Reproductive justice in patient care: tackling systemic racism and health inequities in sexual and reproductive health and rights in Canada

Coen-Sanchez, Karine; Idriss-Wheeler, Dina; Bancroft, Xaand; El-Mowafi, Ieman M.; Yalahow, Abdiasis; Etowa, Josephine; Yaya, Sanni

doi:10.1186/s12978-022-01328-7

Cited by 10 publications

(7 citation statements)

References 25 publications

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“…In addition to risks during and after pregnancy, people with CC may experience discrimination and stigma when seeking reproductive health (RH) care due to their health status 20–25 . A long history of reproductive injustice also shapes the way in which women and birthing people relate to RH decisions, resulting in women of color, those with LGBTQIA+ status, and other minoritized women with CC facing reproductive discrimination from providers and health systems due to their intersecting identities 26–28,29 . For people with CC who do get pregnant and use teratogenic medications or have health concerns during pregnancy, access to abortion is threatened in many regions across the United States 30 .…”

Section: Introductionmentioning

confidence: 99%

“…[20][21][22][23][24][25] A long history of reproductive injustice also shapes the way in which women and birthing people relate to RH decisions, resulting in women of color, those with LGBTQIA+ status, and other minoritized women with CC facing reproductive discrimination from providers and health systems due to their intersecting identities. [26][27][28]29 For people with CC who do get pregnant and use teratogenic medications or have health concerns during pregnancy, access to abortion is threatened in many regions across the United States. 30 Anecdotally, since the repeal of Roe v. Wade, people of child-bearing age report being denied access to first-line treatments for their CC due to concerns about abortion potential should they become pregnant.…”

Section: Introduction 1| Backgroundmentioning

confidence: 99%

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Supporting reproductive health among birthing persons with chronic conditions in the United States: A qualitative multilevel study using systems thinking to inform action

Smith

Fatima

McClain

et al. 2023

Health Services Research

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Objective (Study Question) To use systems thinking with diverse system actors to (a) characterize current problems at the intersection of chronic conditions (CCs) and reproductive health (RH) care and their determinants, (b) determine necessary system actors for change, and (c) document cross‐system actions that can improve identified problems in the United States. Data Sources/Study Setting Data were collected from six groups of system actors via online focus groups. Study Design This is a qualitative multilevel study using the iceberg systems thinking framework. Data Collection/Extraction Methods Data were collected by note‐taking and recording six focus groups; analysis incorporated perspective triangulation using the systems thinking iceberg and system mapping to visualize interconnected system challenges, actors, and action ideas. Principal Findings Participants described eight necessary system actors: health care institutions, medical leaders, medical providers, patient advocates and foundations, patients and families, payors, policy makers, and research funders. Forty pain points were identified, spread across each of the four levels of the systems thinking iceberg: undesirable outcomes (6), concerning trends (9), system structure flaws (15), and problematic mental models (10). In response to these pain points, a set of 46 action ideas was generated by participants and mapped into nine action themes: (1) adjust QI metrics, incentives, and reimbursement, (2) bolster RH medical education and training, (3) break down medical silos, (4) enrich patient education, (5) expand the health care team, (6) improve holistic health care, (7) modify research and programmatic funding to prioritize RH and CC, (8) spur innovation for patient visits, and (9) support professional champions and leaders. Conclusions By embracing system complexity, creating visual maps, and pushing participants to identify actionable strategies for improvement, this study generates a set of specific actions that can be used to address pain points across the multiple system levels that make improving reproductive care for people with CCs so challenging.

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Section: Introductionmentioning

confidence: 99%

Section: Introduction 1| Backgroundmentioning

confidence: 99%

Supporting reproductive health among birthing persons with chronic conditions in the United States: A qualitative multilevel study using systems thinking to inform action

Smith

Fatima

McClain

et al. 2023

Health Services Research

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“…13,14,17 Historically, Black women became victims of experimental gynaecological surgeries without anaesthesia due to the racist belief that Black people have a high pain tolerance. 7,14,[17][18][19] These acts of injustice fuelled by history of reproductive and medical exploitation of enslaved women gave birth to modern-day obstetric practices [18][19][20] and set the precedence for how Black childbearing women are expected to be treated within the healthcare system and by healthcare providers. 13,14 Obstetric racism is experience in subtle and overt ways including neglect, dismissal of concerns, disrespect, performing non-consensual procedures, and surrogate decision-making.…”

Section: Introductionmentioning

confidence: 99%

“…Racism as a determinant of health, along with the intersection of class, gender, and access to health services, adversely affects Black women's health outcomes. [7][8][9][10][11] Disparities in Black maternal health outcomes have been explained by the theories of epigenetics and the disruptive effects of structural racism including inflammatory response and pivotal allostatic imbalance triggering conditions such as preterm labour, gestational diabetes and preeclampsia. 10,12 Beyond these theories of epigenetics, other researchers have reported that obstetric racismrelated barriers to accessing quality prenatal and perinatal care in healthcare institutions may increase the risk of adverse maternal and newborn outcomes for Black women.…”

Section: Introductionmentioning

confidence: 99%

Obstetric racism and perceived quality of maternity care in Canada: Voices of Black women

Boakye,

Prendergast,

Bandari

et al. 2023

Womens Health (Lond Engl)

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Background: Obstetric racism in healthcare encounters impact on access to quality maternal healthcare for Black childbearing women yet remains underexplored in Canada. Understanding the experiences of Black Canadian women is critical to inform policy and create targeted interventions to address obstetric racism and advanced maternal health equity. Objective: The aim of this study was to explore the experiences of obstetric racism and its influence on perceived quality of maternity care among Black women in Toronto, Canada. Design: Qualitative research was conducted using a critical qualitative inquiry approach. Methods: We conducted a semi-structured interviews with 24 Black women who were pregnant and/or have given birth in the last 3 years. The interviews explored their experiences seeking care during pregnancy/childbirth and perceived quality of care. Results: Two themes were generated through the process of thematic analysis: (1) Manifestations and Impacts of Obstetric Racism and (2) Strategies for Addressing Obstetric Racism. Narratives of being dismissed, objectified, dehumanized, trauma and paternalism were reflected in the accounts of the participants. These experiences undermined the quality of care, hindered therapeutic relationships and contributed to mistrust. Conclusion: Black women understood the nature and impact of obstetric racism as it relates to the quality of maternal health care, their safety, and well-being. Participants recommended the need for anti-Black racism training specific to caring of Black childbearing women and increasing Black healthcare provider representation in perinatal settings as strategies to address obstetric racism. Investment in Black maternal health research is urgently needed to generate meaningful evidence to inform policy and interventions to advanced maternal health equity.

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“…The COVID-19 pandemic further magnified existing health inequities that disproportionately impacts the health and well-being of Indigenous women and Two-Spirit Peoples ( 6 , 10 , 21 ). Sex workers and women living with HIV have been affected by the COVID-19 pandemic facing loss of income and lack of access to outreach services as well as stigmatization and harassment by governments and police ( 22 , 23 ).…”

Section: Introductionmentioning

confidence: 99%

Structural racism and violence: Routine healthcare access in a cohort of marginalized Indigenous women and Two-Spirit Peoples during the COVID-19 Pandemic

Perry,

Goldenberg,

Deering

et al. 2023

Preprint

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Objectives Historical and ongoing colonial violence, racism, discrimination, criminalization, and intergenerational trauma continues to impact the health of Indigenous women (cisgender and transgender) and Two-Spirit Peoples. Previous and ongoing work clearly articulate the deeply harmful roles of colonialism and racism in continuing to systemically exclude Indigenous Peoples from accessing equitable and culturally safe healthcare. While the COVID-19 pandemic has amplified structural inequities, little attention has been paid to how the pandemic impacts healthcare access for Indigenous women and Two-Spirit Peoples living in urban settings. The aim of this study was to evaluate factors associated with experiencing difficulty accessing routine healthcare in a cohort of marginalized urban Indigenous women and Two-Spirit Peoples on the ancestral, occupied territories of the Musqueam, Squamish and Tsleil-Waututh Nations in what is now referred to as Metro Vancouver, Canada during the COVID-19 pandemic. Methods Data were drawn from AMPLIFY, a study of Indigenous cis and trans women and Two-Spirit Peoples in Metro Vancouver. Analyses drew on baseline and semi-annual questionnaire data collected with sex workers and women living with HIV from October 2020–August 2021. We used bivariate and multivariable logistic regression with generalized estimating equations (GEE) to model correlates of experiencing difficulty accessing a family doctor, nurse, or clinic for routine healthcare during the COVID-19 pandemic in the last 6-months. Results Amongst 142 marginalized Indigenous women and Two-Spirit Peoples (199 observations), 27.5% reported difficulty accessing routine healthcare. In multivariable GEE logistic regression, participants who had ever been pregnant (AOR:4.71, 95% CI:1.33–16.66) experienced negative changes in psychological and emotional well-being (AOR: 3.99, 95% CI: 1.33–11.98), lacked access to culturally safe health services (AOR:4.67, 95% CI:1.43–15.25), and had concerns regarding safety or violence in their community (AOR:2.72, 95% CI:1.06–6.94) had higher odds of experiencing recent difficulty accessing routine healthcare. Discussion Findings are in line with the BC Commissioned In Plain Sight report which recommends the need for accessible, culturally safe, anti-racist, and trauma-informed routine healthcare for marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples during the current and future pandemics. More community-based research is needed to understand access needs for culturally safe routine healthcare amongst marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples.

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Reproductive justice in patient care: tackling systemic racism and health inequities in sexual and reproductive health and rights in Canada

Cited by 10 publications

References 25 publications

Supporting reproductive health among birthing persons with chronic conditions in the United States: A qualitative multilevel study using systems thinking to inform action

Supporting reproductive health among birthing persons with chronic conditions in the United States: A qualitative multilevel study using systems thinking to inform action

Obstetric racism and perceived quality of maternity care in Canada: Voices of Black women

Structural racism and violence: Routine healthcare access in a cohort of marginalized Indigenous women and Two-Spirit Peoples during the COVID-19 Pandemic

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