Systemic gaps in preconception health surveillance: Why global monitoring fails to capture structural inequities in reproductive care
Original framing: “[Review] Measuring progress in pregnancy planning and preconception health” — The Lancet
Marginalized voices—disabled people, LGBTQ+ individuals, survivors of violence, and racialized communities—are systematically excluded from preconception health discourse, despite facing disproportionate barriers to care. For example, disabled people are often deemed 'unfit' for parenthood in medical systems, while trans men and nonbinary people face erasure in pregnancy data collection. Survivors of gender-based violence may avoid preconception care due to trauma triggers in clinical settings, yet their experiences are absent from indicator frameworks. Centering these voices requires dismantling ableist, cisnormative, and racist assumptions in both care and surveillance.
The Lancet’s review exposes a critical gap in preconception health surveillance, but its framing as a technical challenge obscures how surveillance systems are complicit in reproducing colonial, capitalist, and ableist power structures.
Historically, reproductive health data has been weaponized against marginalized communities, from eugenics-era sterilizations to modern-day data colonialism, where Global South countries provide data but lack decision-making power. Indigenous and cross-cultural knowledge systems offer holistic frameworks that center land, community, and spirituality—dimensions entirely absent from Western biomedical models. Scientifically, current indicators fail to capture the epigenetic and social drivers of reproductive inequity, while future models must grapple with climate collapse and AI-driven bias. The solution lies in decolonizing surveillance through Indigenous-led governance, intersectional indicators, and community-based care networks that treat reproductive health as a collective, ecological, and justice-centered endeavor. Without these transformations, surveillance will remain a tool of exclusion rather than a mechanism for liberation.