This commentary examines the impact of multi-level racism on reproductive health disparities in the United States. Multi-level racism and its impact on reproductive health over the lifespan are described on a societal, community, and individual level. To advance, we recommend using the Remove, Repair, Restructure, Remediate (R4P) approach combined with the Retrofit, Reform, and Reimagine (3R) model to address multiple forms of racism. Emergent policies and actions are identified to proceed towards health equity.