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Reflections, Pt. 3: Recommendations for Public Health Through a Reproductive Justice Lens

We shared our experiences in a “Lessons Learned” debrief upon reviewing the Black Mamas Matter Black Paper and the newly released “Advancing Holistic Maternal Care for Black Women Through Policy” guide (December 2018), which were foundational to the overarching themes of the conference. We identified barriers and relevant

recommendations. First, we agree that public health professionals may sense that they have little recourse for actualizing a reproductive-justice informed clinical and social practice in the public health setting. Their uncertainty may occur for various reasons, such as feeling like a novice in the field. Still, other perceived barriers may stem from colleagues’ attitudes, anticipated backlash, gaslighting, and other defense mechanisms that continue to hold space for racist and discriminatory policies and practices.

We recommend that implicit bias training with a historical, systems-focused lens is part of interdisciplinary collegiate curricula, specifically with disciplines that directly intersect with any aspect of people’s lives. Schools of thought and practice may include Schools of Public Health, Social Work, Education, Nursing, and feeder programs that matriculate pre-med students into Medical School at the undergraduate level. Implicit bias training as a series of core courses integrated into curricula for earning accreditation in four-year universities would institutionalize early recognition of personal and interpersonal bias with a projected outcome of reducing harm within communities of care, learning, and support. Similarly, professionals from these same disciplines responsible for maintaining licensure or certification should have demonstrated continuing education requirements around these topics. We are particularly elevating the need for such training to focus on defining gatekeepers, actualizing the power of gatekeepers, and concrete tools for dismantling barriers. This recommendation aligns with the second policy priority, “Establish equitable systems of care to address racism, obstetric violence, neglect and abuse,” outlined in Advancing Holistic Maternal Care for Black Women Though Policy. Furthermore, we recommend public health professionals have access to a body of people with whom they can debrief their implicit bias training with practical tools for applying theoretical concepts to their scope of work. Training should be at least annually for accreditation purposes, face-to-face biannually.

We must have federal, state, and local data analysis and evaluation of program outcomes with racial stratification to examine the disparity felt by black women as the primary focus rather than as a footnote. Journalists praise efforts in (example) California for cutting the state’s maternal mortality rate in half without engaging a relevant analysis for concurrent birth inequities.

Our final recommendation aligns with the call to action embedded in the second policy priority: “Redefine the concept of health care teams and recognize them as multi-disciplinary-- including doulas, midwives, lactation consultant, perinatal health workers, and other paraprofessionals (or non-licensed professional).” Home visitors should have their place among this team and support efforts to recognize home visiting as a discipline and, as such, standardize the training of home visitors. One of the concepts at the foundation of this training should be understanding pregnancy, the birthing process, and implicit bias abbreviated for home visitors, who in most models are not clinically trained nurses. Home visitors have the unique ability to build social connections with black mothers prenatally through the first 1000 days of their child’s life; this is an opportunity to have a Life Course Perspective in assisting families in navigating through the systems contribute to their Social Determinants of Health.



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