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 language, the Disparities in Preterm Birth 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) Monica R. McLemore PhD, MPH, RN UCSF Obstetrics and Gynecology Update What Does the Evidence Tell Us? 2018 Month YEAR University of California, San Francisco | Bixby Center for Global Reproductive Health Prematurity What? Month YEAR 10/18/2018

Definitions Current Conceptualizations of Social Determinants of Health ⇾ 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 opportunities 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 on 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) Month YEAR Month YEAR Historical Understandings of Social Determinants of Health "In 1906 the national black leader W.E.B. duBois challenged this bleak forecast and countered arguments of inherent black inferiority in The Health Physique of the Negro American , proceedings drawn from an Atlanta So, What? 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. Month YEAR

What’s wrong with the “health disparities” frame? Why is this a problem for preterm birth? ⇾ Uncertainty of parturition (How can we figure out ⇾ No focus on strengths or assets (why aren’t Black people extinct?) how to prevent early birth if we don’t know what causes term birth?) ⇾ Individualistic interventions (that are not proven to work or ⇾ Race is not a risk factor for anything. There is improve outcomes across the reproductive spectrum) nothing inherent about Black skin that increases ⇾ Language of “entitlements” risk – except it overexposes people who have it to ⇾ Default human standard based on white women the real risk factor, RACISM ⇾ The lie of conscientious refusals ⇾ Preterm Birth is a complex medical and social ⇾ Unethical practices of crisis pregnancy centers condition – where the social determinants of health ⇾ Unethical inaction at the policy level – Hyde amendment, intersect with health services provision. lack of Medicaid expansion and ACA repeal/replace ⇾ Healthcare and Social services can’t figure this out efforts in their unique domains, they must work TOGETHER to resolve this issue. Month YEAR Month YEAR Listening to Communities Now, what? Month YEAR Month YEAR

Listening to Black and Brown Women Public Awareness & Dissemination of Research Month YEAR Month YEAR Education and Curricula ⇾ Innovating Education in Reproductive Health Unique Considerations for Clinicians, Researchers, Public Health Practitioners Month YEAR 16

Education and Curricula Month YEAR New Partners – Black Women Birthing Justice Research Communication • Shifting the risk factor from • race to racism • Unpacking ”mommy blame” 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.

New Partners – Roots of Labor Birth Collective 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 Month YEAR 22 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 Thank you – Questions,  Healthy People.gov. Social Determinants of Health: https://www.healthypeople.gov/2020/topics-objectives/topic/social- Comments? 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- Monica R. McLemore – monica.mclemore@ucsf.edu explains-why  McLemore MR, Altman MR, Cooper N, Williams S, Rand L, Franck L. Health care experiences of pregnant, birthing and Instagram, Facebook and Twitter: @mclemoremr 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