How SF is improving pregnancy care for communities of color


When Marna Armstead was just weeks away from her first pregnancy, she noticed irregular bleeding and saw her longtime doctor for a consultation. Although the pregnancy was not planned, she told her doctor that she would keep the baby.

“It was a cold, callous date,” Armstead said. She recalls that the obstetrician used the word “pregnancy” and not “baby” to describe the child she was carrying, and suggested that Armstead might be better not to.

That was almost 22 years ago. While Armstead says some things have changed for black mothers like her, many have remained the same.

San Francisco lost 10 mothers in childbirth between 2007 and 2016, according to the San Francisco Health Improvement Partnership, a group of service providers and community organizations that fight for equity in health. Five of these women were black.

Their babies are also more likely to die. From 2012 to 2016, 5.6 per 1,000 black infants died within 12 months of birth, compared to 1.7 per 1,000 white infants, according to data from SFHIP. Both figures are lower than national and national averages.

“My basic premise is that your health shouldn’t depend on the color of your skin or the neighborhood you live in,” said Malia Cohen, former District 10 supervisor. “The harsh reality, even in this big and wealthy city city ​​is that it is. “

These stubborn disparities haven’t changed much over time. How the city plans to tackle it, did it.

Zea Malawa, a San Francisco-based pediatrician, says that while these inequalities have existed for decades, most interventions have been clinical – a new drug or an antenatal care program, for example – instead of addressing the root cause of these results.

“If we are to reduce the disparity, we have to be honest about what is causing the disparity – it is stress, especially racialized stress,” said Malawa, who heads Expecting Justice, a departmental program. of Health, which seeks to reduce disparities in maternal health. . “We must be prepared to take active steps to dismantle all of this. “

The doulas are a starting point. They provide mothers with information and support throughout pregnancy and childbirth and advocate for mothers’ needs with practitioners.

Such a person would have been of great help to Armstead. The stresses of her life – finding a new doctor, dealing with a falling apart relationship, and thinking about life as a single mother – caught up with her, and she was diagnosed with gestational diabetes, high blood sugar during pregnancy, and preclampsia. , a condition caused by high blood pressure. Her daughter then ended up in the intensive care unit for newborns.

Armstead recalls reading voraciously books on pregnancy to learn about the conditions.

“I had a lot of support from my family, but I still felt really lonely,” she says. “What if I had a doula, someone who could have talked to me and helped me understand what was going on?” “

Black mothers today are even more likely to suffer from pregnancy complications like these, according to the city’s 2019 community health needs assessment. They are more prone to food insecurity, temporary homelessness and unemployment, all of which can contribute to stress-induced health problems.

“There is actually a lot of research that shows how stress gets under the skin and changes your biology and affects your health,” said Anu Manchikanti Gómez, director of the Sexual Health and Reproductive Equity program at the ‘UC Berkeley. “Medical interventions haven’t made a big difference in some of these health disparities, so we know the causes of these inequalities are really deep.”

Doulas help teach a mother about lifestyle changes during pregnancy and prepare her for possible complications. They can attend medical appointments, act as a doctor-patient liaison, and help educate mothers about care options. According to a study published in the Journal of Perinatal Education, mothers assisted by doula were four times less likely to have a low birth weight baby, half as likely to have a birth complication, and much more likely to have a birth weight complication. ‘breastfeed their child.

San Francisco has directed city funding toward programs that attempt to make a doula’s services – which often come at a high price – more accessible to women who need them most. These programs also focus on providing culturally appropriate care to patients.

“Having a racial match at your supplier can often be protective,” Malawa said. “Having someone who sees all of your humanity is really important in building trust and relationships with any supplier.”

Armstead, who herself was trained to be a doula, is now the executive director of SisterWeb, a nonprofit that provides Spanish-speaking, black and Pacific Island women with a stipend while they train to become doulas. . Cohen, then a member of the supervisory board, helped launch a partnership between SisterWeb and local hospitals that allows practitioners to match doulas in the network with mothers from the same communities.

Expecting Justice operates its own training program. He will be graduating a class of 25 new Black and Pacific Island Doulas in the coming weeks with hopes of creating a second cohort later this year. The four-month course is free for participants through a combination of public and private funding.

The city is also experimenting with a universal basic income program for black and Pacific Islander women.

The participants, about 150 of whom just received their first checks in July, will receive $ 1,000 each month during their pregnancy and six months after childbirth with no strings attached to how the money is spent.

The Abundant Birth Project aims to give mothers facing financial insecurity some peace of mind and reduce the rate of preterm births, the leading cause of death for black infants in San Francisco, and other directly related chronic diseases. to stress.

Manchikanti Gómez, who will lead efforts to analyze the results of the program, said survey participants will be asked about levels of anxiety, joy and financial security, among other indicators, to see if the payments help them. mothers underlying stress levels.

“We’re really trying something different,” she said of the driver.

Finally, there is the issue of basic public awareness.

San Francisco partnered with four other Bay Area counties in July to launch #DeliverBirthJustice, a campaign designed to draw attention to these disparities and galvanize public support for change. But many believe that a real math around maternal health requires a more robust transformation of city systems.

The events of the past 18 months have sparked a more honest conversation about race and inequality, but Malawa says real change will require recognition that all of our futures are intertwined.

“What does it cost to have black people so unprotected, in the birthing space or from COVID?” She said. “We have to move through a space and recognize that in fact we all share the same air, literally, and if someone isn’t breathing well, we will all be affected.”

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