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DeSalvo K, Dzau VJ. Understanding and Improving Women's Health-From Cells to Society. JAMA Intern Med 2024; 184:465-466. [PMID: 38497941 DOI: 10.1001/jamainternmed.2024.0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This Viewpoint discusses highlights from the National Academy of Medicine 2023 Annual Meeting Scientific Symposium that are representative of key gaps, trends, and opportunities in women’s health.
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Gilliam SM, Hylick K, Taylor EN, La Barrie DL, Hatchett EE, Finch MY, Kavalakuntla Y. Intersectionality in Black Maternal Health Experiences: Implications for Intersectional Maternal Mental Health Research, Policy, and Practice. J Midwifery Womens Health 2024. [PMID: 38319012 DOI: 10.1111/jmwh.13609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/11/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Black women experience significant maternal mortality and morbidity disparities in the United States. Although emerging research has focused on reducing maternal mortality rates among Black birthing individuals, we must explore structural and social factors contributing to mental health outcomes during the perinatal period. Gaps exist where intersectional identities and experiences in maternal and child health are examined. This study explores the intersectional stress experiences of Black perinatal women in the South. METHODS We collected qualitative data through virtual semistructured interviews with 9 pregnant and 7 postpartum participants (N = 16).These interviews assessed feelings, attitudes, and perceptions about psychological stress due to their intersectional experiences of being Black, pregnant, and a woman in the United States. Findings were analyzed through the lens of critical race theory and intersectionality. RESULTS We identified 5 overarching themes: (1) perinatal mental health experiences, (2) birthing and parenting while Black, (3) socioeconomic factors, (4) how we cope, and (5) community and social support. DISCUSSION Overall, this study revealed how the layers of race, gender, pregnancy, and socioeconomic status influence mental health during the perinatal period. These findings show the need for antiracist and intersectional maternal mental health policies and practices.
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Affiliation(s)
| | - Kandyce Hylick
- Department of Health Promotion and Behavior, University of Georgia, Athens, Georgia
| | - Erica N Taylor
- Department of Health Promotion and Behavior, University of Georgia, Athens, Georgia
| | | | - Emily E Hatchett
- Department of Health Promotion and Behavior, University of Georgia, Athens, Georgia
| | - Morgan Y Finch
- Department of Health Promotion and Behavior, University of Georgia, Athens, Georgia
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Kheyfets A, Dhaurali S, Feyock P, Khan F, Lockley A, Miller B, Cohen L, Anwar E, Amutah-Onukagha N. The impact of hostile abortion legislation on the United States maternal mortality crisis: a call for increased abortion education. Front Public Health 2023; 11:1291668. [PMID: 38115843 PMCID: PMC10728320 DOI: 10.3389/fpubh.2023.1291668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
The growing restrictive abortion policies nationwide and the Supreme Court decision on Dobbs v. Jackson Women's Health Organization place increasing barriers to abortion access in the United States. These restrictions disproportionately affect low-income people of color, immigrants, and non-English speakers, and have the potential to exacerbate already existing racial inequities in maternal and neonatal outcomes. The United States is facing a Black maternal health crisis where Black birthing people are more than twice as likely to experience maternal mortality and severe maternal morbidity compared to White birthing people. Restrictions creating geographic, transportation, and financial barriers to obtaining an abortion can result in increased rates of maternal death and adverse outcomes across all groups but especially among Black birthing people. Restrictive abortion laws in certain states will decrease already limited training opportunities in abortion care for medical professionals, despite the existing abortion provider shortage. There is an immediate need for federal legislation codifying broad abortion care access into law and expanding access to abortion training across medical education. This commentary explores the impact of restrictive abortion laws on the Black maternal health crisis through multiple pathways in a logic model. By identifying current barriers to abortion education in medical school and residency, we created a list of action items to expand abortion education and access.
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Affiliation(s)
- Anna Kheyfets
- Tufts University School of Medicine, Boston, MA, United States
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Shubhecchha Dhaurali
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Paige Feyock
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
- University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Farinaz Khan
- Collective Energy for Nurturing Training in Reproductive and Sexual Health (CENTRS Health), Albuquerque, NM, United States
| | - April Lockley
- Collective Energy for Nurturing Training in Reproductive and Sexual Health (CENTRS Health), Albuquerque, NM, United States
| | - Brenna Miller
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Lauren Cohen
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Eimaan Anwar
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Ndidiamaka Amutah-Onukagha
- Tufts University School of Medicine, Boston, MA, United States
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
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Congdon JL, Bardach NS, Franck LS, Brindis CD, Boscardin WJ, Carrasco Z, Cabana MD, Dehlendorf C. Postpartum Family Planning in Pediatrics: A Survey of Parental Contraceptive Needs and Health Services Preferences. Acad Pediatr 2023; 23:1417-1425. [PMID: 36958531 DOI: 10.1016/j.acap.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE Infant well-child visits are increasingly being explored as opportunities to address parental postpartum health needs, including those related to reproductive health. To inform potential pediatric clinic-based interventions, this study assessed postpartum contraceptive needs and health services preferences. METHODS We surveyed postpartum individuals attending 2 to 6-month well-child visits at three Northern California pediatric clinics (2019-20). We examined unmet contraceptive needs; the acceptability of contraceptive education, counseling, and provision at well-child visits; and sociodemographic and clinical correlates. We conducted univariate and multivariable regression modeling to assess associations between sociodemographic and clinical variables, the status of contraceptive needs, and acceptability measures. RESULTS Study participants (n = 263) were diverse in terms of race and ethnicity (13% Asian, 9% Black, 37% Latinx, 12% Multi-racial or Other, 29% White), and socioeconomic status. Overall, 25% had unmet contraceptive needs. Unmet need was more common among participants who had delivered more recently, were multiparous, or reported ≥ 1 barrier to obtaining contraception; postpartum visit attendance, education, race, and ethnicity were not associated with unmet need. Most participants deemed the following acceptable in the pediatric clinic: receiving contraceptive information (85%), discussing contraception (86%), and obtaining a contraceptive method (81%). Acceptability of these services was greater among participants with unmet contraceptive needs, better self-rated health, and private insurance (all P < .05). CONCLUSIONS A quarter of participants had unmet contraceptive needs beyond the early postpartum period. Most considered the pediatric clinic an acceptable place to address contraception, suggesting the pediatric clinic may be a suitable setting for interventions aiming to prevent undesired pregnancies and their sequelae.
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Affiliation(s)
- Jayme L Congdon
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies (JL Congdon and NS Bardach), University of California San Francisco.
| | - Naomi S Bardach
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies (JL Congdon and NS Bardach), University of California San Francisco.
| | - Linda S Franck
- Department of Family Health Care Nursing (LS Franck), University of California San Francisco, School of Nursing.
| | - Claire D Brindis
- Adolescent and Young Adult Health National Resource Center and Philip R. Lee Institute for Health Policy Studies (CD Brindis), University of California, San Francisco.
| | - W J Boscardin
- Departments of Medicine and Epidemiology and Biostatistics (WJ Boscardin), University of California San Francisco.
| | - Zoe Carrasco
- School of Nursing (Z Carrasco), University of California San Francisco.
| | - Michael D Cabana
- Department of Pediatrics (MD Cabana), Albert Einstein College of Medicine and the Children's Hospital at Montefiore (CHAM), Bronx, NY.
| | - Christine Dehlendorf
- Department of Family and Community Medicine (C Dehlendorf), University of California San Francisco.
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Sayyad A, Lindsey A, Narasimhan S, Turner D, Shah P, Lindberg K, Mosley EA. "We really are seeing racism in the hospitals": Racial identity, racism, and doula care for diverse populations in Georgia. PLoS One 2023; 18:e0286663. [PMID: 37285338 DOI: 10.1371/journal.pone.0286663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Poor birth outcomes are more prevalent for Black communities, but strong evidence shows that doula care can improve those outcomes. More evidence is needed to understand racial differences, discrimination, and equity in doula care. METHODS The current study's objective was to describe the experiences of Black doulas as well as the challenges and facilitators of providing doula care to communities of color in Georgia. From Fall 2020-Fall 2021, 20 surveys and in-depth interviews were conducted with doulas as part of a community-based participatory study co-led by Healthy Mothers, Healthy Babies Coalition of Georgia and academic researchers. RESULTS Doula participants were diverse in age (5% under 25, 40% 25-35, 35% 36-45, and 20% 46+) and race/ethnicity (45% white, 50% Black, 5% Latinx). Most (70%) Black doulas reported that more than 75% of their clientele is Black, while most (78%) white doulas reported that less than 25% of their clientele is Black. Doulas noted the alarming Black maternal mortality rate and how mistreatment causes Black clients to lose trust in medical staff, leaving them in need of advocates. Black doulas were passionate about serving and advocating with Black clients. Participants also described how language and cultural barriers, particularly for Asian and Latinx people, reduce clients' ability to self-advocate, increasing the need for doulas. Doulas also discussed the ways that race influences their connections with clients and their dissatisfaction with the lack of cultural humility or sensitivity training in standard doula training. CONCLUSION Our findings indicate that Black doulas provide essential and supportive services to Black birthing people, and those services are more urgently needed than ever following the overturn of Roe v. Wade. Doula training must be improved to address the cultural needs of diverse clients. Increasing access to doula care for Asian and Latinx communities could also address language and cultural barriers that can negatively impact their maternal and child health outcomes.
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Affiliation(s)
- Ayeesha Sayyad
- Health Promotion and Behavior Concentration, School of Public Health, Georgia State University, Atlanta, GA, United States of America
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Alyssa Lindsey
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Subasri Narasimhan
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Daria Turner
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Priya Shah
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Ky Lindberg
- Healthy Mothers Healthy Babies Coalition of Georgia, Atlanta, GA, United States of America
| | - Elizabeth A Mosley
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- Department of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
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Ferro HP, Williams K, Holbrook DS, O'Conor KJ. Disproportionate impact of abortion restriction: Implications for emergency department clinicians. Am J Emerg Med 2023; 69:160-166. [PMID: 37121065 DOI: 10.1016/j.ajem.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
Individuals experiencing intimate partner violence (IPV) and/or human trafficking (HT) are at increased risk of severe health consequences as a result of legislation criminalizing and/or restricting abortion, which is expected to increase as a result of the Supreme Court decision Dobbs v. Jackson. These risks are further stratified by race, socioeconomics, and other marginalizing demographic attributes. IPV and HT introduce barriers to maintaining physical and mental health, due to control of access to transportation and funds by the abuser, fear of retribution for seeking healthcare, and other barriers. Individuals experiencing IPV or HT often lack reproductive autonomy, as a result of facing reproductive coercion at the hands of their abusers. Following the Dobbs decision, these vulnerable patient populations will face further limitations on their reproductive autonomy and increased obstacles to obtaining an abortion if they medically need or desire one. This will likely result in more patients presenting to the emergency department due to complications from unsafe or unsupervised self-managed abortions, as well as patients being reluctant to report having obtained an unlawful abortion due to fear of legal consequences. This is particularly relevant to individuals experiencing IPV and HT, as they may be more likely to use these methods for obtaining an abortion due to numerous barriers. Emergency medicine clinicians are vital in providing care to these patients, as they frequently present to emergency departments. A multi-pronged approach to better support these patients is essential, involving an increased index of suspicion for IPV, HT or the complications of unsupervised abortion, improved organizational structures, specialized training for staff, improved screening methods, reflection on implicit bias, and recommendations for mindful documentation and legal considerations.
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Affiliation(s)
- Haleigh P Ferro
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21287, United States.
| | - Kelly Williams
- Johns Hopkins Medicine, 1800 Orleans St, Baltimore, MD 21287, United States.
| | - Debra S Holbrook
- Mercy Medical Center, 345 St. Paul Pl, Baltimore, MD 21202, United States.
| | - Katie J O'Conor
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21287, United States.
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Coen-Sanchez K, Ebenso B, El-Mowafi IM, Berghs M, Idriss-Wheeler D, Yaya S. Repercussions of overturning Roe v. Wade for women across systems and beyond borders. Reprod Health 2022; 19:184. [PMID: 36002861 PMCID: PMC9404636 DOI: 10.1186/s12978-022-01490-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
June 24th, 2022, a day that will be etched in today and future generations’ textbooks as a historic day, the United States of America revoked the constitutional right to seek safe abortion care. Overturning Roe v Wade allowed the divided individual states to independently decide the legal parameters regarding abortion care. A decision that disproportionately effects the reproductive lives of women residing on the land of America. Given the systemic impacts of racism, neoliberalism and white supremacy, it is the Black, racialized and poor women who suffer terrible repercussions. In this commentary the authors begin by discussing the historical biopolitical perspective, colonial systems and longstanding impacts on racialized women’s bodies in America. The discussion transitions to the implications of geopolitics at play nationally and cascading impacts globally, focusing on humanitarian and emergency settings. Using a medical humanities perspective, authors highlight the collision between politics and reproductive health policy and its implications on social determinants of health, such as women’s education, employment, housing, racial and gender equity and wellbeing. Long standing advocates, community leaders and healers, leading scientists, birth attendants, doctors, nurses, allied health professionals/providers and humanitarian workers – and many others - are reminded and live the weight of the continuous battle of population control, stemming from the oppressive history of control and exploitation.
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Affiliation(s)
- Karine Coen-Sanchez
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, Canada
| | - Bassey Ebenso
- Leeds Institute Health Sciences, University of Leeds, Leeds, UK
| | | | - Maria Berghs
- Unit for the Social Study of Thalassaemia and Sickle Cell, School of Allied Health Sciences, De Montfort University, Leicester, UK
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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