Category: women’s health

Messages from Rebecca Shlafer, Warrior of the Minnesota Prison Doula Project

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

References:

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.


Mesothelioma, A Lifecourse Perspective

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

References:
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.
7 https://www.mesothelioma.com/mesothelioma/types/pleural.htm


MCH Student Op-ed: Don’t call it universal without including abortion coverage

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:

http://www.kevinmd.com/blog/2017/09/dont-call-universal-without-including-abortion-coverage.html


The Fight Against Severe Maternal Morbidity in Brooklyn: Video

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.


Where is the M in MCH? – March for Moms, Washington DC. Mother’s Day 2017

Katia Garland (left) and her mother, Meghan Garland, attend the Mother’s Day March in Washington D.C.

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.

 

References:

  1. Centers for Disease Control. Deaths: Final Data for 2013. Retrieved from: http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf
  2. 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
  3. 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
  4. 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
  5. 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.
  6. 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

 


Reframing Research on Women’s Bladder Health

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