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© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Background Systemic racism in Canada’s healthcare system continues to contribute to sexual and reproductive health and rights (SRHR) inequities for Indigenous, Black, and womxn of colour. We continue our series on Reproductive Justice (RJ) in Reproductive Health, by highlighting the issue of systemic racism in the context of Canadian SRHR healthcare provision and patient care. In this commentary, we broadly discuss the macro policy and meso organizational structures that contribute to SRHR inequities among racialized individuals and communities. In “Structural Racism, Institutional Agency, and Disrespect”, as argued by Pierce [1], to fully comprehend systematic racism, we must observe the power dynamic, and this “must be understood in terms of injustice rather than disrespect”. This “involves giving a fuller account of how institutions are related to the beliefs, actions, and intentions of individuals, and how they can come to embody a certain kind of agency” [1]. This helps us understand racism from a macro perspective, which can then be followed by an analysis at the institutional and individual levels. These structures, rooted in colonial practices and racial oppression, include Federal and Provincial/ Territorial policies that set the stage for educational systems (i.e., admission processes, training, and licensing of health care professionals) and healthcare systems that perpetuate racism experienced by Indigenous, Black and people of colour (IBPOC) at point of care. By design, these macro level structures facilitate opportunities for the dominant group, thereby reinforcing white privilege throughout meso level institutions and organizations. At the individual level, we provide examples of the lived experiences of racialized groups in Canada who face racism daily within the healthcare system, leading to worse SRHR health outcomes compared to their white counterparts [2]. Once again, we call for policies and programs designed with a Reproductive Justice lens in Canada; we need to dismantle current oppressive structures and create systems of delivery that acknowledge and understand lived SRHR experiences of IBPOC communities [3].