Writing Reproductive Injustice argues that literature offers important yet overlooked insights into the historical racial and class stratification of reproductive health care. I show how twentieth-century transatlantic writers including Nella Larsen, Jean Rhys, and Toni Morrison deploy strategies that I call “narrative refusal” to reject the dominant expectation that their marginalized pregnant, aborting, and birthing protagonists be legibly sympathetic either within their fictional worlds or to readers. Access to reproductive care in Britain and the United States has long been contingent on the performance of transparent deservingness; these authors expose conditions that have made self-revelation within health contexts dangerous or undesirable for many. In chapters informed by extensive archival research I show how fiction offers powerful critiques of the surveillance of poor and racialized mothers by public health workers; the criminalizing gaze of health professionals in contexts of illegal abortion; and the dehumanizing underpinnings of the legal concept of maternal/fetal conflict. This project questions an assumption within feminist activism and the health humanities that the most effective genre for contesting health inequities is the empathy-inducing first person narrative. Engaging Black feminist theories of opacity and reproductive injustice, I forward a model of reading health narratives that shifts the burden of evidence away from marginalized reproducing subjects onto the ideological and material mechanisms limiting their access to care.