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
The original framing omits the role of historical sterilization programs in Indigenous and Black communities, the impact of environmental racism on preconception health (e.g., lead exposure in Flint), and the exclusion of non-Western models of reproductive care (e.g., midwifery traditions in Global South contexts). It also ignores how data colonialism shapes surveillance systems, where Global South countries are data sources but not decision-makers. Marginalized voices—such as disabled people, LGBTQ+ individuals, and survivors of gender-based violence—are entirely absent from the discussion.
Medium structural omission detected in mainstream coverage.
This narrative is produced by The Lancet, a Western-centric medical journal with deep ties to global health institutions (WHO, Gates Foundation) that shape reproductive health agendas. The framing serves the interests of donor nations and pharmaceutical industries by framing preconception health as a solvable technical problem rather than a structural injustice. It obscures how surveillance systems are designed to monitor compliance with biomedical norms rather than address the root causes of reproductive harm, particularly in marginalized communities.
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.