Refusing Motherhood argues that twentieth-century transatlantic writers intervened in reproductive politics by detailing how racism and classism impeded poor and Black women’s access to reproductive healthcare. Bringing together the methods of Black feminist reproductive justice scholarship, feminist and queer literary studies, and the history of medicine, the project examines narratives of reproductive healthcare from early-twentieth-century eugenics to the late-twentieth-century anti-abortion movement. I focus on the work of five authors – Nella Larsen, Jean Rhys, Adrienne Rich, Audre Lorde, and Toni Morrison – whose writing offers unique insights into the embodied effects of shifting practices and attitudes towards birth control, abortion, and birth in Britain and the United States. I draw on archival materials including birth control policies, nursing handbooks, and authors’ manuscript drafts to show how writers used personal knowledge and historical research to produce literary narratives of poor and Black women’s experiences of reproductive healthcare that are underrepresented in the historical record. Refusing Motherhood challenges the tendency of queer and feminist scholars to generalize or romanticize reproduction as either the epitome of oppressive heteronormativity or the site of feminist utopian worldbuilding. I show instead how these authors offer portrayals of motherhood that resist recuperation or reduction. This materialist and historically grounded analysis of reproductive narratives illuminates the socially stratified healthcare of the recent past and offers a pre-history to the reproductive injustices of the present. Specifically, I argue that literature offers prescient insights into the historical emergence of three key areas of reproductive injustice in the present: compelled pregnancy, criminalized pregnancy, and family policing.