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In addition to this weeks readings, let's delve into Black Women's Health Imperative!

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Viewpoint

"What is reproductive justice?" This is almost always the first question we are asked when describing the Black Women's Health Imperative 's work in reproductive justice and sexual health. Oftentimes, people think the term reproductive justice is synonymous with reproductive rights. However, the two are distinctly and philosophically different.

Reproductive rights are centered around the legal right to access reproductive health care services like abortion and birth control. The Supreme Court's decision in represented a watershed moment that cemented a woman's right to choose whether to have an abortion or not. But we are now facing a time when women's reproductive rights are under coordinated, unrelenting and mainstream attacks, and we need to consider new and more nuanced ways of tackling these threats.

What good is a right if you cannot access the services that right has provided? This is why reproductive justice is critical. Reproductive justice links reproductive rights with the social, political and economic inequalities that affect a woman's ability to access reproductive health care services. Core components of reproductive justice include equal access to safe abortion, affordable contraceptives and comprehensive sex education, as well as freedom from sexual violence.

It's not enough that abortion is legal in your state. Access is key. If you are working multiple jobs to pay household bills, how can you afford to take the time off to visit a clinic and make use of their abortion services? And if you live in a state that doesn't have any clinics offering the reproductive services you need, such as birth control, how do you find the means to travel across state lines to access those services? These are questions more and more women are facing as policies that restrict or hinder access to reproductive health care surface. And it's important to note that these policies are no longer constrained to traditionally marginalized communities.

As the attacks to reproductive rights and justice continue to grow, it's more important than ever to build and strengthen a new generation of young Black women who will fight for unrestricted access to comprehensive reproductive health care.

These questions frame the work that we do at the Black Women's Health Imperative, the only national organization solely dedicated to improving the health and wellness of the nation's 21 million Black women and girls - physically, emotionally and financially. One of our signature programs is My Sister's Keeper (MSK), an advocacy and leadership-building initiative for young women attending Historically Black Colleges and Universities. The program is designed to strengthen, engage and mobilize young Black women around reproductive justice and sexual health, as well as sexual violence prevention. As the attacks to reproductive rights and justice continue to grow, it's more important than ever to build and strengthen a new generation of young Black women who will fight for unrestricted access to comprehensive reproductive health care.

To further our work in MSK and the fight for reproductive justice, we are taking steps to ensure policymakers adopt policies that grant and protect a woman's right to make reproductive decisions that are best suited for her life. These policies include repealing the Hyde Amendment and other anti-abortion laws, like 20-week abortion bans, that essentially penalize low-income women and women of color and prevent them from accessing safe abortion care. We also support policies that ensure unrestricted access to contraceptive services such as the Affordable Care Act's birth control coverage requirement, and we continue to call on policymakers to do the same.
Featured Image: Leslie, Organs, used under CC BY-NC-SA 2.0/cropped from the original
Everyone stands to benefit from understanding and joining the reproductive justice movement. We are at a moment in time where it would behoove traditional reproductive rights organizations to tap into the rich history, strength and resilience of this movement. By partnering, reproductive rights and reproductive justice organizations can collectively tackle some of the broadest threats to women's reproductive health we have faced in a generation.

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Reproductive Justice: What It Means and Why It Matters (Now, More Than Ever)

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Viewpoint "What is reproductive justice?" This is almost always the first question we are asked when describing the Black Women's Health Imperative 's work in reproductive justice and sexual health. Oftentimes, people think the term reproductive justice is synonymous with reproductive rights. However, the two are distinctly and philosophically different.

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This image breaks down the differences in reproductive right and justice and includes information such as who was involved, what was their focus, and how it was characterized.

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In this article, it explains how Black women are three to four times more likely to die from pregnancy-related deaths compared to White women. It also provides ways on how to help and improve Black women's maternal health as well as some reasons why it may be caused.

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Black women in the United States experience unacceptably poor maternal health outcomes, including disproportionately high rates of death related to pregnancy or childbirth. Both societal and health system factors contribute to high rates of poor health outcomes and maternal mortality for Black women, who are more likely to experience barriers to obtaining quality care and often face racial Black women are three to four times more likely to experience a pregnancy-related death than white women.discrimination throughout their lives.

These trade-offs are evident in Black women's health outcomes and use of medical care. Compared to white women, Black women are more likely to be uninsured, face greater financial barriers to care when they need it and are less likely to access prenatal care. Indeed, Black women experience higher rates of many preventable diseases and chronic health conditions including diabetes, hypertension and cardiovascular disease. When, or if, Black women choose to become pregnant, these health conditions influence both maternal and infant health outcomes.

To improve Black women's maternal health, we need a multi-faceted approach that addresses Black women's health across the lifespan, improves access to quality care, addresses social determinants of health and provides greater economic security.

Background: Black maternal health disparities

Too many Black women are dying in pregnancy and childbirth. Black women in the United States are more likely to die from pregnancy or childbirth than women in any other race group.

Black women are three to four times more likely to experience a pregnancy-related death than white women.Creanga, A.A., Syverson, C., Seek, K., & Callaghan, W.M. (2017). Pregnancy-Related Mortality in the United States, 2011-2013. Obstetrics & Gynecology, 130(2), 366-373. Retrieved 4 April 2018, available here.

Black women are more likely to experience preventable maternal death compared with white women.Louis, J. M., Menard, M. K., & Gee, R. E. (2015). Racial and ethnic disparities in maternal morbidity and mortality. Obstetrics & Gynecology, 125(3), 690-694.

Black women's heightened risk of pregnancy-related death spans income and education levels.Black Mamas Matter Alliance & Center for Reproductive Rights. (2016). Research Overview of Maternal Mortality and Morbidity in the United States. Retrieved 2 April 2018, available here.

Black women experience more maternal health complications than white women. Black women are more likely to experience complications throughout the course of their pregnancies than white women.

Black women are three times more likely to have fibroids (benign tumors that grow in the uterus and can cause postpartum hemorrhaging) than white women, and the fibroids occur at younger ages and grow more quickly for Black women.Eltoukhi, H. M., Modi, M. N., Weston, M., Armstrong, A. Y., & Stewart, E. A. (2014). The health disparities of uterine fibroid tumors for African American women: a public health issue. American Journal of Obstetrics & Gynecology, 210(3), 194-199. Retrieved 30 March 2018, available here.

Black women display signs of preeclampsia earlier in pregnancy than white women. This condition, which involves high blood pressure during pregnancy, can lead to severe complications including death if improperly treated.Shahul, S., Tung, A., Minhaj, M., Nizamuddin, J., Wenger, J., Mahmood, E., & Talmor, D. (2015). Racial disparities in comorbidities, complications, and maternal and fetal outcomes in women with preeclampsia/eclampsia. Hypertension in Pregnancy, 34(4), 506-515. Retrieved 30 March 2018, available here.

Black women experience physical "weathering," meaning their bodies age faster than white women's due to exposure to chronic stress linked to socioeconomic disadvantage and discrimination over the life course, thus making pregnancy riskier at an earlier age.Geronimus, A. T. (1992). The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethnicity & Disease, 2(3), 207-221.

Black-serving hospitals provide lower quality maternity care. Seventy-five percent of Black women give birth at hospitals that serve predominantly Black populations.

Black-serving hospitals have higher rates of maternal complications than other hospitals. They also perform worse on 12 of 15 birth outcomes, including elective deliveries, non-elective cesarean births and maternal mortality.Creanga, A. A., Bateman, B. T., Mhyre, J. M., Kuklina, E., Shilkrut, A., & Callaghan, W. M. (2014). Performance of racial and ethnic minority-serving hospitals on delivery-related indicators. American Journal of Obstetrics & Gynecology, 211(6), 647-e1. Retrieved 30 March 2018, available here.

Many Black women have a difficult time accessing the reproductive health care that meets their needs. Access to reproductive health care, which helps women plan their families, improves health outcomes for women and children.

Black women experience higher rates of unintended pregnancies than all other racial groups,Finer, L. B. & Zolna, M. R. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006 (p. 480). See, e.g., Dehlendorf, C., Park, S. Y., Emeremni, C. A., Comer, D., Vincett, K., & Borrero, S. (2014). Racial/ethnic disparities in contraceptive use: Variation by age and women's reproductive experiences (p. 526.e1). Contraception, 84, 478-485. in part because of disparities in access to quality contraceptive care and counseling.American Journal of Obstetrics & Gynecology, 210(6), 526.e1-526.e9.

Many Black women lack access to quality contraceptive care and counseling.See, e.g., Dehlendorf, C., Park, S. Y., Emeremni, C. A., Comer, D., Vincett, K., & Borrero, S. (2014). Racial/ethnic disparities in contraceptive use: Variation by age and women's reproductive experiences (p. 526.e1). deBocanegra, H. T., Braughton, M., Bradsberry, M., Howell, M., Logan, J., & Shwarz, E.B. (2017). Racial and ethnic disparities in postpartum care and contraception in California's Medicaid program (pp. e3-e4 ). American Journal of Obstetrics & Gynecology, 210(6), 526.e1-526.e9. For example, in a recent analysis of California women enrolled in Medicaid, Black women were less likely than white or Latina women to receive postpartum contraception, and when they did receive it, they were less likely to receive a highly effective method.American Journal of Obstetrics & Gynecology, 217(47), e1-e7.

Black women's access to abortion is limited,See note 15; see, e.g., Dehlendorf, C., Harris, L. H., & Weitz, T. A. (2013). Disparities in abortion rates: A public health approach. See, e.g., Dehlendorf, C., Harris, L. H., & Weitz, T. A. (2013). Disparities in abortion rates: A public health approach (p. 1776). American Journal of Public Health, 103(10), 1772-1779. and they may be more likely to experience the ill effects of abortion restrictions - such as delayed care, increased costs or lack of access to care.American Journal of Public Health, 103(10), 1772-1779 (describing that "studies have found that restricted access to abortion services can limit women's ability to abort a pregnancy when they wish to do so, and that these effects may be particularly pronounced for Black women and women with lower educational attainment"); Henshaw, S. K., Joyce, T. J., Dennis, A., Finer, L. B., & Blanchard, K. (2009). Restrictions on Medicaid funding for abortions: A literature review. Guttmacher Institute. Retrieved 27 March 2018, available here.

Policymakers, health care professionals and communities can improve Black women's maternal health.
Expand and maintain access to health coverage.
Only 87 percent of Black women of reproductive age have health insurance, and many more experience gaps in coverage during their lives. To improve Black women's health outcomes, policies should focus on expanding and maintaining access to care and coverage.

Women need health coverage throughout their lifespan including access to preventive health care, such as birth control, to maintain their health and to choose when and whether to become a parent. For women who choose to become a parent or expand their families, good prenatal and maternity care are critically important for healthy pregnancies and healthy children. Pregnant women who lack insurance coverage often delay or forgo prenatal care in the first trimester, and inadequate prenatal care is associated with higher rates of maternal mortality.
Provide patient-centered care that is responsive to the needs of Black women.
Black women should receive health care that is respectful, culturally competent, safe and of the highest quality. Unfortunately, research shows that Black women receive a lower quality of care than white women. Much too often, Black women are subject to discrimination in the health care field - 22 percent report discrimination when going to the doctor or clinic.

Public policies and medical practice should incentivize providing patient-centered care that focuses on Black women's individualized needs, including non-clinical, social needs. Moreover, policies should endeavor to eradicate cultural biases and discrimination in medical practice and medical education, increase provider diversity in maternity care and hold individual providers and hospital systems accountable if they fail to provide unbiased, high-quality, evidence-based care.
Address the social determinants of health.
To improve Black maternal health outcomes, social determinants of health must be addressed through policies that raise incomes and build wealth; provide access to clean, safe and affordable housing; improve the quality of education; prioritize reliable public transportation and transport for medical appointments; and increase the availability of healthy, affordable food.
Expand paid family and medical leave.
Black women need paid leave to take care of their own health needs and to have time to care for their children. More than one in four Black workers report that there was a time in the last two years that they needed or wanted to take time away from work for parental, family or medical reasons but could not. Only 30 percent of Black mothers are both eligible for and able to afford to take unpaid leave under the federal Family and Medical Leave Act.
Expand access to quality, patient-centered and comprehensive reproductive health care.
Quality, patient-centered reproductive health care is critical to improving maternal health and addressing the reproductive health disparities that Black women face including higher rates of unintended pregnancies and restricted access to abortion. Researchers attribute these disparities to a number of factors, including disparities in access to high-quality health care generally, and family planning services specifically.Finer, L. B. & Zolna, M. R. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006 (p. 480). See, e.g., generally Tsui, A. O., McDonald-Mosley, R., & Burke, A. E. (2010). Family planning and the burden of unintended pregnancies. See, e.g., generally Conde-Aguedelo, A., Rosas-Bermúdez, A, & Kafury-Goeta, A. C. (2006). Birth spacing and risk of adverse perinatal outcomes: A meta-analysis. Contraception, 84, 478-485. Henshaw, S. K., Joyce, T. J., Dennis, A., Finer, L. B., & Blanchard, K. (2009). Epidemiologic Reviews, 32, 152-174. infant mortality, birth defects, low birth weight and preterm birth. JAMA, 295(15), 1809-1823. Restrictions on Medicaid funding for abortions: A literature review. Guttmacher Institute. Retrieved 27 March 2018, available here. See, e.g., Dehlendorf, C., Park, S. Y., Emeremni, C. A., Comer, D., Vincett, K., & Borrero, S. (2014). Racial/ethnic disparities in contraceptive use: Variation by age and women's reproductive experiences (pp. 526.e7). American Journal of Obstetrics & Gynecology, 210(6), 526.e1-526.e9 (citations omitted). A number of studies have demonstrated that there is not a significant disparity in knowledge about contraception between Black women and white women. See, e.g., Craig, A. D., Dehlendorf, C., Borrero, S., Harper, C. C., & Rocca, C. H. (2014). Exploring young adults' contraceptive knowledge and attitudes: Disparities by race/ethnicity and age. Women's Health Issues, 24(3), e281-e289; Rocca, C. H. & Harper, C. C. (2012). Do racial and ethnic differences in contraceptive attitudes and knowledge explain disparities in method use? Perspectives on Sexual and Reproductive Health, 44(3), 150-158. See also, e.g., Dehlendorf, C., Harris, L. H., & Weitz, T. A. (2013). Disparities in abortion rates: A public health approach (p. 1776). American Journal of Public Health, 103(10), 1772-1779. Indeed, women with unintended pregnancies are at increased risk for maternal mortality and morbidity, maternal depression, experiencing physical violence during pregnancy,

Black women also live with a legacy of reproductive oppression, and continue to experience reproductive coercion, sometimes leading to a distrust of the health care system that further exacerbates disparities. For instance, Black women are more likely to report having been pressured by a clinician to use a contraceptive method.Becker, D. & Tsui, A. O. (2008). Reproductive health service preferences and perceptions of quality among low-income women: Racial, ethnic and language group differences (p. 208). Perspectives on Sexual and Reproductive Health, 40(4), 202-211. Moreover, some Black women may be forced to continue pregnancies because onerous restrictions and a lack of insurance coverage have pushed abortion out of reach.

This experience falls short of the level of high-quality, patient-centered care that all women should be able to expect. Policymakers must work to ensure that Black women are able to plan their families in the way that feels best for them, which includes access to counseling on the contraception method of their choice, access to abortion care without restrictions and access to prenatal and maternity care from providers they trust.
Expand and protect access to trusted community providers.
Community health care providers play an essential role in providing Black women with basic, reproductive and maternal health care services. Without these vital resources, many Black women would not have information about or access to birth control, annual exams, Pap tests and other essential preventive care.See, e.g., Stevenson, A. J., Flores-Vazquez, I. M., Allgeyer, R. L., Schenkkan, P., & Potter, J. E. (2016). Effect of removal of Planned Parenthood from the Texas Women's Health Program. New England Journal of Medicine, 374, 853-860 (describing the negative impact of cuts to family-planning services on women's access to contraception). Recent studies have also shown that, in Texas, deep funding cuts to family planning services correlated with dramatic increases in the maternal mortality rate. See generally MacDorman, M. F., Declercq, E., & Thoma, M. E. (2018). Trends in Texas maternal mortality by maternal age, race/ethnicity, and cause of death, 2006-2015. Birth, 1-9; MacDorman, M. F., Declercq, E., Cabral, H., & Morton, C. (2016). Is the United States maternal mortality rate increasing? Disentangling trends from measurement issues. Obstetrics & Gynecology, 128(3), 447-455 (describing how the reported maternal mortality rate in Texas doubled within a two-year period); see also Bassett, L. (2016, August 18). Pregnancy-Related Deaths Nearly Doubled in Texas After Cuts to Women's Health. Huffington Post. Retrieved 27 March 2018, available here. Policymakers should expand funding for trusted, community-based providers including Planned Parenthood. Community-based providers can help Black women get and stay healthy throughout their lifespan, including when, or if, they choose to become a parent.
Expand protections for pregnant workers.
Women report pregnancy discrimination across races and ethnicities, but Black women are disproportionately affected. Nearly three in 10 charges of pregnancy discrimination (28.6 percent) were filed by Black women from 2011-2015, yet Black women comprise only 14 percent of women ages 16 to 54 in the workforce. Pregnancy discrimination has serious consequences for women and their families. Women who are demoted, not promoted or discharged because they are, or might become, pregnant can lose critical income. If they are discharged or have their hours cut, they may lose their health insurance and other workplace supports at a time when their families' budgets are already stretched. Because Black women are also at a higher risk for pregnancy-related complications like preterm labor, preeclampsia and hypertensive disorders, the loss of wages and health insurance due to pregnancy discrimination is especially challenging.

Stronger protections for pregnant workers, including federal and state laws that ensure that employers provide reasonable accommodations to pregnant women, robust enforcement of the Pregnancy Discrimination Act and continued education about existing legal rights are critical to combatting and, ultimately, eliminating pregnancy discrimination in this country.
Invest in health care safety and quality improvement initiatives.
Maternal mortality is three to four times higher for Black women than it is for white women, and Black women are more likely to experience complications during pregnancy and childbirth. There are existing, proven safety and quality improvement initiatives that need greater uptake to meaningfully improve health care outcomes for Black women.

Similarly, the California Maternal Quality Care Collaborative provides a multifaceted, solutions-based approach to quality improvement including toolkits on how to address the leading causes of preventable death and complications for mothers and infants. State-level perinatal quality collaboratives have begun to address severe maternal morbidity and related quality and safety issues and should be encouraged to expand this critical work as they can scale implementation of the AIM resources and toolkits across states.

Many structural and societal issues affect Black women's health. There is extensive research and evidence that point the way to strategies to improve our health care system and ensure that it delivers safe, effective and evidence-based maternal health care to everyone.

Conclusion

Black women deserve to have safe and healthy pregnancies and childbirth. To meaningfully improve Black maternal health outcomes, we need systemic change that starts with the health care system, improves access to care and makes the places Black women live and work healthier, more fair and more responsive to their needs. Only when we do that will Black women be able to achieve their optimal health and well-being throughout their lifespan, including if they choose to become parents.

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Black women in the United States experience unacceptably poor maternal health outcomes, including disproportionately high rates of death related to pregnancy or childbirth. Both societal and health system factors contribute to high rates of poor health outcomes and maternal mortality for Black women…

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This week we read about Native Americans' birthing experiences, here is a broader view of racial disparities within maternal mortality. This is a very important topic and part of the reason more women - especially women of color are switching to alternate birthing options.

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Perspectives on Maternal Mortality and Morbidity - Identifying Racial and Ethnic Disparities

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This week we are analyzing issues and efforts among Black, Latina and Native women. Here is the main mission statement for Reproductive Justice efforts made on behalf of Latina women!

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National Latina Institute for Reproductive Justice

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At the Latina Institute, we amplify Latina/x voices to change the narratives that seek to tear down the inherent power that resides in our communities. We center Latinas/xs in order to transform the systems that influence our ability to fully make decisions about our bodies and our lives. We do this…

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In Roberts Killing the Black Body, Black women's reproductive lives are the center of this reading. This is an organization created for confronting racial injustice within America to protect Black women's procreative freedom and reproductive health. Check out their website! Click the agenda and read for more information.

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In Our Own Voice - National Black Women's Reproductive Justice Agenda

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In Our Own Voice: National Black Women's Reproductive Justice Agenda is a Reproductive Justice partnership of eight Black women's Reproductive Justice organizations:

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The Sojourn Shelter and Services, Inc. is located here in Springfield Illinois on 1800 Westchester. This is a great resource for all women but more specifically for mothers or those expecting. They also provide services for domestic abuse victims.

Springfield, Illinois also has Planned Parenthood which provides Pregnancy testing and services such as testing, fertility awareness, planning services, etc. They also offer a broad span of women's health care services such as cancer screenings, mammograms and other services.

Programs like these allow for the community especially our women of color to have access to reproductive justice. This week we read about leaders such as Loretta Ross within the reproductive justice movement.

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This connects to this week's readings as we are learning about issues within Native women. Delving into motherhood, I found this to be a crucial topic for motherhood and Native Americans. This also goes further in-depth explaining how Native American Boarding Schools impacted the family structure among Native Americans. For some background history, Native American children were taken from their mothers and sent off to boarding schools where they were stripped of everything within their identities - their language, religion, and other customs. As these Native American children were coming out of boarding schools, they remembered little about their culture and went home struggling to connect with their families. This was a huge deal considering the majority of Native American tribes were maternalistic, relationships with mothers were valued highly within society.

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Native American Boarding Schools: A Lost History

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A anti-abortion activist was found with with 5 fetuses in her home. Her and eight other anti-abortion activists were indicted for blocking access to an abortion clinic.

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police say 5 fetuses found in a dc home allegedly owned by an anti-abortion activist - cnn

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Police say 5 fetuses found in a DC home allegedly owned by an anti-abortion activist

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Police say they found five fetuses in a home in Washington, DC, on Wednesday, days after the indictment of several anti-abortion activists -- including a woman believed to live in the home where the fetuses were discovered -- on charges of blocking access to a reproductive health clinic in 2020.