On June 24th, 2022, the United States Supreme Court’s ruling on Dobbs v. Jackson overturned Roe v. Wade, upending the constitutional right to abortion after nearly 50 years of protection. This decision was a catastrophic blow to reproductive rights and is already creating disastrous impacts nationwide––limiting access to healthcare, instilling fear and insecurity in individuals, and exacerbating a culture that centers on having control and power over people.

South Asian SOAR (SOAR) is witnessing South Asian survivors, communities, and organizations be disproportionately impacted by this decision, as it represents an ongoing assault on bodily autonomy orchestrated by the state over decades. As we attempt to understand the impact of this on the South Asian diaspora in the US, we must acknowledge that ours is a diverse diaspora across ethnicity, language, religious beliefs, caste, class, gender, ability, insurance status, immigration status, and other facets of identity. However, these experiences have often been neglected and overlooked in sexual and reproductive health research, primarily due to the scarcity of disaggregated data on specific Asian and AANHPI subgroups, as well as the perpetuation of the model minority myth.

Through this briefing, we aimed to take a step towards closing this gap in understanding the sexual and reproductive health barriers and needs of South Asians in America. To do this, we turned to our collective of organizations, made up of 32 community-based organizations that predominantly serve South Asian survivors of gender-based and interpersonal violence and who serve as a hub for awareness-raising, education, and increasing access to healthcare for South Asian communities. From April to June 2022, our team conducted a series of three listening and discussion sessions to capture both the immediate and long-term needs on the ground.

The following summary of our listening sessions outlines urgent and strategic areas of investment that directly respond to the needs and challenges experienced by South Asian survivors, communities, and community-based organizations:

At A Glance: Attitudes

• 41% of South Asian voters in Texas name abortion rights among their top issues that they believe Congress should prioritize (Source: Data for Progress)

• 68% of Hindus in America and 55% of Muslims in America believe abortion should be legal in all or most cases (Source: Pew Research Center)

• In Sikh American communities, 59% have either had an abortion or know a Sikh person who has had an abortion (Source: Sikh Family Center)

At A Glance: Access & Needs

• A 2021 study found that Indian Americans have the highest abortion rate among Asian Americans in New York City. (Source)

• A 2005 study of South Asian women found that approximately 39% of participants in qualitative interviews indicated that there was an unwanted pregnancy in their abusive relationship due to a lack of sexual and reproductive control in the relationships. (Source)

Barriers to Accessing Reproductive Healthcare

Across the US, there are nearly 40 organizations that serve South Asian survivors of gender-based violence, and beyond that—they are often the site of offering sexual and reproductive health education, supplies, and support. Alarmingly, nearly one-third of US organizations serving South Asian survivors of GBV are in threatened states, including Texas, Florida, Georgia, Michigan, and more. These organizations are grappling with fear and confusion as they navigate rapidly changing laws around reproductive health access. At the same time, South Asian GBV organizations in states where abortion and healthcare access remains accessible are preparing to face an influx of referrals and requests for care and support from other states.

For South Asians who already experience economic, linguistic, cultural, social, ability, immigration-related, and/or legal barriers, the lost right to an abortion will force the most marginalized in our diaspora to either forgo reproductive healthcare altogether or accept compromised care. This is especially true for working-class people, disabled people, Queer and Trans people, caste-oppressed people, and survivors of gender-based violence. 

The presence of these barriers exacerbates existing inequities, limits individuals' autonomy in making reproductive healthcare decisions, and ultimately leads to poor physical and mental health outcomes. It is imperative to address and overcome these challenges in order to ensure equitable access to comprehensive reproductive healthcare for South Asian survivors and communities.

Below, we offer a high-level understanding of the experience and impact of some of the most significant systemic and cultural barriers:

Systemic Barriers to Reproductive Health

1. Lack of linguistically-accessible & culturally-relevant resources

The South Asian diaspora is incredibly linguistically diverse: hundreds of languages are spoken across South Asian ethnic subgroups. In a recent poll of SOAR’s member organizations, community-based organizations offer services in over 20 South Asian languages. The ability to access care in one’s language at best “enhances trust between patients and physicians, optimizes health outcomes, and advances health equity for diverse populations;” at worst, it “diminish[es] patients’ sense of integrity and intensifi[es] their vulnerability in the clinical setting” leading to poor health outcomes. (Source)

2. Limited or compromised healthcare access due to immigration, insurance, & income status

As mentioned, there is severe income disparity across the South Asian diaspora in the US, with Pakistani, Bangladeshi, and Nepalese communities experiencing some of the highest rates of poverty among Asian Americans in the US. A recent poll of SOAR’s member organizations showed that approximately 40% of their clients are unemployed or underemployed and a majority of clients are not U.S. citizens.

In addition to challenges faced in accessing and navigating public benefits and health insurance, “current policies severely limit the ability of recent AAPI immigrants and their families to obtain affordable health insurance, which leads to higher rates of uninsurance and negative health outcomes for these populations.” (Source)

3. Gendered & cultural biases within mainstream medical spaces

Many South Asians may find more comfort in seeking health care from other South Asian, Asian, or BIPOC providers as mainstream providers often hold biases or stereotypes that are informed by systemic racism, colonialism, and model minority stereotypes. Community-based organizations also identified the lack of culturally responsive sexual and reproductive health providers as a barrier to finding care for their clients.

Cultural Barriers to Reproductive Health

1. Stigmatization and taboos around sexual and reproductive health topics, including sex, contraception, and sexual violence due to culture and religion

Community-based organizations noted the overwhelming prevalence of stigma around topics of sex, sexuality, and sexual violence. They noted that stigma can often lead to additional layers of shame, isolation, and stripping away of autonomy to make empowered and informed decisions about consent, contraception, and more. Oftentimes, because of the silence around these topics, it can be challenging for both survivors and advocates to find the right language and terminology to hold a conversation about them. These barriers lead to a fear of discrimination, judgment, extreme discomfort, and isolation.

2. Harmful patriarchal and gender dynamics that entrench a culture of gender-based violence

A lack of educational resources and dialogue on topics of sexual and reproductive health in community and familial settings has profound and dangerous consequences for South Asians. This is further exacerbated for the marginalized groups mentioned above, especially survivors and LGBTQIA+ South Asians who face even greater challenges in dismantling traditional patriarchal and gender dynamics.

In this cultural context, where traditional gender roles are still deeply ingrained, individuals may face significant barriers in accessing necessary healthcare and exercising their rights. For instance, within healthcare settings, the presence of husbands or mothers-in-law who assert control over decision-making can restrict a woman's ability to express her concerns or voice her needs. This lack of agency can have detrimental effects on their physical and mental well-being, as their health concerns may go unaddressed or dismissed.

Moreover, the perpetuation of traditional gender dynamics can reinforce harmful societal norms that perpetrate gender-based violence and restrict individuals' freedoms. The suppression of voices, limited access to information, and the absence of open dialogue about sexual and reproductive health contributes to a culture of silence and submission, creating an environment where violence and abuse can flourish.

What’s required to meet South Asian survivors’ and communities’ needs in the near-term

Challenges for South Asian survivors, communities, and organizations:

• Misinformation by harm-doers or abusive partners about the state of abortion access in their communities to pressure survivors and influence their decision-making

• Lack of awareness and resources about changing laws and rights amidst bigger crises such as gender-based violence or abuse 

• Alienation from resources for immigrant, non-English speaking, and low-income individuals 

• Religious and cultural stigmas towards birth control, contraception, and abortion

Needs of South Asian survivors and communities:

• Linguistically-accessible, culturally-tailored, and gender-inclusive trainings and resources for clients and community members regarding reproductive health, sexual health, and reproductive rights

• Financial assistance to access abortion, sexual, and reproductive healthcare, including but not limited to, medical care, transportation, accommodation, meals, childcare, and mental health services

• Supplies for reproductive and sexual health, including but not limited to, contraception, abortion pills, menstruation supplies, birth control, and recovery supplies

Needs of community-based organizations:

• Unrestricted funding and general operating support to meet the urgent and complex needs of South Asian survivors and their families mentioned above

• Linguistically-accessible, culturally-tailored, and gender-inclusive trainings and resources for staff regarding reproductive health, sexual health, and reproductive rights

• Support to conduct outreach to survivors and community members about reproductive health, sexual health, and reproductive rights

• Legal support and resources to navigate quickly changing laws and policies that determine how organizations can and cannot support their clients and communities

What’s required to advance reproductive healthcare in the long-term 

As we continue to respond to the urgent reproductive and sexual health needs of South Asian survivors, communities, and GBV organizations, we are keeping a pulse on long-term needs as well. Factoring in the ever-increasing social, health, and economic costs of abortion, SOAR anticipates that the need for childcare, transportation, financial assistance, counseling, and more will increase. 

On an organizational level, while many community-based organizations provide reproductive and sexual health support as part of their existing programming, SOAR recognizes the need for an expansion of funds and resources that establish long-term, sustainable programming that adequately provides accessible, culturally-tailored reproductive and sexual health support services for South Asian communities.

From a policy and research perspective, we uplift all of the needs and recommendations raised in the recently-published agenda: Visibility, Voice, Vision: Asian American and Pacific Islander Reproductive Justice Agenda, which calls for:

• Immigration Reform That Centers Families;

• Accessible And Affordable Health Care;

• Decriminalization Of AAPI Bodies;

• Eradicating A Culture Of Gender-Based Violence;

• Economic Opportunity And Access;

• Ending Us Militarism And Supporting Aapi Communities Impacted By It;

• Honoring And Protecting AAPI Neighborhoods, Communities, And Homelands;

• Racial Justice;

• Language Access; and

• Data Disaggregation In All Agencies.