More Than “Filling a Void”: Addressing Systemic Barriers to Reproductive Health for Youth in LA’s Foster Care System

Upon entry to the foster care system, Belinda* was brought to a group home. During intake, they confiscated the condoms and birth control pills in her bag, noting they were contraband and not allowed.

Soon after, Belinda realized she needed emergency contraception, which is most effective when taken within five days of unprotected sex. Needing transportation and permission to leave the facility, she asked her housing manager to make her an appointment at a local clinic. The manager refused, saying that this violated their policy. They did agree to bring her to a different doctor, but she didn’t get the appointment for four weeks.

Belinda ended up pregnant.

Nationally, teen pregnancy rates are at historic lows – largely attributable to increased access to contraceptives and comprehensive and medically-accurate sexual health education. However, this trend is not true for young people in the child welfare system. By the age of 19, youth in foster care in California are two and a half times more likely to experience pregnancy and childbirth than their non foster care peers. In a county like Los Angeles (home to the largest child welfare system in the nation; a system disproportionately comprised of Black and Latinx young people) this issue is particularly complex.

Predominant stereotypes about pregnancy and youth in foster care center on what I call the “fill a void” narrative (e.g., “Those youth are just trying to create the family they didn’t have!” and “They want someone to love and to love them unconditionally!”) Like many stereotypes, this ignores recent research that highlights a sobering – and critical! – fact: more than two-thirds of youth in foster care in California who have been pregnant (or gotten a partner pregnant) do not describe those pregnancies as intended or wanted. The “filling a void” story is an easy way for people in power to ignore the systemic issues that prevent two-thirds of young people in California’s foster care system – mostly young people of color – around having the power to decide when, if, and under what circumstances to get pregnant and have a child.  

Victoria* became pregnant at 16. While at a doctor’s appointment, the health care provider told Victoria’s foster parent without her permission.

While not planned, she decided she wanted this baby. Her foster parent told her that if she had a baby while in foster care, the child welfare system would take the baby away.

Victoria decided to run. She lived on the street and chose not to get prenatal care because she was sure that the health care system would not honor her confidentiality and would report her. At 32 weeks, she ended up giving birth to a stillborn baby boy on a bathroom floor.

In the hospital, she learned that prenatal care would have prevented the tragedy.

For decades, the leadership team for the Los Angeles Reproductive Health Equity Project for Foster Youth (LA RHEP) has represented, advocated for, litigated on behalf of, provided services to, and amplified the voices of thousands of young people in Los Angeles’ foster care system. Young people who look like Victoria and Belinda. Young people who may have missed sex education due to frequent caregiver and school changes, are too embarrassed to ask their caregiver for help scheduling a sexual health doctor appointment, or are coerced into a particular birth control method or none at all. Young people who, while dealing with trauma, are tasked with navigating a complicated ecosystem in which the dozens of adult professionals are experiencing “diffusion of responsibility,” or to put it simply: everyone thinks that its someone else’s job to support the healthy sexual development of youth in care.

LA RHEP brought our leadership team together to work towards sustainable, population-level change, in partnership with impacted young people. A private-public collective impact campaign, LA RHEP intends to dismantle the systemic barriers that impede youth in Los Angeles County foster care from accessing sexual and reproductive health care and exercising their rights. We aim to significantly reduce the inequitable reproductive health outcomes and experiences that disproportionately impact youth in foster care, including high rates of unintended pregnancy and sexually transmitted infections, obstruction of access to care, and lack of sexual health education. My organization, the National Center for Youth Law, plays the coordinating role for LA RHEP. We want to center the agency of young people and ensure they have the information and power they need in order to realize their own choices – whatever those choices may be.

We understand and acknowledge that because sexual and reproductive health intersects in complex ways with many systems, working toward sustained and meaningful change requires a strategy that engages our heads, hearts, and hands:

“HEAD” | LA RHEP works shoulder-to-shoulder with our child welfare partners to support implementation of the California Foster Youth Sexual Health Education Act in an effort to ensure that all young people in Los Angeles’ foster care system know their sexual and reproductive health rights, have access to care, and obtain comprehensive sexual health education in school.

“HEART” | LA RHEP engages an active Youth Advisory Board to inform our work in all areas, to center the lived experiences, voices, and expertise of young people, and to engage in narrative-change work that focuses on system change instead of individual blame.

“HANDS” | Trauma-informed and culturally-responsive education and training opportunities are a key strategy to increasing local capacity to support the reproductive health of young people. LA RHEP provides and/or evaluates sexual health education for social workers, foster caregivers, members of the juvenile court system, health care providers, and young people themselves – and we share our learnings with the field.

This work – particularly the focus on shifting harmful beliefs about what it means to support young peoples’ reproductive health – is personal for me, as a Black mama to two young boys. I will never forget sinking deep into my chair when my undergraduate adolescent development professor proclaimed that Black girls were disproportionately more likely to experience teen pregnancy because we were “seeking comfort and escape from the hopelessness of living in the ghetto.”

Until we stop blaming and shaming young people without addressing the structural drivers of inequity that create the conditions that obstruct youth in foster care from making their own informed decisions about their own bodies and reproductive lives – we will miss critical opportunities to amplify the voices of the most impacted and create meaningful and sustained change. 

*Not her real name

At the National Center for Youth Law, Lesli LeGras Morris directs the LA Reproductive Health Equity Project for Foster Youth, a collective impact campaign with the audacious goal of dismantling systemic barriers that prevent youth in LA’s foster care system from taking ownership of their reproductive decisions. LeGras Morris’ laser focus on galvanizing collective commitment to promoting equity for marginalized young people is driven by her lived experiences as a Black womxn, born-and-bred resident of South LA, and mother to a joyful infant and vivacious preschooler.