BIPOC birthing parents: one APP's perspective

What's an APP? Advance Practice Provider. As in Physician Assistants (PAs) and Nurse Practitioners (NPs).

I grew up relatively poor but rich in love. Even so, life was oftentimes incredibly hard.  And only because of my father’s quest for a better life for us was I the second individual and first female in my family to attend and graduate from college. And the first to obtain a master's degree. Do you know what’s even harder though?  Being poor and either fertile or pregnant. It’s a dramatically vulnerable status. Overall, it’s no secret that black women and Latinas receive worse medical care than do Caucasians. In addition, black birthing individuals die from pregnancy and childbirth related causes three times more than those who are white (Taylor, 2020). Medical experts agree blacks share the most deplorable health profile in the nation. However, poor maternal health outcomes among this population cannot be solely attributed to social determinants such as poverty, education, or access to health care. Structural racism is another powerful and suffocating social determinant that simply cannot be ignored. Historically, black people have been subjected to exploitative and abusive involuntary experimentation at a rate far higher than any other ethnic group. (Taylor, 2020) Even birth control is intertwined with white supremacy and the pursuit of controlling a black woman’s body. During the human rights era, when experts spoke publicly about the pill in relation to women of color, they were mostly referring to black women of the 1960s. The focus for these women was not liberation, as it was for white women, but rather restraint. Today, structural racism has persisted in more subtle care policies and practices (Solinger, 2019). And, tragically, given the recent jaw dropping political events surrounding American women and our rights to healthcare, many agendas are no longer covert. These factors often perpetuate the prenatal, labor and delivery, and postpartum experiences of the black women for whom I have cared.

Reproductive health and economic empowerment are mutually reinforcing, and both are vital if the overall reproductive health care of black women is going to improve. (Omeish & Kiernan, 2020) Together, they are the key to dignity and security. Disparities coupled with the health risks of black individuals who are of reproductive age seems overwhelming when attempting to provide daily optimal nursing care. I can think of two practical ways in which to improve care, however. The first is to empower women with body literacy. Women need to know more about their bodies and fertility rather than leaving such knowledge to the “experts”. This was a popular approach during the 1970s but waned into the 1980s (Solinger, 2019). However, the idea has regained momentum through individuals like Lisa Hendrickson-Jack, a black American woman who recently authored The Fifth Vital Sign and who advocates for grass roots body literacy classes both in person (pre-pandemic) and online.

Secondly, decentralizing traditional care in the United States with clinical models like Tia could potentially further empower black women by providing a robust collaborative care model. The care philosophy of Tia is to “treat the person, not the patient” and providers promote shared decision making with patients while combining Western medicine with evidence-based wellness modalities (Jaramillo, 2019).

How can healthcare professionals best increase the health literacy of the public at large?  One of the most effective ways to increase health literacy with respect to those born with XX chromosome associated reproductive organs is to begin proactive education during the tween years. Offering age-appropriate content and non-judgmental conversations is a great launching pad. I’ve worked with providers who recommend books 1 and 2 from the American Girl series The Care and Keeping of You.  For older adolescents and young adults, I’d advocate for credible media such as the 2021 documentary The Business of Birth Control. It’s an indie film that is now available on Amazon and elsewhere. I had the privilege of viewing one of the early showings about a two to three years ago now and would have every high school and college student watch it if I could. The film traces the feminist movement to fully investigate the history of the pill and seeks genuine gender justice by unpacking the power structures surrounding the reproductive health industry. A major part of health literacy is understanding the power held and wielded by corporate structures. The content is rich and yet does not sit fully on the left or the right politically. Also, with respect to health literacy and birthing persons, Centering Pregnancy groups are (research) evidence based and have been shown to decrease the rate of preterm and low weight babies. In addition, Centering Pregnancy has been acknowledged to nearly eliminate racial disparities with respect to preterm birth.  Even better is the fact that Medicaid and insurance will often cover a program.  Given the democratization of information at our fingertips thanks to today’s technology, we can know better and thus do better. Let’s not wait for the “powers that be” to come to our rescue. Because they probably won’t. 

references

https://www.asktia.com

https://www.centeringhealthcare.org/why-centering

Epstein, A. (Director). (2021). The business of birth control. James Costa, Abby Epstein, Anna Kobler, Holly Grigg-Spall producers. https://www.thebusinessof.life/business-of-birth-control.

Hendrickson-Jack, L. (2019) The Fifth Vital Sign: Master Your Cycles & Optimize Your Fertility. Fertility Friday Publishing Inc.

Jaramillo, J. (2019, August 21). Innovative, holistic and empathetic: the women-led clinics defining the future of health and wellness. Forbes. https://www.forbes.com/sites/estrellajaramillo/2019/08/21/personalized-holistic-women-led-clinics-the-future-of-health-and-wellness

Johnson, R., Scott, J., & Schenita, R. (2020). COVID-19 and black America: the intersection of health equity and the NP work force. The Nurse Practitioner 45(10), 11-14.

Mechanic, D. & Tanner, J. (2007). Vulnerable people, groups, and populations: societal view. Health Affairs 26(5), 1220-1230.

Omeish, Y. & Kiernan, S. (2020). Targeting bias to improve maternal care and outcomes for black women in the USA. The Lancet 27(100568), 430-433. https://doi.org/10.1016/jeclinm.100568

Solinger, R. Pregnancy and Power: the History of Reproductive Politics in the United States. (2019). New York University Press,134-135;170-175.

Taylor, J. (2020). Structural racism and maternal health among black women. The Journal of Law, Medicine and Ethics 48(3), 107-117. https://doi.org/10.1177/1073110520958875

Washington, H. Medical Apartheid: the Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. 2008. Anchor Books, 20-21.