One 

She lay on the hospital bed, staring vacantly at the ceiling—as if somewhere far beyond the fluorescent lights. She was an Aboriginal woman from Boulder, close to Kalgoorlie in central Western Australia. She showed no flicker of engagement. No smile, no touch to her belly.  She was still. Her arms lay stiffly by her sides, not cradling her bump, not moving at all. It was as though the baby inside her was not hers, just something growing through her, not with her. She was alone. Her notes revealed this was her second child, the first being in state care. The Department of Child Protection (DCP) was already involved in this pregnancy, concerned about financial instability, considering whether or not she would opt for a long-acting contraceptive method to prevent future pregnancies. Why bond with a baby you know may be taken away? 

Two 

She sat across from myself and my supervising obstetrician, in an antenatal clinic in rural India. She was young, maybe in her mid-twenties, just older than me, with a small child on her lap. She looked older, her eyes weary, her salwar faded. She told the obstetrician that she had found out she was pregnant, and that she didn’t want to be. The obstetrician nodded. That was all. Within the hour, we were in theatre. A surgical termination was performed, and an Intrauterine Device (IUD) inserted. No paperwork. No discussion of options. No explanation of the procedure. No consent for the IUD. She was told to return in five years.  

These women, separated by oceans, united by dispossession, are threads in the same story. A long story that reminds me that reproductive healthcare is never just clinical. It is cultural. It is personal. It is political. This was what first drew me to the field: the belief that reproductive care could provide autonomy and empowerment across every aspect of a woman’s life. However, that same holistic nature is also where the vulnerability of reproductive healthcare lies. I am an Australian-educated, upper-middle-class woman and a first-generation Indian migrant who has worked in reproductive healthcare across both rural and metropolitan Australia and India. I have seen how deeply reproductive rights remain entangled with empire. Colonisation did not only take land. It claimed bodies, especially those deemed excessive, too fertile, too brown. Through these intersecting lenses, every day I confront the post-colonial realities of reproductive rights and the enduring challenge of decolonising reproductive healthcare for women of colour. 

What is the history that shapes reproductive rights for women of colour? When the results of the 1966 Australian Census came out, they revealed the Aboriginal population was rapidly growing, sparking eugenic fears of “too many brown babies.” The response was multi-faceted and insidious. Pilot projects ran on settlements and missions throughout the late 1960s, “offering” Aboriginal women contraception and setting up clinics in local hospitals. These projects were spearheaded by the “Director of Welfare,” the same “Director of Welfare” who controlled where Aboriginal women worked, travelled, who they married, and importantly, custody of their children. Many Aboriginal women at the time cite threats, both expressed and implied, that their children would be removed from them should they not adhere to contraception. Even the favoured contraceptive method for these projects is telling. The strong preference for IUDs, which are long-lasting, do not depend on correct daily use, and require a bedside procedure with no anaesthesia or follow-up, and therefore minimal process for informed consent, paints the picture of an easily subjugated, sterilised population.  

In fact, across the Indian Ocean, Indian women at this same point in history were the guinea pigs for the latest IUDs, the Libby’s Loop. Many bureaucrats worried whether the individual woman could be relied upon to take a birth control pill, with the president of the International Planned Parenthood Foundation’s World Population Division critiquing that “our methods are largely birth control for the individual, not birth control for a nation.” As part of the IUD program, funded by the American Population Council, one million IUDs were donated to India. These devices arrived unsterilised and with insufficient applicators, highlighting the disregard for safety in the program’s rollout. The Indian Government organised large-scale insertion camps targeting the poorest and most marginalised women, often with little consent. The situation only accelerated in 1965, with India threatened by famine. American aid to India was contingent on the government formally incentivising sterilisation, leading to the Family Planning Programme. This included a door-to-door campaign in rural areas and financial incentives for sterilisation. For every woman brought to a government clinic, middlemen were paid 15 rupees (USD $2). These were not trivial sums, considering that per capita gross national product was less than USD $70 a year. These campaigns exemplify a colonial ethos where reproductive healthcare was subordinated to economic and demographic goals, treating women of colour and their bodies as instruments of Western policy.  

With such a precedent, it is no surprise that women of colour continue to face colonial dispossession of their reproductive rights. Post-colonial statecraft, rather than the woman, continues to determine what constitutes responsible reproduction.  

As recently as 2003, reporters for the Australian Broadcasting Corporation (ABC) were approached by an Aboriginal woman whistleblowing about continuing coercive sterilisation in Arnhem Land. The local Katherine Hospital merely denied the claims, and no further investigation was pursued. The rates of Aboriginal children in out-of-home care currently sit at 43%, representative of a new “Stolen Generation.” When fear of child removal continues to influence the reproductive choices of Aboriginal women, we must understand that “choice” does not exist in a vacuum. Meanwhile, Indian jurisdictions offer motorcycles, televisions and even a chance to win a car to women who undergo sterilisation. Nationally, there were an estimated 3.9 million sterilisations from 2013 to 2014, often at government-organised “sterilisation camps,” at break-neck pace. One camp in Chhattisgarh in central India carried out 83 sterilisations in just six hours, leading to 11 deaths. The fervour of population control holds its roots in the persisting colonial construct, where women of colour carry the disproportionate imperative of family planning against the backdrop of reproductive, financial and social coercion. Where an Aboriginal woman whose baby was likely to be removed from her care, was encouraged to opt for contraception. Where a woman of a lower caste in India had an IUD inserted with little discussion and no formal consent.  

Three 

She lay in a hospital bed in metropolitan Australia, a day following her emergency Caesarean Section. She had not left the bed yet. She ate her roti and curry, brought in by her parents, who sat in the corner. We sternly reminded her of the importance of mobilising after an operation, detailing the risks of not doing so including blood clots and fluid in the lungs. Her baby started to cry, and her mother began to soothe it. Afterward, in the staffroom, we debriefed with the midwife who was looking after her. She hadn’t yet mobilised. She hadn’t picked up her baby. She wasn’t engaging. And then, the feared term in healthcare, so often ascribed to people of colour, she was “non-compliant.” My own sense of embarrassment, as an Indian woman myself, was acute. 

Four  

“Please don’t come into my room until you’ve read my Birth Plan.” She sat on her gym ball, surrounded by soft candlelight. On a shelf sat a pinboard of family photographs and sonograms. Music played from her laptop, set to a Spotify playlist called ‘Birth Music,’ interrupted occasionally by the rattling of the nitrous oxide machine. Her partner massaged her shoulders behind her. On the floor beneath her sat her doula, rubbing her knees. The Birth Plan was laminated, annotated, detailing everything from requests for the language and manner in which she wished to be addressed, to the level of lighting and music that should be playing, to more specific requests about interventions that she would and would not accept.  

I don’t have to look as far as government or policy to stare at the colonial incursions on reproductive healthcare. Over a handful of years of Western birth practice, we have erased traditional views towards birth that persisted for millennia prior.  

Many cultures promote and practice ethnokinship, where family support networks are central to reproductive healthcare. Traditionally, Aboriginal women gave birth in the place where they were born, with other women by their side. Young women learnt about birthing from the older generation. In India, birth is a deeply spiritual process. Like many countries out of the Western world, Indian women observe rituals of confinement, recognising the strenuousness of childbirth and insisting on bedrest and a nourishing diet. Whilst not necessarily congruent with a Western, evidence-based approach to peripartum care, good practice is recognising that health is not just physical. It is cultural, emotional, spiritual. Yet, when women of colour exercise these practices, our colonial systems are quick to label it as non-compliant.  

However, a Caucasian woman exercising similar autonomy, such as with the use of a birth plan, is celebrated, as it should be. It is an immensely positive step for women to have transformed birth from a medical event with about as much autonomy as a root canal, into a curated, empowering experience. But a step for who? Where is the birth plan for a woman who gives birth in an unfamiliar and culturally unsafe environment, thousands of kilometres away from her traditional land? Where is the birth plan for a woman who once would have given birth surrounded by a family network, and is now restricted to one visitor, and a legion of people she has never met before? How is it fair to celebrate the autonomy of one woman, and denigrate it as non-compliance in another? 

Part of the reason Caucasian women have been able to attain this level of autonomy in comparison to their counterparts is the existence of designated birth advocates, also known as doulas. The term ‘doula’ comes from the ancient Greek word doulē, meaning “female servant.” It was popularised in the 1970s by medical anthropologist Dana Raphael, who used it to describe a trained, non-medical companion who supports a birthing person. The irony of a term rooted in servitude being reclaimed and professionalised for the benefit of mostly white, middle-class women is not lost on me, but ironically, women of colour have been deprived of access to comparable figures when they give birth. These figures existed for centuries but were forced out by colonial systems.  

In India, traditional birthing models involved the use of dāīs, who acted as midwives during the colonial era. Though vilified by colonial authorities as “hags of low caste and evil repute,” they were indispensable actors in this landscape. They embodied a rich repository of reproductive expertise and advocacy. Similarly, Aboriginal cultures have had figures who were instrumental in childbirth. An example is the djäkamirr of the Yolnju people of Northeast Arnhem Land. The djäkamirr are midwifery caretakers who used ancestral wisdom to support women. When Western missionaries arrived in the 1920s and childbirth was moved to hospitals, Yolnju women became increasingly disconnected from their support systems. They now face profound health inequities, including the highest rate of preterm birth in Australia. Similar stories are seen across Aboriginal communities in Australia, where the loss of traditional practices and removal of birthing women off traditional land has impacted reproductive outcomes for Aboriginal women. These disparities remind us that autonomy in childbirth is not equally distributed. The right to a culturally grounded, community-supported, and spiritually safe birth has long existed for women of colour, yet it has been systematically dismantled by colonial powers.  

Where do we go from here? The way that we decolonise reproductive healthcare for women of colour is multi-faceted, involving government policy, grassroots movements and individual healthcare interactions. It is time to shift the narrative from dispossession to decolonisation and build health systems where culture is central to care. This shift requires that Western institutions, and those who work within them, shift their focus, be guided by traditional knowledge systems, and unlearn their assumed authority.  

We must move away from policies that view reproductive rights through the lens of numerical outcomes, which echo the paternalistic logic of colonial family planning policies. Instead, funding must be directed toward culturally safe, community-controlled health services. Policies should prioritise the expansion of grassroots health organisations, the formal recognition of traditional midwifery systems, and long-term investment in training community members to deliver care within their own cultural frameworks. 

The Birthing on Country movement in Australia is a powerful example of this. It prioritises Aboriginal governance, strengthens cultural identity, and integrates holistic care into mainstream services. Programs like Caring for Mum on Country in Yolŋu Country work with local women to address perinatal inequities. These programs combine evidence-based Western maternity care with cultural practices delivered by djäkamirr, who are trained in both Western midwifery and Yolŋu knowledge systems. The outcomes have been significant; improved antenatal engagement, higher breastfeeding rates, and reduced preterm births. These results demonstrate that culturally safe care not only protects reproductive rights, but also leads to measurable improvements in reproductive outcomes.  

Similar to the Birthing on Country model, we must also reevaluate the role of traditional knowledge for all women of colour, particularly in areas where health services are inaccessible or coercively delivered. In India, organisations such as Motherhood and Traditional Resources, Information, Knowledge, and Action (MATRIKA) recognise the worth of Indigenous birthing knowledge. Instead of replacing it with Western models, MATRIKA works alongside dāīs to learn from their methods and preserve their practices. This collaborative approach maintains cultural integrity while offering practical alternatives to state-led biomedical care. Although these efforts may seem small in scale, they empower women to resist and reshape the colonial systems that have excluded them and tangibly improve reproductive outcomes. It is essential that more time, energy and resources are devoted to their expansion. 

Decolonising methodology also requires rethinking how we evaluate interventions and produce knowledge. Much of what we consider evidence is shaped by Western biomedical models and the academic rigour they prioritise. Effective reproductive healthcare must also be assessed by less quantifiable outcomes such as the ability to foster trust, preserve cultural integrity, and build lasting relationships between healthcare providers and communities. We must move away from dismissing cultural practices as unscientific and instead engage with communities to understand their physical, emotional, and spiritual significance. These practices should be documented respectfully within health literature and integrated into current models of care, much like a birth plan is read, acknowledged, and acted upon. Crucially, knowledge must remain with the communities from which it originates, shared through their own systems of transmission including oral traditions, traditional languages, and intergenerational teaching. Elders and community leaders must be recognised not as sources of information, but as co-creators and custodians of knowledge. 

Much of this transformation requires institutional humility. We must change not only what health professionals learn, but what we are willing to unlearn. Assumptions of neutrality, superiority, and universality underpin much of Western medical education. Medical curricula must include the histories of colonial medicine, the epistemologies of traditional healing systems, and the ongoing impact of colonialism on health, and how we can work to change this.  

Finally, decolonised reproductive healthcare comes down to individual interactions. I have critically examined my own practice, and so should others who are privileged to be delivering reproductive care. Every day has been a journey, foregrounded by the stories of women. They remind me to deepen my knowledge of the colonial legacy of reproductive healthcare in the places that I move through. To take a step back, to allow them to speak. To ask questions and care deeply about the answers. To unlearn what I see as medicalised norms, and the discomfort I feel when they are challenged. To treat these challenges with respect and collaboration, not opposition. To hold myself accountable not to outcomes, but to relationships. To question myself constantly, as to whose knowledge I am centring. In honouring these women, I commit to a practice of care that is culturally humble and always in conversation with those who have been spoken over for too long. 

Five 

“I would like to discuss my birth plan.” It was a conversation between the woman, her doctors and midwife, her partner, and the dai who accompanied her. It detailed many things, each of which were listened to and explored. She would be observing 40 days of confinement, and asked that the hospital provide other options to help reduce her risks of blood clots and fluid in the lungs. She asked if it would be possible to have another bed in her room after birth, so that her mum could stay with her. She was still unsure about what contraception she wanted to use after birth, but felt that she knew enough about all of the options. She left the conversation feeling heard, empowered and knowledgeable.  

Six 

She birthed on her traditional land, like her mother and her grandmother before her. The same land where she was born, the deep red dirt scorched with the fresh blood of so many women and babies before her. In a few days, they would find a place in that dirt to bury her placenta, so that her baby could be brought into the land. The woman who was looking after her, looked like her. She taught things to the midwife from the local health service, who was there too. Around her were her sisters, her aunties, her mum. They all coached her through each wave of pain, singing songs to welcome the baby’s wäŋa, its spirit. In time, she would hold her baby, without fear of it being taken away. She wasn’t a patient here, just a woman, a woman continuing a sacred lineage.