LAUSR

Comprehensive reproductive health care for people with chronic health conditions is reproductive justice in action. As the authors in this special series have underscored, lack of quality, coordinated, and respectful reproductive care for this population leads to infertility, mental distress, untreated and misunderstood health problems, and altered life courses that can result in maternal mortality and morbidity, poor outcomes for infants, and exacerbation of conditions that have lasting impacts on people with chronic conditions and their families. Improving reproductive wellness requires the engagement of many system actors, identified by Hassmiller Lich et al., as health care institutions, medical leaders, medical providers, patient advocates and foundations, patients and families, payers, policymakers, and research funders. Their research identified 40 pain points and 46 corresponding action items for change. Their systems approach to problem solving underscored that there is not a single lever or action that can affect broad reform; rather, this is a time that calls for complex thinking and work happening simultaneously across sectors and systems. Their call for collaboration across all sectors was answered in part by the research of Goodsmith et al., who explored the acceptability of integrating reproductive goal assessment into mental health service provision. While the timing and approach need to be carefully considered and based on a foundation of trust, patients and providers alike expressed an interest in and the value of opening space for conversations about having or not having children. Thematic across the papers in this special series is the urgent call for health care providers and professionals to invest time in understanding and addressing their own biases—overt and covert—on the reproductive care they provide to patients with chronic conditions as well as building their knowledge on the most current treatment options available. Opening opportunities for conversations about reproductive goals is especially important for people with chronic conditions, for whom the stakes are high for their own health as well as that of their family and future children, if desired. These conversations must be based on a foundation of trust and, if done well, can be a bridge to comprehensive care and well-being. There are resources available for people as consumers of information at ShowYourLoveToday.com and for people in their role as professionals at BeforeandBeyond.org. In response to the work elevating lived experiences, a patient research advisory group is being developed to provide feedback to researchers. There is a group of change agents that meets quarterly to advance this work. Reach out to the author if you are interested in engaging further. The research and expertise shared across the 12 articles in this series offer a wealth of ideas and strategies for advancing care for this population, including the opening commentary that offers a clear model for change. The next steps are up to readers. The answers are there; now we must find the moral courage and collective response to make it happen.