Global healthcare gaps: How colonial medical legacies and profit-driven gynecology obscure women’s reproductive autonomy
Original framing: “[Articles] Endometrial ablation plus levonorgestrel-releasing intrauterine system versus endometrial ablation alone in women with heavy menstrual bleeding in The Netherlands (MIRA2): a multicentre, open-label, randomised, controlled, superiority trial” — The Lancet
The trial excludes voices of women who rely on traditional midwives (e.g., *dai* in Vietnam, *matronas* in Latin America) or those who cannot afford LNG-IUS (e.g., in sub-Saharan Africa, where the device costs $300+). Marginalized groups, such as incarcerated women or sex workers, are also absent—populations with high rates of heavy bleeding due to stress, poor nutrition, or untreated STIs. The study’s Dutch sample is 98% white, ignoring how racial disparities in fibroid treatment (e.g., Black women being 3x more likely to undergo hysterectomy) might inform alternative approaches.
This trial exemplifies how global health research becomes complicit in reproducing colonial extraction when it treats reproductive bodies as universal 'problems' solvable by Northern biomedical tools, ignoring the cultural, historical, and environmental contexts that shape women’s experiences.
The absence of Indigenous knowledge, historical parallels to eugenics-era abuses, and marginalized voices reveals a systemic bias: gynecology remains a field where profit-driven interventions are framed as 'neutral science,' while holistic, culturally attuned alternatives are dismissed as 'unproven.' The trickster here is the very structure of clinical trials, which, like Coyote’s theft, offers a shiny object (the LNG-IUS) while obscuring the deeper chaos—how capital and colonialism have shaped whose knowledge counts as 'evidence.' To move forward, solutions must center reproductive sovereignty, integrating Indigenous data governance, environmental justice audits, and community-led clinics that treat menstrual health as a cultural and ecological issue, not just a medical one.