How to Train the Next Generation of Activist Scientists
By Anjanique Mariquit Rosete Lu
In December 2018, The New York Times published an article presenting perspectives on the role of long-acting reversible contraceptives in reducing poverty.1 A few weeks later, a second article raised concern that these perspectives bias physicians into coercing marginalized groups to use contraceptives.2 Read together, the articles consider issues of reproductive health that extend beyond individual choice and into structural inequities.
I emailed the articles to first-year medical students involved with Reproductive Health Advocates (RHA), a student-led organization at the University of Miami. RHA pairs student advocates with patients seeking reproductive healthcare in Miami, Florida. My fellow third-year advocates and I prepare new advocates using a ten-hour curriculum that covers reproductive services, phone counseling, and policy barriers.
In response to my email, one new advocate expressed gratitude that RHA was beginning to address reproductive justice. I thought, “Beginning to?” Her response prompted me to review our hundreds of curriculum slides. What I found was a training that focuses primarily on technical skills required to counsel patients and navigate the healthcare system—a training that does not do justice to the value of advocacy espoused in our organization’s name. Our curriculum fails to explicitly name racism, sexism, xenophobia, and the many systems of oppression that lead to reproductive injustices. Without the ability to recognize oppression, our advocates could not be expected to play a direct role in promoting reproductive justice for the patients we serve. What we need is a curriculum that helps our advocates develop as activists.
In reproductive health and across all the sciences, activist curricula provide the next generation of scientists with the tools to ensure that our work fights for the vulnerable. This article will explore the need for activist education in the sciences, examples of institutionalized curriculum initiatives, and ways that individual scientists can start to teach activism in our organizations.
Why an Activist Curriculum
One of the first things emphasized in the elementary science classroom is the long-held principle that science is an objective pursuit. But as we know, science has always been political. Throughout history, scientists and scientific institutions have exploited marginalized peoples for research and advanced theories based on discrimination and racism.3 Without an activist curriculum that addresses these histories, unjust practices will inevitably continue.
In reproductive health in particular, scientific prejudice is evident in the eugenics movement of the twentieth century. Scientists studied the inheritance of human traits in hopes of eliminating those considered inferior. Eugenics targeted characteristics that allowed people in power to subjugate people of color, people who were poor, were imprisoned, with disabilities, and with behavioral conditions.4 In the US alone, over 60,000 individuals across 32 states were subjected to compulsory sterilization between 1907-1981, with innumerable additional individuals affected across Puerto Rico, Guam, the Philippines and other current and former US colonies.5 The mission of eugenics—to manipulate populations—manifests today in many ways such as coercive reproductive counseling practices and interference with immigrant women’s pregnancy options.6
Not all health professionals look the other way in the face of injustice. In the 1990s, lawmakers across the US offered financial incentives for women on welfare to receive the contraceptive Norplant. Dr. Sheldon Segal, the physician scientist who led the development of Norplant, responded strongly, “Those who suggest using Norplant for involuntary or coercive sterilization or birth control will find me leading the opposition.”7 This sentiment strengthened visibility of existing activist opposition. As a result, coercive policies were largely abandoned. (It is necessary to note that Segal was the biomedical director for the Population Council, an organization originally founded by eugenicists in the 1950s and that has continually struggled to improve its population politics.8)
Stories like this demonstrate the need for activist scientists across all scientific organizations. At the root of the many definitions of activist is the desire to enact change. In the past few decades, Science for the People and various global campaigns have asked scientists to engage in change and to prevent science from causing or perpetuating social harm. In the same vein, RHA selects student advocates who express passion for changing the reproductive health field. Manifesting this change starts with the training that these advocates receive, one that up until now has fallen short in helping our advocates safeguard against patient mistreatment.
When we review gynecological instruments in our technical modules, we fail to mention that the modern speculum’s predecessor was invented by J. Marion Sims. Sims built his career in gynecologic surgery by experimenting on Black slaves without anesthesia, likely bolstered by the assertion of pro-slavery physicians at the time that Black slaves feel less pain.9 This myth is perpetuated today, as physicians underestimate Black patients’ pain and are less likely to provide epidural anesthesia to Black and Hispanic women in labor.10 When we teach students about contraceptives, sterilization, and policies that limit local access to reproductive health options, we vocalize vague, distant-seeming histories of reproductive coercion in the US, but don’t provide contemporary evidence. Our students never learn about court-sanctioned contraceptives and sterilization of prisoners in the 2000s, with even more recent cases from California, West Virginia, and Tennessee.11 During role-play counseling scenarios, our leadership team doesn’t caution that Black and Latina women in the US are more likely to feel pressured to use contraceptives and more likely to be offered IUDs than their white counterparts.12
Adding these missing elements to our training would encourage advocates to promote our patients’ well-being more comprehensively. If advocates are made aware of these histories, they will be more likely to believe Black and Hispanic women’s pain, to check themselves against coercive counseling practices, and to engage in research that fights coercive policies. Such historical narratives are necessary in all scientific training because they prioritize the experiences of marginalized communities that are impacted by scientists.
Institutionalized Activist Curricula
In the past two decades, there have been renewed efforts to formally integrate activism and social justice into science curricula at all levels of learning, from elementary to postgraduate education. Collaborations such as the Journal for Activist Science and Technology Education (JASTE), the Science and Social Justice Project, and the Social Medicine Consortium bring expert scientists, activists, and educators together to further the pedagogy and praxis of social justice and activism in North America.13 Scientists are organizing to incorporate activist education within their respective fields as well. In 2017, the US National Council of Mathematic Teachers released a call-to-action for equity and social justice in math curricula.14 Engineering, Social Justice, and Peace, another professional organization, holds an annual conference and publishes a journal that highlights engineering practices to enhance equity.15 An increasing number of North American medical schools have sought to expand social justice curricula beyond cultural competence.16
One physician at an academic medical center, Sayantani DasGupta, describes that she and her fellow educators encourage scientific activism by giving their resident trainees dedicated time to collaborate with community-based organizations.17 As a result, her trainees have established health programs at local schools and hosted voter registration drives in the clinic. One lecture asked trainees to search for emergency contraception at local pharmacies. Through this activity, trainees experienced the barriers their patients face and took on more leadership in improving emergency contraception access in their community. Such curricula actively develop the next generation of activist scientists.
Nevertheless, institutionalized activist education remains sparse across all fields of science. These initiatives are not available at every institute or are not mandatory training for all members. Education promoting activism is considered radical or marginal in some fields, largely because it clashes with the longstanding “hidden” curricula which values scientists who refrain from social critique.18
At institutions that do incorporate activism and social justice into training, the resulting lectures vary in approach, reach, and effectiveness. Administrators who wish to fulfill the higher education checkboxes of “diversity” and “inclusion” may misunderstand that these values do not equate to lessons on justice and anti-oppression. As a result, initiatives are left underfunded, insufficient, and as the burden of employees of color, some who lack expertise or passion for the subject.19 It should not be expected of the historically marginalized to teach their privileged peers. Well-meaning educators do students a disservice by describing cultures homogeneously and providing no context of the power structures that shape culture.20 Service-learning, in which students engage in community volunteering, has long been theorized to foster understanding of cultural differences.21 However, service groups may uphold elitist and imperialist ideologies such as “the white man’s burden,” ultimately harming the very communities they serve.22
Even when scientist educators do possess expertise in activism, they often find their work subverted to appease institutional neoliberal agendas.23 Educator Arturo Rodriguez describes neoliberal education in the sciences as advancing “the production of workers, everyday tools for the expansion of empires, a police state, and the war machine.”24 In other words, liberal learning objectives are welcomed only when they align with the goals of the socioeconomic elite.
A group of women-of-color faculty at a medical school experienced this clash firsthand. They had initially built momentum amongst themselves in developing an anti-racist curriculum at their institution. Once they began including well-intentioned white male administrators, the group dynamic and educational goals changed. One minority faculty member recalls, “I had to put on my armor and fight” to justify aspects of the curriculum proposal that white faculty members found too “radical” or “political.”25
If scientists are to prioritize the oppressed, activist curricula must be radical and political.26 In his 1970 work Pedagogy of the Oppressed, Brazilian educator Paulo Freire emphasizes education as a means to develop sociopolitical consciousness—conscientização.27 His philosophies, termed critical pedagogy, are often applied by activist scientists to challenge neoliberal agendas. Critical pedagogy asks that teachers be allowed to engage students in social critique, to dismantle systematic oppression, and to value radical political engagement.28 These critical goals are not always fully realized in scientific organizations. At the institutional level, progress varies in meeting Freire’s appeal that students be taught to “read the world” in order to deliver socially responsible contributions to communities.29
Starting an Activist Scientist Curriculum
Without the benefit of an institutionalized activist curriculum, individual scientists are resource-strapped to incorporate activism in student organizations, project committees, and other less formal educational settings. For those readers who, like me, have long considered themselves more of a scientist than an educator or activist, how do we build an activist curriculum? After all, knowing about systems of oppression isn’t the same as teaching about systems of oppression.
The task of teaching activism may seem daunting until that task is viewed as a continuous process of improvement. Steve Alsop and Larry Bencze, activist scientists with JASTE, caution against the “somewhat romanticised notion of activist knowledge and practices as being necessarily […] superior to other practices”.30 Those who find themselves charged with instructing others should strive for an environment that allows for mistakes and encourages feedback, self-reflection, and refinement. As Freire posits, students benefit when instructors take on the role as informed facilitators of student learning rather than the “depositors” of information into the mental vaults of learners.31
This still leaves a vital question: where do we start in our process? I identified five fundamental themes emphasized across current activist curricula initiatives, and explored how these themes serve as a springboard for my RHA co-leaders to further our curriculum. My hope is that these five themes can be a starting point for other scientists to improve how they train in their field.
1) Examine History and Policy
Storytelling is perhaps the most attainable first step for an individual educator to undertake. Alsop and Bencze assert that activist science curricula must “reflect on the ways in which dominant policies and practices serve to sustain particular social structures and subjectivities.”32 A story about science contributing to bigotry serves as a powerful cautionary tale. A story about science acting to dismantle unjust systems serves as an inspiring anecdote. Students can harness these narratives to envision how their own work should shape future science policy.
The majority of RHA’s patients are from historically vulnerable communities: immigrants, people of color, undocumented folks, and minors. Future lessons will review US eugenic policies that hurt populations we serve. One story that reproductive justice activists often tell is that of the Relf sisters: two Black teenage girls who were involuntarily sterilized without consent in 1973. The ensuing court case uncovered many similar stories and highlighted the need for stricter informed consent.33 Paired with modern patient narratives of coercion, the story demonstrates to new advocates the need for appropriate patient counseling and continued policy reform.
2) Introduce Activist Theories
Alongside knowledge of past examples of exploitation, students must gain an understanding of systems of oppression and power disparities. Training can easily introduce relevant activist theory first through assigned readings by activist scholars. Many activist organizations employ the use of resource toolkits that serve as a layperson’s starting point to learn about a niche in social justice. Scientist educators can build on this basic knowledge by inviting expert speakers from local social justice organizations who can best connect activist theories to the practice of science.34
Our RHA team will introduce a training module that directly connects existing activist theories with the goals of our organization. For example, this module will explore critical race scholar Kimberlé Crenshaw’s theory of intersectionality and how reproductive health must consider overlapping identities of race, class, gender, sexuality, ability, and immigration status.35 The training will juxtapose the concept of “reproductive rights” with the concept of “reproductive justice,” exploring how the former movement expanded the right to choose sterilization and contraception while the latter brought narratives of forced sterilization and coerced contraception to the forefront.36
3) Apply Critical Pedagogy
Educators can develop lessons using pedagogical techniques already being successfully employed. For example, Freire’s philosophy of conscientização is well-known within general education literature and used amongst activist scientists. His technique of problem-posing asks students to identify problems in their field and work towards solutions. This strategy encourages a participatory dialogue, de-emphasizes instructors as the primary source of knowledge, and helps students play a more active role in establishing their own critical analysis and political engagement.37
The RHA training already problem-poses by presenting trainees with counseling scenarios. Additional counseling scenarios about contraceptive coercion and oppressive barriers to care and will allow students to generate ideas of how our organization should address these issues. Our instructors will serve to moderate dialogue and help students review literature and resources.
4) Set Learning Norms and Values
A trusting group culture is necessary when training activist scientists, since students may feel uncomfortable reflecting on discrimination and privilege.38 Dialogues sometimes become dominated by students hoping to either defend long-held conventions about society or practice performative allyship. The learning environment should not prioritize privileged students at the expense of marginalized students. Instructors can try to subvert power structures in a group of students by setting norms for behavior and for group dialogue. For example, activist discussions sometimes employ versions of the progressive stack, a technique used by the Occupy Wall Street movement.39 This group expectation asks participants for intentional shifts in conversation to elevate the voices of marginalized groups.
RHA does not currently ask students to abide by group norms. Our future meetings will begin by inviting students to set expectations for our training and for the emotional process of discussing systematic inequality. A social identity activity will engage students in one-on-one dialogue to listen to others’ viewpoints and reflect on their own perspectives. These two exercises will foster a respectful learning environment and develop awareness of how to navigate difficult conversations.
5) Value Accountability to Communities
Service-learning is already commonly incorporated in science training. In some cases, these activities further the agenda of an institute more than they address the needs of the community.40 An activist curriculum should request scientist learners to re-assess and improve their role in creating social change.41 This means that service-learning should take place on community members’ terms and measure its success by the community’s standards.
RHA engagement though patient counseling and navigation provides advocates the opportunity to learn about social, economic, political, cultural, financial and legal issues that inform reproductive decision-making. We will conduct participatory quality improvement initiatives that seek patients’ feedback and center leadership from local community activists. Additionally, future research will avoid the dangerous metric of “number of contraceptives placed” as a sole measure of success.
Fittingly, the five themes above span the spectrum of participatory reproductive justice that our RHA leadership aspires towards. In their paper “Reproductive Justice,” sociologists Zakiya Luna and Kristin Luker describe that at minimum, individuals can participate in activism by reading historical narratives and texts by reproductive justice theorists.42 Maximal engagement involves service, self-evaluation, and improvement to advance the field. As RHA continues its process to incorporate activism in our training, my hope is that students eventually engage in full participation to the benefit of the patients we serve. This spectrum of engagement can help guide the development of an activist curriculum for any field of science. Scientist educators can start by establishing a foundation in historical narratives and work towards well-structured critical activism and community engagement.
The Future of Activist Curricula in the Sciences
Even with a clearer starting point, teaching activism remains challenging. Institutional cultures can impede endeavors in multiple ways, including neglect, denial, or outright hostility. Some scientific institutions may believe activism is not a priority for their members. Others may feel that their existing efforts around diversity and inclusion are sufficient. There are those who maintain the belief of science as objective and apolitical. Beyond institutional barriers, the time demands of academic testing and technical science curricula force teachers to prioritize traditional learning goals over activist learning goals.43 Time also limits educators’ ability to develop the expertise needed to develop a comprehensive curriculum.44
With limited time, expertise, and resources, how do we continue to strengthen curricula that are works-in-progress? Alongside tools of anti-oppression, current students can be provided the tools to teach. Training students to teach builds students’ ability to lead and organize. In establishing even a small group of scientists that value activist education and work, these new activist scientists share this foundation with other groups. In turn, this can drive momentum for institutional changes towards a more rigorous activist curricula imparted to all students.
I expect to graduate medical school next year, but I hope to train one last cohort of RHA students with an activist curriculum before I leave. They in turn will train students the year afterwards. In propagating future generations of activist scientists, our small student organization leverages more power in spreading progressive values across the student body as a whole. We leverage more power to shift our institution’s values. We leverage more power to give back to the oppressed. An activist curricula is a nidus for change, teaching future scientists to “read the world” in order to “write the world,” and ultimately change the world.45
About the Author
Mariquit Rosete Lu is a medical student at the University of Miami Miller School of Medicine in Florida. She aims to pursue a residency in Obstetrics and Gynecology. She was born in the Philippines, raised in Indonesia, and educated in the U.S.. Prior to her medical studies, she received a Master’s degree of public administration in international health policy at New York University. Her career interests include global reproductive health policy and anti-racism training in medicine. Currently, she serves on the leadership team of Reproductive Health Advocates, a student-led organization that helps patients access desired reproductive health services in Miami, Florida. She also serves as a co-founding member of the non-profit anti-racism organization White Coats 4 Black Lives: whitecoats4blacklives.org.
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- Christine Dehlendorf and Kelsey Holt, “The Dangerous Rise of the IUD as Poverty Cure,” The New York Times, January 2, 2019, https://www.nytimes.com/2019/01/02/opinion/iud-implants-contraception-poverty.html.
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- Sheldon J. Segal, “Norplant Developed for All Women, Not Just the Well-to-Do,” The New York Times, January 6, 1991, https://www.nytimes.com/1991/01/06/opinion/l-norplant-developed-for-all-women-not-just-the-well-to-do-584392.
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- Elaine M Howle, “Sterilization of Female Inmates” California State Auditor Report 2013-120 (Sacramento, 2014), https://www.auditor.ca.gov/pdfs/reports/2013-120.pdf; Lea Hunter, “The US is Still Forcibly Sterilizing Prisoners,” Talk Poverty, August 23, 2017, accessed March 3, 2019, https://talkpoverty.org/2017/08/23/u-s-still-forcibly-sterilizing-prisoners/.
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