Author: Isabella Litwack, MPH(c) Community Health Sciences, Maternal and Child Health
When I turned 18 years old, I did not vote in the 2012 election. This crucial birthday fell when I was in the middle of my senior year of high school. My true belief at the time was that voting was a useless waste of my time, and my singular vote could never possibly fix a system that was so terribly broken. As I write this as an almost 23-year-old, I know that this attitude came from a place of privilege. I was thinking from the standpoint of someone who grew up white, upper-middle class, educated, healthy, and soon going off to college with no loans taken out. Maybe I felt like I didn’t need to vote because I was living in a system that was actually somewhat working for me. It wasn’t until I was in the middle of my college career, when feminism and activism became a major part of my life, that I realized my previous views about politics and voting were misguided. Although I had begun to recognize my privilege, I also was learning exactly what being a woman in America, specifically in Indiana, meant. I began reading books about feminism, culture, and health, and a cord within me struck. Then, Trump became President and I realized how much of a difference all of those singular votes could have made, especially after realizing that about 100 million people did not vote at all (Ingraham, 2016). After the election, I knew I had to be an advocate for reproductive justice, the physical, mental, political, social, and economic well-being of women and girls, and I knew exactly where I was going to do it.
Planned Parenthood (PP) is probably my grandmother’s favorite organization in the world. My entire family supports PP proudly, and I could not wait to see how I could help (little did I know how much PP would get me politically involved). When I came to Chicago, I joined a Planned Parenthood group on campus, and became a Planned Parenthood Illinois Action (PPIA) volunteer. On January 24, I volunteered for their Roe v Wade anniversary fundraiser, where the theme was “Act. Vote. Win!”. The event featured political leaders, state representatives, aldermen, and people who hope to take a local office in the upcoming Illinois elections. One of PPIA’s main focus points of the year is to encourage people in Illinois to vote, specifically for someone who has PPIA’s stamp of approval. They showed a video of the women’s march, and other events that happened in 2017, and inspired the crowd to make their way to the poles in 2018. Trump’s election made me truly realize how important it is to vote, but this event solidified that belief even more. That election also showed me the importance of voting beyond presidential elections, such as congressional /and local elections as well. Policies that shape and determine women’s health vary vastly from state to state and it is critical that folks show up to the polls and vote for candidates that will protect women’s right and women’s health. If every young person believes what I used to believe, that their vote couldn’t possibly change anything, then we are losing a significant number of votes from people who could make an impact on any election. If people vote for what they believe in, they can be active participants in their communities, and see the changes that they feel are important to them.
Ingraham, C. (2016). About 100 million people couldn’t be bothered to vote this year. Retrieved from https://www.washingtonpost.com/news/wonk/wp/2016/11/12/about-100-million-people-couldnt-be-bothered-to-vote-this-year/?utm_term=.b734b3a9acfc
- How Feminism Made me a Voter
- Dr. Rebecca Singer’s Insights on Gender-Based Violence and the Role of Public Health
- Messages from Rebecca Shlafer, Warrior of the Minnesota Prison Doula Project
- Mesothelioma, A Lifecourse Perspective
- MCH Student Op-ed: Don’t call it universal without including abortion coverage
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Author: Isabella Litwack, MPH(c) Community Health Sciences, Maternal and Child Health
By: Amanda Wojan, MPH(c)
Gender-based violence, defined as violence against a person due to their gender, is a significant problem that affects countries around the globe. On November 15th, 2017 Dr. Rebecca Singer, UIC Nursing faculty, spoke at the School of Public Health regarding the impact of gender-based violence in various countries that she has worked in through Doctors without Borders, including the Democratic Republic of the Congo and Papua New Guinea. Many people tend to think that gender-based violence, such as sexual violence, is a “bigger problem” or more prevalent in developing countries. However, as Dr. Singer stated, this type of violence occurs everywhere, and is an ever present problem in the United States as well. Further, gender-based violence is often used interchangeably with talk of sexual violence/assault against women. Although this is a common type of gender-based violence, it encompasses much more, including violence against men (European Institute for Gender Equality).
Despite the broad scope of gender-based violence, we know that women are particularly vulnerable. According to the WHO Department of Gender, Women and Health, women and children are particularly affected by disaster situations, accounting for more than 75% of displaced persons. Subsequently, women are often left more vulnerable than men during disaster situations, as they face increased risk of reproductive and sexual health problems and increased rates of sexual and domestic violence. Dr. Singer discussed themes along these same lines throughout her lecture, stating that women are often expected to take on caretaker roles in times of disaster (such as at refugee camps), but face severe challenges in doing so. This vulnerability tends to emerge due to lack of resources (women may need to sell their bodies to provide food for their families) and a lack of infrastructure in place to promote safety.
Dr. Singer told stories of women who were beaten or sexually assaulted by partners, family members, and/or strangers. Many only had the Doctors’ Without Borders Clinics that she helped coordinate to receive the critical services they needed following an assault. These services included medication to prevent pregnancy and/or STI contraction (ex: post exposure prophylaxis), mental health counseling (when funds were available), and a medical certificate documenting the assault. Despite the important role these services play in helping survivors of gender-based violence, they often do not address the root cause of the problem: gender-based violence is a perpetual issue in many societies due to sexism and persistent gender disparities. So what can we do to improve this issue around the globe and promote a society that condemns gender-based violence? Dr. Singer named a few strategies that have emerged throughout her work:
❖ Educate perpetrators on what constitutes sexual assault and gender-based violence.
➢ Dr. Singer stated that in her experience, some perpetrators do not realize that what they are doing constitutes gender-based violence.
➢ Change the narrative! Give people alternatives to violence when they are having a disagreement with a partner.
❖ Incorporate wrap-around services for survivors of sexual assault that encompass mental health care and advocacy.
❖ Empower communities to engage in grassroots efforts.
➢ Let the communities lead!
➢ Evidence shows that grassroots efforts that work from the bottom up make meaningful and sustainable behavior change possible in communities (Mathie & Cunningham, 2003).
➢ Engage women as full and equal partners in community based action, and ensure that they are involved in the highest levels of planning and decision-making, particularly when it involves their own health and reproductive rights.
Dr. Singer emphasized that in many communities in which she worked the providers that worked at these support clinics were also survivors of gender-based violence themselves. Thus, they are the experts, positioned to provide powerful insight on how to combat this violence within their communities. As one clinician Dr. Singer worked with stated, “We are all survivors”. This is public health: harness the power of the people in the communities – they have the knowledge and the tools.
European Institute for Gender Equality. Retrieved from http://eige.europa.eu/gender-based-violence/what-is-gender-based-violence
Mathie, A., & Cunningham, G. (2003). From clients to citizens: Asset-based community development as a strategy for community-driven development. Development in practice, 13(5), 474-486.
Singer, R. (2017). Sexual Violence in Conflict and Non-conflict Settings: Challenges and Opportunity. [Lecture]. Retrieved on November 15th 2017.
WHO Department of Gender, Women, and Health. Retrieved from http://www.who.int/gender-equity-rights/en/
By: Amanda Wojan, MPH(c)
On September 27th Dr. Rebecca Shlafer, an Assistant Professor in the Division of General Pediatrics and Adolescent Health at the University of Minnesota, came to UIC to discuss her work implementing a prison doula project. Her lecture discussed the crucial nature of implementing policies that humanize incarcerated pregnant women throughout their pregnancy journeys. She discussed that prior to the implementation of this doula program in Minnesota, they lacked the resources and knowledge necessary to provide incarcerated pregnant women with what they needed to maintain their own health/the health of their babies. As Dr. Shlafer stated, the population of women in prison who are pregnant are a vulnerable group, potentially facing environmental risks, physical health issues, and issues related to mental health and substance misuse which in turn can lead to poor perinatal outcomes such as preterm and small for gestational age infants.1 Thus, focus on interventions that promote their health and well-being is of particular interest for public health professionals thinking in terms of lifecourse models. The long term health outcomes of these babies are dependent on both the prenatal and postnatal care that these women receive, as well as their ability to form important attachments with their babies early on.
The Minnesota Prison Doula Project implemented two core components into their programming: 1) a new moms informational group, and 2) one-on-one doula supports for all pregnant women in the prison. These components are meant to provide these mothers with the resources that they need to have a healthy and successful pregnancy, and to learn the skills necessary to form positive relationships with their babies. Dr. Shlafer mentioned that the doulas also provide emotional and social support to the woman post pregnancy when they are separated from their babies. They help the mothers establish healthy coping skills in this incredibly difficult separation process.
Doula support during childbirth is associated with better health outcomes for both the mother and the baby, including better APGAR scores, shorter first stage of labor, less medical interventions required during labor/delivery, and decreased c-sections.2 Doulas are not only helpful before, during, and directly after pregnancy, but they are also key players throughout the weeks postpartum in supporting the mother and baby in activities such as breastfeeding and forming healthy relationships. A key component of forming positive relationships between mother and baby is skin to skin contact. The benefits of skin to skin contact between mother and baby are invaluable: it helps to calm the baby by reducing stress levels in both mother and baby; it helps the mother’s milk to flow more easily; it boosts the baby’s immune system; it builds important neural connections in the baby’s brain via the smells, textures, and sounds that the baby experiences; it lowers the mother’s risk of a postpartum mood disorder; and ultimately it creates lasting connections and strong attachments between the mother and baby.3
This seemingly simple concept is something that can prove extremely challenging for women in prison. Many do not have access to their babies postpartum, as they are entered back into prison after their 48 hour stay in the hospital. This leaves them only their occasional visitations with family to have any human contact with their babies. This crucial issue proposes important next steps for groups that work with these vulnerable women. The implementation of doulas in state prisons is extremely beneficial, and the data show that it improves birthing outcomes. But what comes next? How can we support new mothers who are still in prison to have successful and positive relationships with their newborns? This falls heavily on policy, advocacy, and compassion stemming from the multidisciplinary team that works to promote the health outcomes of these women and children. Our work here is not done and this is of importance considering over the last two decades the number of women in prison in the US has dramatically increased and approximately 76% of incarcerated women are of childbearing age.4
Which leads me to a powerful quote from Dr. Shlafer’s presentation: “Research without advocacy is just a dusty journal on someone’s shelf. Advocacy without research is just a temper tantrum.”5
1 Shlafer, R. J., Hellerstedt, W. L., Secor-Turner, M., Gerrity, E. and Baker, R. (2015), Doulas’ Perspectives about Providing Support to Incarcerated Women: A Feasibility Study. Public Health Nurs, 32: 316–326. doi:10.1111/phn.12137
2 BOlBOl-haGhiGhi, N., MaSOuMi, S. Z., & KaZeMi, F. (2016). Effect of Continued Support of Midwifery Students in Labour on the Childbirth and Labour Consequences: A Randomized Controlled Clinical Trial. Journal of clinical and diagnostic research: JCDR, 10(9), QC14.
3 Breastmilk, Every Ounce Counts. Retrieved from http://www.breastmilkcounts.com/breastfeeding-101/skin-to-skin/
4 Shlafer, R. J., Hellerstedt, W. L., Secor-Turner, M., Gerrity, E. and Baker, R. (2015), Doulas’ Perspectives about Providing Support to Incarcerated Women: A Feasibility Study. Public Health Nurs, 32: 316–326. doi:10.1111/phn.12137
5 Shlafer, R. (2017). Pregnant and parenting among incarcerated women: from research to advocacy. [PowerPoint slides]. Retrieved on September 27 2017.
By: Emily Walsh, in collaboration with the Mesothelioma Cancer Alliance, and Amanda Wojan
Exposure to environmental toxins and the subsequent disease exposure can lead to lifelong complications and issues. While people are more commonly aware of the threat of carbon monoxide or lead, asbestos is a toxin that is very much present in daily life and has the potential to be vastly more dangerous. Widespread use in the past century means that existing asbestos can be readily found in homes, schools, and spaces, both across the United States and globally. A known human carcinogen, asbestos has been proven to cause several illnesses including asbestos cancer, more widely known as mesothelioma, which develops in the linings of organs. The most common type of this rare cancer is pleural mesothelioma affecting the lungs, however it can also present in the abdomen and around the heart.7
The risk of exposure to environmental toxins is inequitably distributed and most impacts marginalized communities. Studies have noted that communities that are low-resourced, with higher populations of people of color are more vulnerable to these exposures.1-5 Unfortunately, these communities are also not positioned to adequately address the source of these toxins. Having fewer economic resources can lead people to live in substandard housing conditions, where toxins such as mold and asbestos are present.6 This is a clear example of how social factors can work to determine one’s health outcomes. Because of the unjust and unequal distribution of these exposures, rectifying and addressing this inequity should be a public health priority.
Heather Von St. James is an 11-year survivor, receiving her diagnosis of malignant pleural mesothelioma just over three months after giving birth to her daughter. She was exposed to asbestos as a child, wearing her father’s work coat while doing her outdoor chores everyday. Asbestos fibers were in the dust caked into the fabric from his construction job, and she unknowingly breathed them in as she wore the coat. This exposure eventually led to her diagnosis with this aggressive, rare cancer at the age of 36.
One of the dangers of this cancer, as well as other asbestos-related diseases, is that it can take anywhere from 10-50 years after exposure to develop. This long delay of symptoms, coupled with their general nature, can make it easy to receive misdiagnoses at first. As such, patients are often faced with a poor prognosis and limited treatment options. Heather faced a prognosis of just 15 months to live without treatment. However, an intensive, experimental surgery that removed her left lung, two ribs, half her diaphragm, and the lining of her lung and heart, followed with chemotherapy and radiation, meant that she outlived her best-case prognosis of ten years and is still celebrating her health today.
Heather’s story illustrates a powerful point about life-cycle illnesses in that they do not always have to be chronic, yet they can touch every stage of the life course. While her exposure occurred as a child, her cancer developed years later and her life was irrevocably changed by her diagnosis. Physically, Heather must live with one lung and faces limits on her activity. She had to give up her career, and she faces lifelong anxiety around her bi-annual scans. Her cancer journey will follow her throughout her entire life.
Heather has taken this experience and channeled it into her passion and calling as an advocate. She now works to support the mesothelioma community by connecting with patients, educating people about what mesothelioma is, and spreading awareness about rare cancers. Speaking from experience, she also lends her voice in Washington D.C., often working to advocate for legislation that supports a full and final ban on the use of asbestos in the United States.
Mesothelioma Awareness Day is September 26th and it serves as an ideal opportunity to call attention to the education, awareness and support this community and cause needs.
To learn more about pleural mesothelioma, check out this website: https://www.mesothelioma.com/mesothelioma/types/pleural.htm
1 Sampson, R. J., & Winter, A. S. (2016). The racial ecology of lead poisoning: Toxic inequality in Chicago neighborhoods, 1995-2013. Du Bois Review: Social Science Research on Race, 13(2), 261-283.
2 Moody, H. A., Darden, J. T., & Pigozzi, B. W. (2016). The relationship of neighborhood socioeconomic differences and racial residential segregation to childhood blood lead levels in Metropolitan Detroit. Journal of Urban Health, 93(5), 820-839.
3 Berg, K., Kuhn, S., & Van Dyke, M. (2017). Spatial surveillance of childhood lead exposure in a targeted screening state: an application of generalized additive models in Denver, Colorado. Journal of Public Health Management and Practice, 23, S79-S92.
4 Winter, A. S., & Sampson, R. J. (2017). From Lead Exposure in Early Childhood to Adolescent Health: A Chicago Birth Cohort. American Journal of Public Health, 107(9), 1496-1501.
5 Hao, H., Chang, H. H., Holmes, H. A., Mulholland, J. A., Klein, M., Darrow, L. A., & Strickland, M. J. (2016). Air pollution and preterm birth in the US State of Georgia (2002–2006): associations with concentrations of 11 ambient air pollutants estimated by combining Community Multiscale Air Quality Model (CMAQ) simulations with stationary monitor measurements. Environmental health perspectives, 124(6), 875.
6 Evans, G. W., & Kantrowitz, E. (2002). Socioeconomic status and health: the potential role of environmental risk exposure. Annual review of public health, 23(1), 303-331.
By: Vidya Visvabharathy, MPH (c)
As Sen. Bernie Sanders prepares to introduce a universal health care bill in the next few weeks, many progressives who support a universal single-payer program worry about its effects on abortion access. Can we win Medicare for all while protecting hard-won reproductive rights? As a woman of color, a reproductive rights advocate, and graduate student of public health, I recognize the importance for marginalized groups to stand in solidarity for progress to happen. I urge single-payer advocates to push to repeal the Hyde Amendment as part of our fight for truly universal health care.
It’s no surprise that the majority of Americans support a national health program. Although the U.S. spends twice as much on health care than other industrialized nations, key health outcomes such as life expectancy and infant mortality fare much worse as compared to our international counterparts. Most of this difference in spending can be traced to our fractured, profit-based insurance industry, which wastes nearly a quarter of our health care dollars on billing, advertising and profits, none of which contribute to quality of care. In contrast, a single-payer health program is a universal health care model that is publicly financed and covers all Americans for medically-necessary care, such as doctor visits, hospital stays, long-term care, and drugs.
Single-payer has been a long-standing progressive cause, and would seem to have no problem gaining support from all progressive groups. However, many women’s advocacy groups are hesitant to back a single-payer system because it could restrict access to abortion. The Hyde Amendment, passed in1976 after the landmark Roe v. Wade case legalized abortion, bans all federal funding for abortion services except in the cases of rape, incest, and life endangerment to the mother. Therefore, a single-payer program could not fund abortion, unless explicitly stating that reproductive and abortion services would also be covered. Single-payer advocates should ally with women’s advocates and work to repeal the Hyde Amendment to increase support for both causes.
Progressives can learn a lot from efforts to enact single-payer programs at the state level. For example, in November 2016, Colorado lawmakers tried to enact a health care system similar to single-payer, known as ColoradoCare. However, NARAL (National Abortion and Reproductive Rights Action League) opposed the plan because it would leave more than 550,000 women without access to abortion services due to the state’s constitutional ban on funding for abortions except for life-threatening circumstances. Many women who have access to abortion services through private insurance plans would have lost this coverage under ColoradoCare. According to a statement by NARAL, the bill “is not truly universal” since it does not guarantee abortion services. Ignoring reproductive health caused ColoradoCare to lose key supporters necessary to win universal care.
The statewide single-payer legislation in New York serves as a promising model that explicitly incorporates reproductive services in the health system. The program, known as New York Health, covers all medically-necessary services that are currently covered by the state Medicaid program, including abortions. Diverse health organizations such as New York State Family Physicians and the Reproductive Health Access Project were heavily involved in crafting the bill from the start, underscoring the need for single-payer and women’s health groups to build legislation together.
In order to avoid the mistakes of ColoradoCare at both the state and national level, single-payer groups must explicitly advocate for coverage of abortion services, and work with reproductive health advocates to repeal the Hyde Amendment. While it is laudable that the single-payer advocacy organization Physicians for a National Health Program recently released a statement supporting abortion coverage, supporting causes ideologically is not enough. Reproductive health services, including abortion, must be explicitly written into any single-payer bill. If we want a universal health care system, it must be a system that covers comprehensive reproductive services as well.
Vidya is an MPH student completing her degree in MCH-Epidemiology. Her research interests include women’s health and reproductive justice. In the future, she hopes to practice as a physician-advocate for marginalized populations in Chicago.
This article was originally posted on KevinMD at the following link:
By: Janet Murphy from City Limits
Statistically speaking, during the time you’re watching the video segment below, three new New Yorkers will be born somewhere in the city—three of the 120,000 or so births that occur here in a typical year. Most of those babies and their mothers get through the process in good health. But some moms end up very sick. That’s a problem called severe maternal morbidity — and it has been getting worse.
From 2008 to 2012, it shot up 28 percent in New York. And city statistics indicate race, poverty, age, access to healthcare and even whether a patient really wanted to have a baby all have dramatic effects on the risks different women face. Neighborhoods also matter: Central Brooklyn is the epicenter of SMM in New York City.
Reducing maternal morbidity is a goal of city health officials educators and providers. On Thursday’s BkLive, I was joined by Dr. Deborah Kaplan, the Assistant Commissioner for the Bureau of Maternal, Infant and Reproductive Health at the city’s Department of Health and Mental Hygiene, and Dr. Monica Sweeney, a Clinical Professor at SUNY Downstate Medical Center, where she is Chair of the Department of Health Policy and Management and the Vice Dean for Global Engagement.
The effort to fight maternal morbidity is part of the effort to reduce the more serious, if smaller, problem of maternal mortality. The U.S. has one of the worst rates of maternal mortality in the developed world, and it has edged higher in recent years. Every year, New York hospitals lose around three dozens mothers. The impact of such a death, as Sweeney notes in the video, is broad and devastating.
View the video below:
To read the full article and more articles from City Limit, please click here.
By Katie Garland, MPH
Alumna, UIC School of Public Health, Community Health Sciences and Maternal Child Health
Visiting Research Specialist, UIC Center for Research on Women and Gender
Thirty years ago, researchers asked “where is the M in MCH?”(Rosenfield & Maine 1985) Today, we are still asking ourselves the same question. Since 1980, infant mortality declined 52% in the US but during the same time, maternal mortality rose, defying global trends (Centers for Disease Control, MacDorman, Declercq, Cabral & Morton 2016). The US now has the worst maternal mortality ratio in the industrialized world (Kassebaum et al 2016, MacDorman et al. 2016). Maternal mortality does not affect all populations equally; Black mothers are three to four times more likely to die than White mothers (CDC Foundation 2017). Maternal mortality is a fixable problem; other countries have succeeded in dramatically lowering their rates. We know that at least half of maternal deaths in the US are preventable (CDC Foundation 2017). However, maternal health is woefully underfunded compared to infant and child health. Only 6% of MCH block grant funding is devoted to maternal health (Martin & Montagne, 2017). In a political climate where severe cuts to public health programs and the social safety net are likely, it is critical that maternal health advocates and stakeholders gather together and demand action. And gather we did.
On Mother’s day, over 100 maternal health stakeholders gathered at the Jefferson Memorial in Washington DC to march for America’s mothers. The best part of the march was the diversity of stakeholders that were involved. Representatives from ACOG, AABC, AWHONN, ACNM, and multiple nonprofits spoke at the march. Health practitioners, academics researchers, doulas, advocates, and families were all in attendance. The speakers discussed a wide range of maternal health topics including maternal mortality in the US and globally, postpartum depression, perinatal disparities in Black and Native communities, preterm birth, and stillbirth.
Some of the most powerful words came from Jennie Joseph, CPM and executive director of Commonsense Childbirth.
“I challenge you to reexamine how you think about what’s happening. This is not new. The system is broken and has been for decades. Let’s stop blaming the women. Let go of the judgement, the shaming, the discrimination, the stereotypes. Become aware of the conscious and unconscious biases that shape our OB care today. Recognize that these outrageous statistics cannot stand year in and year out without the acknowledgement or the impact of racism, classism, sexism. It’s killing our babies. It’s killing our mothers. “
The march was also an excellent opportunity to network with other maternal health stakeholders. I was able to discuss my current work in maternal health and make connections with researchers and advocates in many different areas of maternal health. The organizers hope to hold another march in DC next year.
Advocacy was another theme of the march. Attendees were encouraged to meet with their senators and representative before and after the march. Currently, there are bills in the House and Senate that would designate funding for maternal mortality review committees and grant funding for state projects addressing maternal mortality disparities. This is a critical step to ensuring accurate nationwide surveillance of maternal mortality. However, it is just the first step to addressing the broader issue of maternal mortality. In order to really prevent maternal deaths in the US, a variety of changes will need to happen. Equitable access to affordable, quality healthcare (including family planning), a robust social safety net, investments in the health of communities of color, and paid family leave will all help save the lives of the 700-900 American mothers who die every year.
- Centers for Disease Control. Deaths: Final Data for 2013. Retrieved from: http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf
- CDC Foundation (2017). Report From Maternal Mortality Review Committees: A View Into Their Critical Role. Retrieved from: https://www.cdcfoundation.org/sites/default/files/upload/pdf/MMRIAReport.pdf
- Kassebaum, N. et al (2016). Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1775 – 1812. doi: http://dx.doi.org/10.1016/S0140-6736(16)31470-2
- Macdorman, M. F., Declercq, E., Cabral, H., & Morton, C. (2016). Recent Increases in the U.S. Maternal Mortality Rate. Obstetrics & Gynecology, 128(3), 447-455. doi:10.1097/aog.0000000000001556
- Martin, N., & Montagne, R. (Writers). (2017, May 12). Focus on Infants during Childbirth Leaves U.S. Moms in Danger [Transcript, Radio broadcast]. In Morning Edition. Washington DC: National Public Radio.
- Rosenfield, A., & Maine, D. (1985). Maternal Mortality-A Neglected Tragedy Where is the M in MCH? The Lancet, 326(8446), 83-85. doi:10.1016/s0140-6736(85)90188-6
When thinking about common public health women’s issues, bladder health may not initially come to mind. However, Dr. Jeni Hebert-Beirne and the Prevention of Lower Urinary Symptoms in Women (PLUS) Consortium are working to reframe the current approach to addressing women’s bladder health and lower urinary tract symptoms (LUTS) with an exclusive focus on prevention.
LUTS includes accidentally leaking urine, needing to go often during the day and having a strong and sudden need to urinate. In the U.S. 20-40% of women young and middle-aged are affected by these symptoms. LUTS increases women’s risk for other health issues such as depression, obesity and diabetes. While an issue that affects women’s lives, many may not feel comfortable actually discussing their symptoms let along seeking care. When symptoms reach the threshold of care seeking many women are confronted with health care providers who are unskilled and untrained in addressing their symptoms. LUTS have a significant economic impact on the health care system and on families impacted. Therefore, the PLUS Consortium was formed, through funding the National Institutes of Health (NIH), as a transdisplinary research initiative comprised of experts from various fields across the country conducting studies that will guide future prevention and program research for LUTS.
As a member of the PLUS Consortium, Dr. Hebert-Beirne is launching the research by conducting a focus group study with women and girls across the country to understand how they learn about issues with their bladders and who they talk to about bladder health. These focus groups will prioritize special populations of women including those who work in occupations where they have little control over their bladders (e.g. factory workers), women who speak a language other than English and teens. Building off of Dr. Hebert-Beirne’s extensive work on social determinants of health, this research aims to understand bladder health in the context of women’s lives and through the life course model. Dr. Hebert-Beirne, who previously conducted research on bladder health through the Women’s Health Foundation, is enthusiastic about this NIH initiative. “I am drawn to issues that are ignored and the degree to which they impact people’s lives. Women are suffering in silence. Surgeons have been treating LUTS over and over without much success and are finally realizing we should move upstream.”
To prepare for the upcoming focus groups, Dr. Hebert-Beirne and PLUS Consortium partners at Loyola are holding a training at UIC-SPH this month for group facilitators from all over the country. This training will ensure that facilitators are equipped with the skills necessary to lead and encourage discussions with women on topics that they may not be used to openly discussing.
Information learned from the national focus groups will guide next research steps that may explore women’s social networks and how these networks relate to bladder health. Dr. Hebert-Beirne hopes to also expand this research to look specifically at LBTQ women, a group often ignored in the field. For public health researchers and students interested in research similar to the PLUS Consortium initiative, Dr. Hebert-Beirne stressed the importance of getting involved in community engagement efforts. “The [Plus Consortium] is taking the need for research that is community engaged and informed seriously…Community engagement is important to build an infrastructure in communities.”
To learn more about the PLUS Consortium visit https://plusconsortium.umn.edu/.
Written by Danielle Noriega, MPH/MBA Candidate
By: Erin Howes, MPH Candidate in Community Health Sciences and Maternal and Child Health
This April I had the incredible opportunity, thanks to the UIC- Center of Excellence of Maternal and Child Health, to experience two firsts: visit Seattle and attend an academic conference! The 2017 Making Lifelong Connections (MLC), held in Seattle, Washington on April 5th-7th, 2017, hosted current and former trainees from the various Maternal and Child Health (MCH) training programs. MLC provided a platform for personal and professional networking and to share ideas on how to advocate for MCH populations.
The conference kicked off with any student’s dream – drinks, appetizers, and poster presentations. Listening to other student poster presentations was an informative experience where I learned so much and felt inspired for my own capstone project, which I will conduct next year. One of my favorite presentations was from a social worker in Seattle focusing on refugee health. This presentation drew my attention because of my interests in public health. I currently work at an FQHC in Chicago, Esperanza Health Center, which is located the community of Little Village. This community is predominantly immigrant and most residents are of Mexican decent. I was interested to see how the health status of immigrant communities in Seattle differ from those in Chicago. I learned about the healthcare system in Washington, the different populations they serve, and how the differences in healthcare policy affect women, children and families. It’s amazing how different maternal and child health issues can look from state to state and I never would have learned about Washington’s needs without meeting these fellow trainees.
Attending the MLC also gave me a deeper appreciation for the families that are impacted by MCH programs and services. During another portion of the meeting, I had the opportunity to meet a mother who has children with a special healthcare need. This woman collaborates with the LEND (Leadership Education in Nerodevelopmental and Related Disabilities) Program. She shared her story and informed us that she is a foster parent to 7 children and that 4 of these children have disabilities. Beyond being a foster parent, she is also a community health worker and a researcher. She used her experiences to inform her research and to understand the caregiver experience. She also examined the needs of children and youth with special healthcare needs as they transition to adulthood and their higher risk of homelessness. I appreciated the opportunity to hear this narrative because it provided me the context to appreciate the importance of programs that serve families who have children with special healthcare needs and how multiple systems should come together to protect vulnerable population.
Because this conference places a strong focus on building connections, many of the events allowed for interaction and reflection. A key activity that continued throughout the conference was the “Ring of Connections” in which every participant was provided with their own personal business cards to trade with new connections throughout the conference. This served as an icebreaker and allowed people to get to know each other, while also having the contact information to maintain communication following the conference. We also did some speed-networking, which allowing us to meet dozens of trainees in minutes.
Finally, the conference provided three wonderful, thought-provoking keynote speeches from booming professionals in the MCH field. One speech made a profound impact on me was given by Lauren Raskin Ramos, the director of the Division of MCH Workforce Development under HRSA. She spoke about her professional journey, taught us about the possibilities of our careers, and the power of making change by serving in government. One piece of her speech that stood out to me was her advice to seek people who see you as a leader. Sometimes we need to look for outside associations and organizations for leadership roles. Lauren encouraged us to pursue those skills and opportunities if they are not in front of you, and to be the kind of leader you would follow. I appreciated the reminder from Lauren who motivated me to re-evaluate my strategy to strengthen my leadership skills, and provided me an example of how to combine my passion for MCH with my goal to become a leader in public health.
I truly enjoyed this conference and I look forward to connecting with MCH leaders in the future!
To learn more about Making Lifeling Connections, click here.
On October 18th 2016, experts in housing, health and employment; students, and early childhood advocates met at Loyola University’s Sargent Shriver National Center on Poverty Law to discuss progress, explore new data on the race and poverty disparities of health, and develop a trajectory for future research in the field of early childhood health. This conference, titled, Justice from the Start: Exploring Racial Disparities in Access to Services for Babies and Toddlers, included keynote speaker Olivia Garden, Executive Director of Loyola’s Center for Law and Social Policy, and featured Dr. Aisha Ray, Professor Emeritus at Erikson Institute.
In Chicago, Hispanic children are two times as likely to be born into poverty, and among African American children, this statistic increases to three. The mission of Shriver Center is to “promote justice, and improve the quality of life and opportunities for upward mobility for those living in poverty.” To best identify and address the needs of our most disadvantaged communities, advocates must approach system change with the application of a “race lens.” As Olivia Golden presented: young children of color are the poorest population among children aged 0-3; and a child born poor, is more likely to become an adult who is poor.
A theme throughout the conference was the intersection of race and poverty and their impacts on health of young children and their families. Early exposure to poverty impacts the lives of children in many direct and indirect ways. Increased food or housing insecurity, a lack of health care services, racial discrimination, and limited proximity to early childhood centers compound the challenges faced by young children and their families. Those who are invested in the fight to break the cycle of poverty in Early Childhood to break the cycle of poverty: must prioritize racial justice. This approach will impact the lives and stability of parents, and as a result the health and wellbeing of their young children will be improved.
Participants explored the importance of structural racism and equity in the development of policies, services, and programs targeting the needs of infants and toddlers. In Chicago, across the United States, race remains a controversial subject, and racism as a barrier to health needs to be included in our nations dialogue of health equity. Structural and institutional factors, such as early childhood education centers or screening programs, influence childhood health outcomes; however, we need to recognize how we exclude the most at need when we frame future laws and policies. The following are examples of policies that impact health equity in Early Childhood:
- Proximity of high quality, bi-lingual early childhood programs to the infants and toddlers most in need;
- Policies which allow the expulsion or suspension of preschool-aged children;
- Implicit bias and lower expectations of children and families of color;
- Quality of programs or curricula used with children in poverty and of color.
Beyond recognizing the many challenges and barriers Early Childhood advocates face, participants had the opportunity to discuss areas where we can advocate. With an accumulation of research focusing on equity in early childhood, there is an increasing wealth of data that can be leveraged to strategize future steps. To reduce structural racialization and implicit bias, we can target different levels of change. Through personal and interpersonal change, individuals become more effective in relating to others and interpersonal conflict in reduced. Individuals and groups can collaborate to address structural and systemic inequities, such as biased hiring practices and promotion, policies, and a lack of inclusive institutional cultures. Participants then discussed how to address these systemic inequities. The following are some examples of proposed strategies:
- Improve data collection to make up for inconsistent data
- Focus on structural racism systemic inequality rather than personal prejudices
- Broaden the representation of diverse individuals and communities most affected by early childhood policies and programs
- Develop a highly qualified, culturally, racially, and linguistically diverse early childhood workforce.
We are tasked with the responsibility as professionals in early childhood to challenge these barriers to equity. With further research and a greater understanding of new data on race disparities in early childhood, advocates can ensure that all children have equal access to services, regardless of their race or poverty status.
Written by: Paula Satariano, MPH Candidate 2018 and Irving Harris Early Childhood Scholar