Upstream is a reproductive health organization that utilizes a Reproductive Justice framework to inform our approach and our program.

Upstream shares the commitment of Reproductive Justice organizations to equity and justice. Upstream is a reproductive health organization and, as such, we aim to be supportive of, amplify, and be in solidarity with Reproductive Justice organizations. 

SisterSong Women of Color Reproductive Justice Collective defines Reproductive Justice as the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities. The term was originally created by African-American women in 1994 after the International Conference on Population and Development in Cairo. Today’s framework moves women’s reproductive rights past a legal and political debate to incorporate the economic, social, and health factors that impact reproductive choices and decision-making ability.

Examples of how Upstream acts to align with the principles of the Reproductive Justice framework include:

• We work with our partners to create access to contraceptive care that is patient-centered. Each person is the expert in their own lives, and should have the ability and resources to make decisions that concern their own body and reproduction. Conversations around contraception should support patients to make these decisions based on their self-identified needs, goals, and desires. This includes allowing patients to freely make and act on decisions to choose or not choose any particular birth control method, or to stop, remove, or change a method on their terms.
• We center the patient’s experience with our healthcare providers. We facilitate surveys at health center partners that assess the quality of a patient’s visit, including whether or not they felt supported and listened to by their provider, and if they were in charge of making their own healthcare decisions. We also conduct focus groups and listening sessions, as well as have a dedicated department focused on patient engagement and support.
• We implement the National Women’s Health Network and Sister Song’s LARC Statement of Principles in our program and in every interaction we have with health care agencies. There is no “one size fits all” contraceptive method, and some patients are seeking contraception for benefits in addition to, or other than, pregnancy prevention. We share this commitment on our website and utilize it when describing our approach.
• We encourage the health centers that we work with to take action (e.g. staff training, agency assessments) around staff and agency bias that could lead to coercive practices in contraceptive care and broader healthcare experiences.

Upstream believes in and is committed to the principles of the Reproductive Justice Framework. Examples include:

• We strive to utilize the expertise of the people living and working in the communities where our health center partners operate. We believe people rooted in the communities where we work, with knowledge of a region’s unique history and cultural context, play a significant role in ensuring competent, appropriate, and respectful contraceptive care.
• We believe that patients should have access to the full range of contraceptive methods, and ensure that our work with health centers focuses on identifying and removing barriers to every method, not just IUDs and implants.
• We acknowledge the history of bias, coercion, oppression, and violence in contraceptive care and management—particularly directed at people of color, members of the LGBTQIA+ community, individuals with disabilities, and other groups that have been targeted by reproductive oppression and/or left out of reproductive health conversations—and highlight these injustices in our training content.

Upstream has taken the following steps to further our own learning and growth in this area:

• Connecting with individuals and organizations in the Reproductive Justice movement to build trust and relationships.
• Requiring all new staff to receive specific training on our patient-centered approach, the history of reproductive coercion and racism in reproductive healthcare, and recognizing bias.
• Adding more robust content to our health center training on the history of reproductive oppression in the U.S., and strengthening our content on identifying bias and addressing coercion.
• Utilizing Upstream staff to help health center staff apply learnings from the training into their day-to-day work, and to address biases that may arise.
• Providing opportunities for staff to learn about and engage with the Reproductive Justice community, including conferences such as SisterSong’s Let’s Talk About Sex. We also foster opportunities for staff to reflect on the insights they gain and how to apply them to our work.

We believe in the work we’re doing, and acknowledge that there will always be room for growth. Through continuous reflection and ongoing conversations with others, including Reproductive Justice leaders and organizations, community leaders, and patient feedback, we hold ourselves accountable to creating access to patient-centered contraceptive care.

We recognize that we are one part of the broader reproductive health landscape, and we are grateful to the organizations that are leading the rights and justice work to support people in achieving their full potential. Upstream is committed to modeling Reproductive Justice principles among our staff and with our health center partners. Our focus is on giving credit, space, visibility and power to the people who have been leading Reproductive Justice work for a long time; not for Upstream to be viewed as a leader in this movement. To that end, please visit and support SisterSong, Black Mamas Matter Alliance, Forward Together, and many more to learn more about their leadership and impact.

This page was created and informed by members of the Upstream staff at all levels of our organization following internal and external discussions and learnings. We are on a journey and as such, we welcome feedback, suggestions, and ideas about our approach.