determined to be non-viable (Mendez, 2022). Because these rulings do not include specific guidelines for physicians to make such determination, to protect themselves doctors are taking a longer time to perform the abortion. This wait has resulted in loss of life and places the pregnant person in agony and danger. In its law, the state of Texas included the provision that doctors who assist with abortion can face up to a 99-year prison sentence, $100,000 fine, and loss of medical license. To further criminalize abortion, two states—Texas and Oklahoma—have laws affecting organizations that are seen as helping people to cross state lines to obtain an abortion, and Idaho passed legislation noting that if you help a minor leave a state for an abortion, the penalty will be 2–5 years in prison (Zablocki & Sutrina, 2022).

The lack of access to abortion is profound for both bodily autonomy and its implications for who lives and who dies. In 2022, the US had the highest maternal mortality rate of any developed country, and structural racism and white supremacy meant that Native American people were twice as likely to die than their white counterparts in childbirth, and Black women four times (Villavicencio et al., 2020). As maternal mortality rates are decreasing across the globe, they are rising for Black women in the US. Some have estimated that the Dobbs decision will bring a 21% increase in maternal deaths and a 33% increase among Black women (Stevenson, 2021).

Additionally, the Dobbs decision will exacerbate a variety of health outcomes that will affect life and death. In addition to physical effects, data support a growth in anxiety and depression among people who are unable to secure an abortion, which can lead to hospitalization and suicide. Given that 23% of people seeking abortion prior to Dobbs did so because of intimate partner violence, the lack of access to abortion will likely mean that these individuals will be less able to leave dangerous relationships (Tobin-Taylor, 2022). Although there has not been a projection regarding the impact of Dobbs on TNB communities, we do know that regardless of legality some TNB people are choosing to end a pregnancy on their own as they do not view clinic care as a safe or accessible option (Moseson et al., 2021). Because the overturning of abortion occurs within other state legislatures that works to erase queer and trans life, both metaphorically and actually, it can be argued that each ruling creates an opening of another and another attack on bodily autonomy.

Gender

Of the 83 anti-transgender bills that have been passed in state legislatures, 22 restrict healthcare, 12 institute sports bans, 8 institute bathroom bans, 20 impose restrictions on educational institutions, and 21 impose other restrictions (e.g., Montana's definition of gender as females having XX chromosomes and producing eggs and males having XY chromosomes and producing sperm). Tennessee has become the center for anti-LGBTQIA + laws, including making gender-affirming care illegal for minors and “restricting transgender therapy,” denying state Medicaid funds for gender-affirming care, prohibiting drag shows as well as transgender youth participating in sports, articulating teachers’ rights to use pronouns based on sex assigned at birth, requiring that warning signs must be posted on bathrooms if a transgender person might use it, and giving parents 30-day advance notice if their student is going to learn about gender or sexual orientation (Stockard, 2023, February 14). Across the nation, there are more than a dozen court cases seeking to block these repressive laws that have been passed (Lambda Legal, n.d.).

Just as the Dobbs decision has deadly consequences, so do laws targeting TNB people. In the area of health and mental health, Kidd et al. (2021) surveyed 273 parents of TNB youth about their children's mental health, and the vast majority of parents feared for their children's mental health and suicidal ideation with the passage of anti-TNB laws. An analysis of data from the US Transgender Survey found that transgender individuals who were able to access gender-affirming hormone therapy when desired were less likely to express past year suicidal ideation, and being able to access this treatment in adolescence compared to adulthood was also associated with lower odds of suicidal ideation (Turban et al., 2022). Surveys of TNB youth ages 13–20 within a gender clinic also found that youth with access to gender-affirming care, including puberty blockers and gender-affirming hormone therapy, were less likely to have symptoms of moderate or severe depression or suicidality at 12-month follow-up (Tordoff et al., 2022). LGBTQIA + people have experienced violence based on their identities, and many continue to receive inadequate care. The largest survey of TNB adults in the United States found that 23% of respondents did not seek healthcare in the past year due to fear of being mistreated and among those accessing healthcare in the past year, 24% had to educate their provider about trans care and 15% were asked invasive questions (James et al., 2016). The issue of sexual and reproductive health care is particularly salient among TNB individuals.

Anti-abortion laws also impact individuals who are transgender because clinics providing abortions may also provide transgender health care (Jones et al., 2020). In settings such as a women's clinic or hospital birthing center, these patients often are faced with institutional cisgenderism—upholding the gender binary (Agénor et al., 2022). Qualitative research has documented additional overlapping issues of racism and heterosexism among transmasculine young adults of color (Agénor et al., 2022). Examples of problems for TNB patients in such settings include a lack of affirming and knowledgeable care; avoiding care due to anticipated discrimination and/or lack of preparedness among providers; dysphoria related to seeking care designated for a gender with which they do not identify including seeking pregnancy or abortion care, being treated inhumanely, providers making incorrect assumptions about sexual behaviors, health risks, and pregnancy risk; hypersexualized assumptions about Black TNB patients; and a lack of information about queer-specific reproductive health (Agénor et al., 2022; Gebel & Diamond, 2022; Norris & Borneskog, 2022; Seelman & Poteat, 2020).

While much of the data involving TNB youth centers on mental, behavioral, and physical health, the issues are much larger. Together these state laws reinforce the mythology that the TNB individual is deviant and to be feared. Reinforcement of these cruel stereotypes can lead to bullying, suicide, and murder and some assent to parents that “disown” or remove their children from their home (Robinson, 2020). Once the youth experiences homelessness, they/she/he is more likely to be forced into survival sex as well as experience violence and victimization, HIV infection, or harassment. These youth are also targeted by the criminal legal system, and this is especially true for youth of color (Robinson, 2020).

Estimates suggest that 20% of TNB individuals experience homelessness, and more than one in four TNB people have lost a job due to bias. National data found that about 60% of LGBTQIA + students feel unsafe at school. For example, in addition to being discriminatory and transphobic, there are ways in which lack of access to sports limits youth's engagement in prosocial activities, and when a child is forced to play on a team incongruent with their gender identity, they are subject to bullying and harm (Turban et al., 2022). These laws are state violence in their complicit support of violence, homelessness, poverty, and pain.

Intersections of Race and Gender

To gain greater insight into the biopower, necropower and debility found in state law, it is important to see the interlocking nature of legislation. This legislation as it affects reproduction and gender involves multiple axes of racialized and gendered ideologies, each of which, on their own and combined, lets some populations live while others are made debilitated or let to die. For example, anti-bodily autonomy policies tend to be adopted in the same states that pass other racialized and repressive laws. At present, Alabama, Georgia, Mississippi, and Tennessee have not expanded Medicaid, have implemented bans on abortion (with Georgia allowing abortion within the first 6 weeks of pregnancy), and banned or limited gender-affirming care, with Georgia allowing for the use of puberty blockers among youth (Human Rights Campaign, n.d.). These states also have among the highest rates of poverty in the United States, with Mississippi having the highest in the country, while Alabama, Georgia, and Tennessee are 5th, 9th, and 16^th, respectively (World Population Review, 2023). These states also have among the largest percentage of Black residents, and in support of the biopolitical arsenal of race, the CDC illuminates the racialization of health care. It estimated that with Medicaid expansion, 26% more white individuals and 34% more Black individuals would have access to health care (Riley et al., 2022). This care can include gender-affirming care as well as pre- and post-natal care for pregnant people. Gehi and Arkles (2007) argue that limiting Medicaid coverage either by not expanding coverage or outlawing gender-affirming care works to “reproduce hierarchies of race and class” (p. 7). These states also support a host of laws that strengthen debility—including lack of access to Medicaid and efforts to discourage a living wage. If debility is the slow wearing down of populations, pregnant and TNB individuals cannot be disentangled from debility-producing conditions, such as lack of health care, poverty, racism, homo- and transphobia, low wages, and lack of legal support. These data support an intersectional analysis of the conditions that play a role in who may or may not live (and thrive) in the context of the loss of bodily autonomy (Crissman et al., 2017).

The loss of bodily autonomy described in this section can be seen as what Lenning et al.'s (2021) term violent ideologies that enable violent policies, which result in violent actions. To fully examine the implications of the laws and the losses to bodily autonomy, it is important to contextualize the laws within the hierarchical ideologies of race, class, sexuality, and gender and to see the linage of bodily autonomy as a cisheteropatriarchal tool that supports white supremacy (Lamble, 2008). Indeed, Daum (2022) argues the disproportional burden experienced by BIPOC who are pregnant is “an exercise of biopower that works to maintain institutionalized white supremacy” (476). Drawing from this perspective, the loss of sovereignty is more than an individual issue and supports social work's calls for bodily autonomy within the broader context of intersectionality, cisheteropatriarchy, and white supremacy, while highlighting the importance of RJ as a tool for social justice. In the following section, we use the framework of RJ, including its development as response to white supremacy, to make these connections.

Reproductive Justice: A Tool in Dismantling White Cisheteronormative Supremacy

Reproductive Justice was developed in 1994 by BIPOC who recognized that issues of Black women's reproduction—including its violent and racialized practices—were overlooked and that the voices of POC were marginalized in the white-led women's movement that framed the struggle for abortion rights as an issue of “choice” (Ross & Solinger, 2017; Silliman et al., 2017). While privileged women wanted choice to end a pregnancy or not, BIPOC and LGBTQIA + individuals recognized that their ability to determine what happens to their body and whether to parent or not is affected by multiple injustices that are outside the realm of individual choice. As activist, scholar and a key founding member of the RJ movement, Loretta Ross, explained, “our ability to control our bodies is constantly challenged by poverty, racism, environmental degradation, sexism, homophobia, and injustice in the United States” (Silliman et al., 2004, p. 11).

Describing the development of the RJ movement, Ross (2017) writes about how its formation was influenced by the intersectional analysis of the Combahee River Collective. While intersectionality tends to be watered down in social work to multiculturalism as noted by Mehortra, (2010), the RJ founders’ built from the tradition of the Combahee River Collective in which intersectionality is a site of oppression, but more importantly it is also a politic, position of power, and standpoint. (Ross, 2017). As the Combahee River Collective (1977) explains:

Our politics initially sprang from the shared belief that Black women are inherently valuable, that our liberation is a necessity not as an adjunct to somebody else's may because of our need as human persons for autonomy.

Thus, Ross writes that in the RJ movement:

[w]e created new self-definitions to validate our standpoints, and offered a fresh worldview of our epistemological power to articulate our conscious resistance to all forms of reproductive repression. (p. 287)

Dorothy Roberts (1997) powerfully traces this very standpoint in her book Killing the Black Body. In her book, she ties together the forced rape for the commodification of humans during enslavement; the horrific experimentation, often surgical, that was done on Black women's and TNB peoples’ reproductive systems that led to the creation of the medical field of gynecology (Snorton, 2017); and the nineteenth century eugenics movement, with the latter deploying the biopower of forced sterilizations to meet their goals of furthering “desirable aspects societal traits.” With the Supreme Court's 1927 ruling in Buck v. Bell, states were given the constitutional right to protect their populous from those labeled as “unfit,” which in turn fueled the eugenics movement that included 70,000 forced sterilizations, many of which were focused on the South and Native land/reservations (Hansen & King, 2014; Roberts, 1997).

While the use of sterilization without consent has fallen out of favor, it is still used and legal in several states, and as losses to bodily autonomy loom, there may be a wider resurgence of its use. It is also important to recognize the use of eugenics within the carceral state. In the 1980s, under the guise of protecting the unborn baby and society, new laws allowed for the incarceration of pregnant women who were suspected of using drugs, and TNB sex workers became targets for incarceration (Roberts, 1997). With the advent of Long Lasting Reversable-Contraceptives, both men and women were able to bargain for shorter prison sentences if they agreed to their use or sterilization (Winters & McLaughlin, 2020). Moreover, with the growth of the prison industrial complex, the carceral state itself is a site of eugenics, as BIPOC women and men and TNB people of child-bearing age are removed from the possibility of procreation.

As an intersectional movement that is rooted in human rights, there is, too, a clear alignment between RJ and the liberatory work that is being done in queer and reproductive rights. Price (2017) describes the relationship between the two movements as interlocking and intersecting. This view of TNB rights is well-argued in Miriam Perez's retort to then President Clinton's statement that abortion is an LGBT issue only in cases of adoption and surrogacy. Perez retorted: “reproductive justice is not just about one's ability to reproduce. It is about autonomy, respect, shared principles based in the human right to health and a desire for real social change.” There is also a shared agenda in support of sexual justice, which includes consent and pleasure (Price, 2017). So while Puar (2007) asks which queer lives matter and which do not, trans legal scholar Dean Spade argues for a “political trans power perspective” that is based on the politic of Black feminist activists in which the standpoint of those most harmed, subjugated, and targeted is centered and state violence is named and refused.

Social Work and Social Worker's Response

In this section, we explore what social workers, and the field of social work can do to support bodily autonomy. We begin by exploring the importance of RJ as a tool for social work. Next, we examine what social workers can do at the macro and individual level in support of policy change, community organizing, and their clients.

RJ requires a commitment to intersectionality as defined by Black feminists, as well as a commitment to human rights. While it is beyond the scope of this article to describe what is meant by human rights, the right to health care, housing, education, and food are just some of the rights that have received specific support from social work scholars (Libal & Harding, 2015). In their discussion of rights, Ross and Solinger (2017) include sexual rights, such as “same-sex rights, transgender rights, right to birth control and abortion, right to sexual pleasure, and to define families” (p. 83). While the human rights perspective is supported in the CSWE's competencies, the literature regarding social work and human rights, especially that emanating from the United States, is paltry, and contradictions have been noted between the needs-based and individual approaches often associated with social work and a rights-based approach (Libal & Harding, 2015). Reproductive rights provide the opportunity to merge bodily autonomy with human rights in social work teaching, research, and practice, and in so doing support scholars and practitioners arguing for greater alignment between social work and human rights. While some scholars criticize human rights as Western-centric and normative, its framework does mediate some of the more severe forms of state violence (Puar, 2007).

In support of RJ, social work must also begin to change the way in which we talk about intersectionality. Every social worker should read the statement of Combahee River Collective so that they are directly hearing the words of the Black lesbians who helped to define its usage. Thus, rather than seeing intersectionality as equivalent to multiculturalism, social work needs to highlight the ways in which intersectionality is used as tool to dismantle white supremacy; focuses on structural forces; acknowledges the political power of BIPOC and others who have been racialized, marginalized, sexualized, gendered, and harmed in our present structure; and acknowledges that the ability to visualize change resides among those most affected by the conditions. Indeed, the history of the RJ movement brings each of these factors to light. The statement of the Combahee River Collective and the development of the RJ movement also emphasize self-help and the idea that the personal is political.

Social work should not shy away from ideas of self-help or see it as a threat. Rather, social workers can help facilitate its use by engaging with the work of Paulo Freire and others to enable groups to explore conversations that bring together one's own experience with social, political, and economic realities. Ross (2017) highlights the need for storytelling, and within organizing frameworks there should be space to allow individuals to share their stories and perhaps heal from the collective experience of doing so. Moreover Ross (2017) notes that highlighting stories supports the development of polyvocal narratives and experiences that can then lead to a broader vision of what social change looks like.

Most importantly, RJ talks about the need for coalition work and building an inclusive movement that builds alliances with those organizations working collectively across human rights issues. When engaging in this work, social workers need to recognize some of the paradigm shifts that are coming from the work of the BIPOC community. This includes recognizing the significance of movements being led by those most affected. Social workers need to explore the ideas associated with Black and queer joy, as well as component concepts such as self-compassion and empathy, and view joy as foundation for resistance (Lewis-Giggetts, 2022). The concept of healing justice and the work of Hersey (2022) also need to be elevated in social work. As part of challenging the discourse that TNB lives needing to be controlled or extinguished through state control, organizations, activists, and scholars are constructing counternarratives about gender euphoria and trans joy. An example comes from the Transgender Law Center, which has launched a youth-driven zine called Trans Youth Joy (Transgender Law Center, 2023). Social work education can incorporate theories, methods, and practice opportunities that build upon such forms of resistance and counternarrative as ways of challenging state violence, white supremacy, and cisheteropatriarchy.

Beyond supporting RJ or addressing issues of bodily autonomy from the RJ perspective, social workers can take additional actions to support in support of bodily autonomy. Goldblatt Hyatt et al. (2022) provide a list of things that social work can do to support RJ and liberation, including getting involved with local organizations or national RJ organizations, partnering with community organizations to support low-income parents, supporting abortion funds, gathering research from those most affected, lobbying and partnering with legislators, voting for those who support anti-racism and autonomy, exploring RJ and critical theory in research, advocating for social work organizations such as the CSWE to recognize RJ as central to social work, and as Goldblatt Hyatt et al. (2022) remind us:

In your personal life, consciously work to uplift voices of people of color, LGBTQIA + those with disabilities, and/or poorly resourced people. Acknowledge how systems of oppression work to minoritize, marginalize, and stigmatize people to silence. How are you promoting and centering voices that have been previously silenced in this fight? Whose stories are you narrating when you stand before lawmakers who would restrict RJ? Lend your voice when asked. Turn up and show up. (p. 200)

Social workers should become familiar with the legislative and judicial landscape. Critical efforts are already happening in the court systems to advocate for the autonomy of TNB people, including cases challenging policies that restrict access to gender-affirming care (L. W. v. Skrmetti; ACLU, 2023c), restrict access to Medicaid coverage for gender-affirming care (Fain v. Crouch; Lambda Legal, n.d.), keep TNB youth from participating in sports aligned with their gender (Hecox v. Little; ACLU, 2023b), restrict bathroom access by gender (Bridge v. Oklahoma State Department of Education; ACLU, 2023a), and require K-12 teachers to disclose a TNB student's gender or pronouns to their parents (Wiessner, 2023). Simultaneously, 15 states are currently litigating the abortion bans, and the outcomes range from upholding or temporarily stopping the abortion bans while litigation occurs. Social workers can take steps to support such litigation, connect with legal experts to support individuals, share policy information with affected communities, and keep updated on changing laws. In areas where abortions are illegal, but the laws do not prohibit someone from traveling out of state to obtain an abortion, social workers should support these efforts. Social workers must also learn about ways to access abortion funds where they exist and support efforts to create them where they do not exist. Even in states where abortions are illegal, social workers need to consult with the closest organizations supporting reproductive rights to provide access to care whenever that option is legally available. In all cases, social workers must understand the current laws and be aware of the risks that they might be taking. In places where self-managed abortions are illegal there are advocates who are working on supporting policy that “deprioritizes” prosecution. Social workers also need to learn about pregnancy centers (sometimes called pregnancy resource centers or pregnancy crisis centers), which are organizations seeded by the anti-abortion movement that are advertised as supporting pregnant women. The LA Times has labeled these centers a growth industry (Hennessy-Fiske, June 12, 2022), and in Texas, $100 million dollars of support has been given to them. However, research shows that the level of support offered by these organizations often turns out to be significantly less than what women were told that they would receive (Hutchens, 2021). Thus, social workers need to have the facts about the pregnancy centers, including how they operate, so that they are able to share accurate details with clients and community members.

Social workers need to understand what it means to connect clients with services in areas where support has been criminalized. In municipalities where abortion is illegal some advocates have worked to have self-managed abortions deprioritized in their criminal legal system. Social workers must also understand the effects of non-prescribed treatment for TNB individuals and be prepared to provide options for accessing affirming healthcare, including locating TNB mutual aid resources and accessing funding for out-of-state healthcare. Social workers can assist TNB people in seeking out knowledgeable providers with shared identities. In the wake of loss of TNB bodily autonomy, social workers need to recognize the need for trauma-informed care, while also seeking out reliable information about sexual and reproductive health tailored to TNB populations and individuals who do not want to be pregnant. This includes locating providers who are safe for disclosure and encouraging clients to bring a support person to act as an advocate for bodily autonomy during healthcare encounters (Agénor et al., 2022; Gebel & Diamond, 2022).

As legislators and judges take rights from those who identify as TNB, social workers must gain knowledge on anti-TNB bullying and harassment, including how to identify these situations, best practices in intervening and providing support, and the effects on TNB people. Social workers must also stand with TNB individuals in ways that are supportive and clear and encourage others to do the same. Social workers should also understand that all major medical associations have released statements supporting gender-affirming care, which includes hormone therapy, surgical procedures, and other needed medical care (Dawson et al. 2022). Social workers must advocate for gender-affirming care in the states that allow it. In the 14 states that have made gender-affirming care illegal and/or that prohibit the use of Medicaid funds for gender-affirming care (Mallory & Tentindo, 2022), social workers must be proactive. Social workers must link TNB individuals with mental health services to address the depression and suicidality that gender-affirming care mitigates, and research and share information about grassroots efforts to support TNB individuals. These efforts include support with funding for travel and healthcare, help identifying affirming providers, and patient navigation efforts, such as the Campaign for Southern Equality's Southern Trans Youth Emergency Project (n.d.).

When incursions into bodily autonomy are viewed through the lens of state violence and white supremacy, social workers must also understand that there may be even more destructive legislation ahead, as the goals of white supremacy and cisheteropatriarchy are not fully realized. This can include a resurgence of forced sterilizations within the carceral system, and beyond, as well as efforts to eliminate all gender-affirming care under the faulty presumption that this will eliminate the existence of TNB people. Moreover, as social workers gain insight into biopower, necropower, and debility, they can begin to analyze the way in which these ideas both create the conditions that social work seeks to address as well as analyze the ways in which social work also utilizes these forms of power and control.

Just as social conservatives worked to change the discourse about pregnancy, social work organizations need to take the lead in standing with all people whose rights are eroded and participate in organizing efforts. Social workers can draw from the work of Daftary et al. (2021) who detail the value of Critical Race Theory in analyzing policymaking and the racism that is evident in the policy-making process. Social workers should be supported in running for public office, from school boards and municipal elections to state and federal offices, as part of advancing voices that call for greater bodily autonomy and help others to understand the loss of autonomy as a form of state violence.

Conclusion

Within this article, we argued that threats to bodily autonomy are significant and growing, and yet social work has not done enough to proactively acknowledge and respond to this issue. State violence and related forms of biopolitics, necropolitics, and debility are enacted in ways that disproportionately lead to the deaths or severe wearing down of BIPOC women and TNB individuals. Increasing restrictions on abortion treat the person who is pregnant as a life less worthy than that of the fetus, and those laws restricting TNB people try to erase gender creative lives. Losses to bodily sovereignty reflect the violence of broader white cisheteropatriarchal norms, calling for a broad and urgent response from social work. We argue that the RJ movement presents a key intersectional framework for understanding and framing these issues within social work and possible strategies for action, drawing from the formative and ongoing, paradigm-shifting work of BIPOC individuals. Such action is critical to addressing the modern political landscape's quickening and deepening efforts to limit the sovereignty of BIPOC individuals, women, and TNB communities in the latest iterations of state violence.