Winter 2024 Issue

Reproductive Justice Theory
By Rachel Fryman, PhD, LCSW, and Daniel Pollack, MSW, JD
Social Work Today
Vol. 24 No. 1 P. 22

Teaching Social Work Ethics While Being Mindful of Individual Values

It’s inevitable, due to the demographic diversity of social workers, for conflicts to arise between the values of the profession and personal values of the social worker—for example, religious beliefs or deeply held political convictions. Yet social work students aren’t adequately prepared to navigate such conflicts.

Entry-level social work positions for recent graduates across different domains may include case management and large caseloads with nominal supervision, and social workers in these positions confront significant challenges working with vulnerable populations. Depending on the setting, ethical dilemmas pertaining to religious and political convictions such as end-of-life advanced directives, mandated reporting of child abuse and neglect, and reproductive health ranging from sexual education to prenatal and postnatal care can arise. Especially in post-Roe America, the topic of women’s health care, and specifically reproductive health, has been polarized and politicized so much that social work graduates in various settings will confront personal and professional challenges navigating their religious and political values alongside those of the social work profession.1,2 The NASW Code of Ethics3 enumerates social justice as a value but recognizes that social workers may have their own values and beliefs regarding reproductive health care. In an environment where ethical dilemmas and values conflict related to reproductive health and social work practice are likely to arise, understanding reproductive justice theory within social work’s philosophical and theoretical foundations allows both recent graduates and experienced social workers to consider frameworks already commonplace in social work for ethical decision-making.4-8

Philosophical and Theoretical Foundations of Social Work Practice
A defining feature of the social work profession is a commitment to social justice and advocacy, including working with vulnerable populations. The preamble to the NASW Code of Ethics explicitly states that social workers are tasked with the responsibility to “promote social justice and social change with and on behalf of clients … Social workers are sensitive to cultural and ethnic diversity and strive to end discrimination, oppression, poverty, and other forms of social injustice.”3 Furthermore, consistent with the philosophical foundation of social work practice is a commitment to social justice on behalf of vulnerable populations and specifically working to challenge social injustice. The Code of Ethics states that “Social workers strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making for all people” as a value of social justice advocacy. Much of the work conducted by social workers with women in reproductive health includes counseling and case management to access information and resources as a form of advocacy and best practice.2 As health care and maternal health outcomes are a growing concern, vulnerable women benefit from social workers’ support advocating on their behalf, which may present specific challenges for individual social workers depending on their religious beliefs and political orientations.9

Integration Into Social Work Philosophical and Theoretical Foundations
The academic research on reproductive justice is an area in need of further inquiry,10-13 specifically within social work literature. However, reproductive justice provides an important framework for considering individual women’s health—and specifically, reproductive health—that is compatible with social work philosophical and theoretical foundations.14 By incorporating and understanding reproductive justice as a theory compatible with social work values and practice, social workers challenged by religious and political issues in their professional work have a resource within mainstream social work literature and education in which to seek clarification and support. Individual practitioners may be more familiar with and comfortable tackling differences by learning about theories of reproductive justice through a social work lens. For practitioners working with women and families, dilemmas involving reproductive justice may include abortions but also general women’s reproductive decision-making, including sexual health education, contraception use with family planning, funding and supporting women with infertility, and both pre- and postnatal care.

Although reproductive justice theory appears compatible with the core values of the social work profession, due to the lack of literature on reproductive justice theory in social work journals, social work graduates may not necessarily have the training or the framework to address when they are uncomfortable with issues such as reproductive health. In “Reproductive Justice: An Introduction,” reproductive justice theory is defined as a “contemporary framework for activism and for thinking about the experience of reproduction. It is also a political movement that splices reproductive rights with social justice to achieve reproductive justice. The definition of reproductive justice goes beyond the pro-choice/prolife debate and has three primary principles: (1) the right not to have a child, (2) the right to have a child, and (3) the right to parent children in safe and healthy environments.”14

In a more general sense, support for the right not to have a child can be expanded to cover different areas of professional social work, including sexual education ranging from contraception to abstinence, as well as helping individuals access appropriate gynecological health care and support.

Furthermore, support for the right to have a child can be expanded to include social workers advocating and caring for individuals during periods of infertility and navigating family building, such as during pregnancy losses, which include miscarriages as well as abortion. This could also include direct counseling or more general psychoeducation and case management, such as educating and making referrals to reproductive endocrinology and more general policy work on behalf of individuals experiencing infertility and pregnancy loss. Regardless of a social worker’s political and religious convictions, there’s flexibility within the reproductive justice framework to consider social work values and ethics toward social justice and providing care to vulnerable populations.

Case Study Examples
The two case studies that follow illustrate the challenges entry-level social workers have when reconciling their own personal values with professional values and ethics around issues of reproductive health care. Following these case studies is a summary of how these examples may be conceptualized utilizing familiar social work frameworks for ethical decision-making.

Case Study A
As a social worker providing counseling to young adults at a community mental health clinic affiliated with a large urban hospital, you are working with a teenager who wishes to have an abortion after being in an abusive relationship with a neighbor. Although the clinic is separate from the medical center, you are aware that referrals can be made directly to the family planning department that meets with women to explore terminating pregnancies as well as other options. Due to your own personal religious beliefs, you are not sure whether you feel comfortable continuing to work with the young woman who is strongly leaning toward having an abortion. In consultation with your supervisor, you share these concerns and are directed to meet with the director of social work services. What will you do?

Case Study B
As a social worker at an OB-GYN clinic in a state that no longer provides abortions, you are not sure how or where to turn for support to provide referrals to patients requesting abortions. Personally and professionally, you believe in the autonomy of clients to determine what’s best for themselves in terms of decision-making regarding possible termination. Today, a patient at the clinic was informed that her fetus has severe malformations and carries a chromosomal genetic disorder incompatible with life. Prior to the overturn of Roe, you were referring patients to centers in a neighboring state, but you have heard from referrals and colleagues that they are unable to service everyone. In addition, now that the state has signed a bill implementing a six-week abortion ban, you are not sure what to do going forward. You have left a message for your clinic’s legal counsel and have reached out to the NASW Ethics hotline for guidance. What else can you do?

Application of Case Studies to Familiar Social Work Ethical Frameworks
When confronted with ethical dilemmas such as those in the aforementioned cases illustrations, there’s no clear response for how social workers can process their countertransference or make decisions without further deliberation. In case study A, the social worker feels her own religious convictions may prevent her from making a referral. In case study B, the social worker identifies that there are institutional limitations to practicing according to social work values reflecting his own professional values.

In each case study, social workers can be further informed by drawing upon the social work frameworks for ethical decision-making already commonplace and established in the curricula of social work schools, licensing exams, and professional development, and can consider principles of reproductive justice theory (ie, that individuals both have the right to not have a child and the right to have a child). Since there’s a dearth of scholarship on the topic of reproductive justice generally and, specifically, on navigating ethical dilemmas in social work scholarship, turning to established social work frameworks provides a basis for social workers, including scholars and educators, to begin this important area of research and teaching.14

In practice, when issues of personal religious or political convictions arise for social workers, turning to an ethical decision-making framework can offer valuable guidance. For example, in the widely accepted Reamer Ethical Decision Making Framework,15 a seven-step model for navigating ethical dilemmas in social work practice builds on and draws from the Code of Ethics. It considers different theoretical models that could include reproductive justice principles as well as individual social workers’ personal values.

In addition to Reamer’s, there are other available frameworks for ethical dilemmas already taught and familiar to social workers.16 These include, for example, approaches by Barsky,17 Beauchamp and Childress,18 Congress,19 Levy,20 Linzer,21 (1999), and Loewenberg.22 In addition to being able to navigate frameworks, it’s incumbent on social workers to consider their own value systems as well as develop a solid working knowledge of the Social Work Code of Ethics. As clinicians confront ethical conflicts between their personal values and beliefs and those of their professional selves, literature on ethical decision-making becomes a tool for processing conflicting interests. As enumerated in the Reamer framework, the steps offer newer social workers guidance on how to identify and navigate when personal and professional values—including values of religious and political beliefs—can contribute to ethical dilemmas in professional practice, such as (but not limited to) issues of reproductive health, and more generally, reproductive justice.

Tools for Conceptualizing Social Justice
In such a fractured political atmosphere, educating social workers about ethical decision-making frameworks, as well as considering theoretical orientations such as reproductive justice, can help them conceptualize their professional roles more holistically. Although demographics concerning the religious or political beliefs of recent graduates are unknown, social workers are entering the field at a time when there are significant needs for vulnerable populations and are likely working with individuals who have similar, as well as different, religious and political convictions.23 For graduates engaging with individual clients, reproductive justice can be considered a tool for conceptualizing social justice for reproductive health and can provide social workers with an additional theory to gain greater clarity about their personal and professional values as well as their ethical responsibilities as professionals. Furthermore, reproductive justice theory can be utilized even when social workers have personal objections and do not necessarily share the religious or political convictions often associated with reproductive justice.

In the two case examples described, social workers experienced dilemmas navigating their personal and professional selves in relation to the reproductive health of clients at their places of employment. In light of the demands presented to social workers entering the field, social work schools and recent graduates must acknowledge the divergence of political and religious convictions and should consider turning to ethical decision-making frameworks. Teaching and reviewing ethical decision-making frameworks in social work practice is essential when religious and political convictions appear to present ethical dilemmas due to differences in values. In addition, more scholarship is needed on social justice, including reproductive justice in social work, to support social work graduates who are navigating ethical decision making.

— Rachel Fryman, PhD, LCSW, is an assistant professor at Wurzweiler School of Social Work, Yeshiva University in New York City.

— Daniel Pollack, MSW, JD, is a professor at Wurzweiler School of Social Work, Yeshiva University in New York City.

References
1. Infusing social work and reproductive justice to advocate for women’s sexual health. The New Social Worker website. https://www.socialworker.com/feature-articles/practice/Infusing_
Social_Work_and_Reproductive_Justice_To_Advocate_for_Women%27s_Sexual_Health/. Published 2012.

2. Wright RL, Bird M, Frost CJ. Reproductive health in the United States: a review of the recent social work literature. Social Work. 2015;60(4):295-304.

3. Code of ethics. National Association of Social Workers website. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English. Updated 2021.

4. Alzate MM. The role of sexual and reproductive rights in social work practice. Affilia. 2009;24(2):108-119.

5. Gomez AM, Downey MM, Carpenter E, et al. Advancing reproductive justice to close the health gap: a call to action for social work. Soc Work. 2020;65(4):358-367.

6. Rowan D, Richardson S, Long DD. Practice-informed research: contemporary challenges and ethical decision-making. J Soc Work Values Ethics. 2018;15(2):15-22.

7. Smith BD. Reproductive justice: a policy window for social work advocacy. Soc Work. 2017;62(3):221-226.

8. Younes M, Goldblatt Hyatt E, Witt H, Franklin C. A call to action: addressing ambivalence and promoting advocacy for reproductive rights in social work education. J Soc Work Educ. 2021;57(4):625-635.

9. Women’s health. Centers for Disease Control and Prevention website. https://www.cdc.gov/women/index.htm

10. Price K. What is reproductive justice? How women of color activists are redefining the pro-choice paradigm. Meridians: Feminism, Race, Transnationalism. 2010;10:42-65.

11. Ross L. Understanding reproductive justice: transforming the pro-choice movement. Off Our Backs. 2006;36:14-19.

12. Ross L, Solinger R. Reproductive Justice: An Introduction. 1st ed. Berkley, California: University of California Press; 2017.

13. SisterSong; Women of Color Reproductive Health Collective. Understanding reproductive justice. http://www.sistersong.net/publications_and_articles/Understanding_RJ.pdf. Published May 2006.

14. Liddell JL. Reproductive justice and the social work profession: common grounds and current trends. Affilia. 2019;34(1):99-115.

15. Reamer FG. Social Work Values and Ethics. 4th ed. New York City: Columbia University Press; 2013.

16. Uriz MJ, Idareta F, Viscarret J, Ballestero A. Methodologies for ethical decision making in social work. Yearbook of Social Work. 2017;24(1):33-54.

17. Barsky AE. Ethics and Values in Social Work: An Integrated Approach for a Comprehensive Curriculum. 2nd ed. New York City: Oxford University Press; 2019.

18. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 6th ed. New York City: Oxford University Press; 2009.

19. Congress E. What social workers should know about ethics: understanding and resolving practice dilemmas. Adv Soc Work. 2000;1(1):1-25.

20. Levy CS. Social Work Ethics. 1st ed. New York City: Human Sciences Press; 1976.

21. Linzer N. Resolving Ethical Dilemmas in Social Work Practice. 1st ed. Boston: Allyn & Bacon; 1999.

22. Loewenberg FM, Dolgoff R, Harrington D. Ethical Decisions for Social Work Practice. 6th ed. Pacific Grove, California: Thomson Brooks; 2000.

23. Berzoff J. Falling Through the Cracks: Psychodynamic Practice With Vulnerable and Oppressed Populations. 1st ed. New York City: Columbia University Press; 2012.