From Disparities to Equity in Birth: Transformative Initiatives and Ongoing Commitments for Full Health Potential [Competency 5: Communication; 7: Diversity, Equity, Inclusion, and Accessibility (DEIA)]

MCH Leads Health Equity Edition – In order to advance health equity for MCH populations, beginning January 2023, MCH Leads will feature trainees’ health equity-focused work. We look forward to highlighting trainees’ experiences supporting the health and well-being of vulnerable and underserved populations and communities. Also, their work assessing and addressing the underlying causes of health disparities–and their efforts to promote diversity, equity, and inclusion–ultimately improving MCH outcomes. In addition, we encourage trainees to reflect on how the MCH Leadership Competencies are applicable to their health equity-focused stories.

Full Health Potential For All Individuals

Health equity exists when all individuals have access to health resources that allow them to attain their highest level of health (CDC, 2022). Health equity should be looked at through the lens of social determinants of health, which are non-medical factors that influence health outcomes (CDC, 2023). These include factors such as socioeconomic status, education, employment, social support networks, and environmental conditions. When we take into account the factors that lead people to where they are in their state of health and health disparities, we can achieve health equity. It is worth mentioning that health equity cannot be achieved without systematic change, demanding fundamental shifts in policies, structures, and practices. Collaboration among public health officials, politicians, and medical establishments requires coordinated efforts across different sectors, as they each play a crucial role in shaping the health of populations. 

The concept of everyone achieving the “highest level of health” for all individuals reflects the goal of health equity. This means not just addressing basic health needs but ensuring that everyone has the opportunity to reach their full health potential by taking into account individual differences and circumstances. The idea of an ongoing commitment at various levels suggests that efforts to achieve health equity should be sustained over time and involve commitment from multiple stakeholders. This could include sustained policy initiatives, community engagement, and ongoing efforts to address emerging health disparities. 

Recognizing the social determinants of health and their impact on health outcomes can have a  profound effect on individuals, families, and communities (Artiga et al., 2018). Efforts to achieve health equity must, therefore, involve strategies that tackle these root causes. Socioeconomic disparities can significantly affect access to resources, opportunities, and ultimately, health outcomes. Addressing health equity requires attention to socioeconomic disparities, housing conditions, and educational opportunities to ensure that all individuals have the necessary resources for maximum health (Artiga et al., 2018). Strategies for health equity should include initiatives for poverty alleviation and the implementation of economic policies that promote financial well-being. Racism, both systemic and interpersonal, has intergenerational effects on health. People belonging to marginalized racial and ethnic groups often face disparities in healthcare access, the quality of care received, and overall health outcomes (CDC, 2023). Achieving health equity means dismantling structural racism. Historical injustices, including colonialism, displacement due to conflict, and other forms of systemic oppression, can have long-lasting effects on the health of populations (United Nations, 2022). Recognizing and addressing these historical injustices is essential for achieving health equity, as they contribute to the persistent disparities seen today.

Birth Equity Internship Experiences

Birth By Us

In a world where technology seeps into every aspect of our lives, the role of Birth By Us becomes crucial in empowering Black mothers and birthing people. Cofounder Ijeoma Uche writes in her MCH Leads article that research shows the challenges faced by Black women and expectant parents. She notes that they often feel disempowered and afraid due to a lack of resources during their pregnancy and postpartum journeys (Uche, 2023). The application provides a platform that is not only informative but also transformative, as it is a tool for overcoming barriers related to racial disparities in access to birth equity. An emphasis was placed on addressing racial disparities in access to birth equity, as highlighted by the CDC’s alarming statistic that Black women are three times more likely to die from a pregnancy-related cause than their White counterparts, regardless of education, income, or any other socioeconomic factors (CDC, 2023). At Birth By Us, my role as a student research intern in Spring 2023 involved compiling and analyzing data related to pregnancy, birth, and postpartum experiences. Communication is at the heart of any effective healthcare intervention, and by bridging the information gap, Birth By Us ensures that users are well-informed about their reproductive health. This promotes informed decision-making and reduces disparities in access to healthcare resources for Black women, ultimately breaking down barriers to equitable care. Co-founders Mercy Oladipo and Ijeoma Uche, MPH, created a platform that empowers Black mothers and birthing people through technology, by allowing them to shape their birthing experiences while giving providers and hospital systems the necessary insights to achieve patient-centered care. The application’s commitment to Diversity, Equity, Inclusion, and Accessibility (DEIA) is evident in its tailored approach to resources and symptom tracking, ensuring that Black women feel represented and valued. The application ensures that every user, regardless of background, has access to the information and support they need for a healthy pregnancy and birth. 

UCSF PTBI

During my Internship in the Summer of 2023 with UCSF California Preterm Birth Initiative (PTBI), I was able to explore various projects, both in progress and completed. Two projects I was introduced to were Human Milk Feeding in the City and County of San Francisco and the Black Coalition for Birth Justice. In the landscape analysis for the San Francisco Department of Public Health (SFDPH), the project focused on breastfeeding research addressing the concerning disparities in breastfeeding rates within San Francisco. While working alongside researchers on the landscape analysis, I was able to shadow interviews and listen to conversations with key stakeholders, such as hospital administrators, clinicians, community-based organization leaders, lactation consultants, and parents who had given birth in San Francisco County in the past five years. Being a part of these important conversations provided valuable insights into the strengths, resources, and needs of the community regarding human milk feeding. Additionally, I also had the opportunity to transcribe interviews for other projects that highlight MCH leaders and connect community members to their resources. 

Another project I worked closely with is the Black Coalition for Birth Justice, where I had the opportunity to learn about the agenda that the coalition co-founders and backbone team were dedicated to implementing. The agenda includes strategies aimed at dismantling system barriers, advocating for policy changes, and fostering community partnerships to address Black maternal inequalities. Through my internship with the Black Coalition for Birth Justice, I gained a deep understanding of the agenda’s objectives and initiatives that align with the goal of achieving birth equity and reducing Black maternal inequities.

Integrating MCH Competencies into my Internships 

The experiences at UCSF PTBI and Birth By Us directly integrated MCH Leadership Competencies, particularly in communication and diversity, equity, inclusion, and accessibility. Resources are available for all with accessible research. Projects such as the breastfeeding landscape analysis project, and the agenda by the Black Coalition for Birth Justice to identify and address disparities reflect a commitment to fostering inclusive communities and understanding the impact of culture of communication. The integration of these competencies will contribute to the broader goal of improving MCH outcomes and achieving health equity. Both Birth By Us and UCSF PTBI exemplify the significance of community-based services in advancing health equity. Community-based systems play a crucial role in tailoring interventions to the unique needs of local populations, fostering trust, and ensuring culturally competent care. By actively engaging with community-based organizations and coalitions, these initiatives recognize that effective healthcare solutions must be rooted in the communities they serve. Birth By Us and UCSF PTBI take a comprehensive approach to address health inequalities. At the individual level, these initiatives provide targeted resources and support, acknowledging the diverse needs of pregnant individuals. Organizationally, they collaborate with community-based organizations, healthcare institutions, and advocacy groups to implement inclusive and equitable practices. Systemically, both initiatives contribute to the broader conversation on health equity, advocating for policy changes and systemic reforms to dismantle structural barriers.

5: Communication (Maternal and Child Health Leadership Competencies)

Understanding the impact of cultural nuances, language diversity, varying literacy levels, and disabilities is fundamental to effective communication. Birth By Us and UCSF PTBI prioritize communication strategies that consider these factors, ensuring that information is accessible and resonates with the diverse populations they serve. Effective communication involves a multifaceted approach. Birth By Us and UCSF PTBI employ verbal, written, and non-verbal communication modalities to reach individuals with diverse communication preferences, ensuring that crucial information is disseminated in a way that is easily understood and retained. Cultural responsiveness is embedded in the communication strategies of both initiatives. They recognize the importance of tailoring messages to align with cultural norms and values, fostering trust and engagement within diverse communities. By actively engaging with community members, stakeholders, and participants, these initiatives demonstrate a commitment to fostering meaningful dialogue and understanding the unique needs of their audiences.

7: Diversity, Equity, Inclusion, and Accessibility (DEIA) (Maternal and Child Health Leadership Competencies)

Birth By Us and UCSF PTBI actively contribute to creating respectful and inclusive communities by leading with DEIA principles. These initiatives recognize the importance of fostering environments where all individuals feel valued, respected, and included. In creating respectful and inclusive communities, we can address the unique challenges faced by individuals with intersecting identities. This might include developing targeted resources, engaging with community leaders, and advocating for policies that address the specific needs of diverse populations. Both Birth By Us and UCSF PTBI actively implement DEIA principles in research by ensuring diverse representation, considering cultural nuances, and promoting inclusivity. By prioritizing community engagement, these initiatives create spaces where individuals feel a sense of belonging in research processes. As MCH leaders, it is crucial to recognize that health disparities are the result of a complex interplay of Social Determinants of Health. Birth By Us and UCSF PTBI, in their initiatives, demonstrate awareness of these factors, acknowledging that factors such as race, socioeconomic status, education, and geographic location intersect to create disparities in health outcomes. 

Emphasizing the Importance of Ongoing Commitment to Health Equity

The ongoing commitment to health equity is a fundamental necessity for the well-being of all individuals. Initiatives can positively impact communities when guided by principles of communication, diversity, equity, inclusion, and accessibility. Birth By Us and UCSF PTBI illuminate the path forward, showcasing that achieving health equity demands a comprehensive and sustained commitment from all sectors of society. Building on the statement previously mentioned, the “highest level of health” for everyone necessitates addressing social determinants and requires systematic changes in policies and practices. In essence, the commitment to health equity entails acknowledging and rectifying historical injustices to pave the way for a future where health disparities are replaced with a universal opportunity for all individuals to attain their full health potential.

References

“What Is Health Equity?” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 1 July 2022, www.cdc.gov/healthequity/whatis/index.html. 

“Working Together to Reduce Black Maternal Mortality.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 Apr. 2023, www.cdc.gov/healthequity/features/maternal-mortality/index.html#:~:text=Racial%20Disparities%20Exist,structural%20racism%2C%20and%20implicit%20bias. 

“CDC – Social Determinants of Health – STLT Gateway.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 15 Sept. 2023, www.cdc.gov/publichealthgateway/sdoh/index.html. 

Uche, Ijeoma. “Closing the Gap: Mobile App for Birth Equity [Competency 7: Cultural Competency; 11: Working with Communities and Systems].” MCH LEADS, MCH LEADS, 1 Mar. 2023, www.mchleads.com/?p=1136. 

Artiga, Samantha, and Elizabeth Hinton. “Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity.” KFF, 9 July 2019, www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/. 

“Racism and Health.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 18 Sept. 2023, www.cdc.gov/minorityhealth/racism-disparities/index.html. Acting High Commissioner: Addressing the Legacies of Colonialism Can …, United Nations, 28 Sept. 2022, www.ohchr.org/en/press-releases/2022/09/acting-high-commissioner-addressing-legacies-colonialism-can-contribute.