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Changing the Narrative: this presentation, except where I am quoting - - PowerPoint PPT Presentation

Disclosures I have no financial disclosures My preferred pronouns are She/Her I will use gender neutral language throughout Changing the Narrative: this presentation, except where I am quoting the work of others I use their


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University of California, San Francisco | Bixby Center for Global Reproductive Health

Changing the Narrative:

Disparities in Preterm Birth

UCSF Obstetrics and Gynecology Update What Does the Evidence Tell Us? 2018

Monica R. McLemore PhD, MPH, RN

Disclosures

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⇾ I have no financial disclosures ⇾ My preferred pronouns are She/Her ⇾ I will use gender neutral language throughout this presentation, except where I am quoting the work of others – I use their language, the language of patients, and the people I’m lucky enough to serve ⇾ All social media is okay, I’m me everywhere @mclemoremr (Facebook, Twitter, Instagram)

Prematurity

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What?

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Definitions

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⇾ Social Determinants of Health ⇾ The conditions in the environments in which people are born, live, learn, work,

play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. (Healthy People, 2020).

⇾ Health Disparities ⇾ Preventable differences in the burden of disease, injury, violence, or

  • pportunities to achieve optimal health that are experienced by socially

disadvantaged populations. (CDC, 2016)

⇾ Health Inequities ⇾ Health inequities are avoidable inequalities in health between groups of people

within countries and between countries. These inequities arise from inequalities within and between societies. Social and economic conditions and their effects

  • n people’s lives determine their risk of illness and the actions taken to prevent

them becoming ill or treat illness when it occurs. (WHO, 2018)

Current Conceptualizations of Social Determinants of Health

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Historical Understandings of Social Determinants of Health

"In 1906 the national black leader W.E.B. duBois challenged this bleak forecast and countered arguments

  • f inherent black inferiority in The Health Physique of

the Negro American, proceedings drawn from an Atlanta conference on Black health. The conference findings pointed to the impact of environmental and social conditions on black morbidity and mortality rates. Commenting on the higher black rates, du Bois noted that "the present differences in mortality seem to be sufficiently explained by conditions of life." ⇾

Susan L. Smith: Sick and Tired of Being Sick and Tired: Black Women's Health Activism in America 1890-1950.

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So, What?

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What’s wrong with the “health disparities” frame?

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⇾ No focus on strengths or assets (why aren’t Black people extinct?) ⇾ Individualistic interventions (that are not proven to work or improve outcomes across the reproductive spectrum) ⇾ Language of “entitlements” ⇾ Default human standard based on white women ⇾ The lie of conscientious refusals ⇾ Unethical practices of crisis pregnancy centers ⇾ Unethical inaction at the policy level – Hyde amendment, lack of Medicaid expansion and ACA repeal/replace efforts

Why is this a problem for preterm birth?

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⇾ Uncertainty of parturition (How can we figure out how to prevent early birth if we don’t know what causes term birth?) ⇾ Race is not a risk factor for anything. There is nothing inherent about Black skin that increases risk – except it overexposes people who have it to the real risk factor, RACISM ⇾ Preterm Birth is a complex medical and social condition – where the social determinants of health intersect with health services provision. ⇾ Healthcare and Social services can’t figure this out in their unique domains, they must work TOGETHER to resolve this issue.

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Now, what?

Listening to Communities

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Listening to Black and Brown Women

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Public Awareness & Dissemination of Research

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Unique Considerations for Clinicians, Researchers, Public Health Practitioners

Education and Curricula

⇾ Innovating Education in Reproductive Health

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Education and Curricula

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Research Communication

  • Shifting the risk factor from
  • race to racism
  • Unpacking ”mommy blame”

New Partners – Black Women Birthing Justice

Black Women Birthing Justice is a collective of African-American, African, Caribbean and multiracial women who are committed to transforming birthing experiences for Black women. Vision: Every woman should have an empowering birthing experience free of unnecessary medical interventions.

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New Partners – Roots of Labor Birth Collective

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New Partnerships and Models of Care

⇾ Alignment of SOCIAL and CLINICAL ⇾ Full integration of Black Infant Health, Centering Healthcare, Midwives and Doulas into clinical health services as the STANDARD OF CARE ⇾ Co-locations of services – Midwifery and Doula led ⇾ Legislative Action ⇾ Congressional Black Caucus Health Brain Trust ⇾ Pending Bills from: Booker (D-NJ); Kelly (D-IL); Harris (D-

CA); Beutler (R-WA) & DeGatte (D-CO) & Costello (R-PA)

⇾ Diversification of the workforce ⇾ Pathways to the health professions ⇾ Leadership programs and summer internships

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References

  • Bonaparte, A. (2007) The Persecution and Prosecution of Granny Midwives in South Carolina: 1900-1940. Doctoral Dissertation.

Vanderbilt University.

  • Centers for Disease Control and Prevention. Health Disparities: https://www.cdc.gov/healthyyouth/disparities/index.htm
  • Healthy People.gov. Social Determinants of Health: https://www.healthypeople.gov/2020/topics-objectives/topic/social-

determinants-of-health

  • Martin N. & Montange R. NPR All Things Considered. Black Mothers Keep Dying After Giving Birth. Shalon Irving’s Story

Explains Why: https://www.npr.org/2017/12/07/568948782/black-mothers-keep-dying-after-giving-birth-shalon-irvings-story- explains-why

  • McLemore MR, Altman MR, Cooper N, Williams S, Rand L, Franck L. Health care experiences of pregnant, birthing and

postnatal women of color at risk for preterm birth. Soc Sci Med. 2018 Mar;201:127-135.

  • Oparah, JC. & Bonaparte, A. Birthing Justice: Black Women, Pregnancy, and Childbirth. 2016: Routledge Press: New York, NY.
  • Roberts, Dorothy E. 1997. Killing the black body: race, reproduction, and the meaning of liberty. New York: Pantheon Books.
  • World Health Organization. Health Inequities:

http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/

University of California, San Francisco | Bixby Center for Global Reproductive Health

Thank you – Questions, Comments?

Monica R. McLemore – monica.mclemore@ucsf.edu

Instagram, Facebook and Twitter: @mclemoremr