MAPPING THE POLICY LANDSCAPE FOR INTERRUPTING ANTI-BLACKNESS AND INDIGENOUS ERASURE: A social work public health equity analysis of reproductive health practice in Washington State during COVID-19 and beyond.

Abstract

The failure of the United States government and medical system to equitably respond to the COVID-19 pandemic has further revealed the reality that our national information systems and response mechanisms are fractured, ill-equipped, and uncoordinated. This is especially true for marginalized populations. Prior to this global crisis that has irrevocably compromised societal health and well-being [as measured by social determinant of equity (SDOE) indicators], there were several marginalized populations whose health needs were already not being met by medical systems1. One such population in the US are pregnant and birthing people. To decrease maternal mortality rates (MMR) and pregnancy related deaths (PRD), public health interventions need to address both proximal and ultimate gaps in reproductive and perinatal health care for people of color across the reproductive lifespan. The “supremacy of birth” creates an erasure of the spectrum of reproductive health needs and is a contributing factor in the myopic scope of largely clinical perinatal health interventions within public health to address these disparities. Simultaneously, structural racism and the historical legacies of reproductive violence inherent in the field of obstetrics have created maternal mortality disparities by race with Indigenous and Black populations most significantly impacted. Clinical and proximal interventions are not adequate to address the health disparities that exist due to a lifetime of structural oppression. In order to improve maternal mortality disparities and pregnancy related deaths, policy interventions must consider holistic reproductive health needs across three reproductive justice2 principles: 1) the right to give birth; 2) the right to not give birth; and 3) the right to raise children in safe and healthy environments. Utilizing a social work public health praxis for equitable health policy, our policy recommendation takes into consideration health care delivery systems and coordinated response mechanisms aligned with stakeholder needs not only specific to the urgency posed by the novel COVID-19 pandemic but also in preparation for future disasters. After carefully weighing policy options using a rigorous review of available literature and qualitative data collected using community partnered participatory practices, I am recommending the adoption of all three policy options. Each option targets different public entities, creating a multi-system approach across ecological layers. This kind of diverse approach is understood to be most effective in undoing systematic racialized policy harms3. Doing so is aligned with the evaluative criteria I have outlined: adopting all three options is financially responsible; addresses structural determinants of equity; centers the autonomy, pleasure, joy, and liberation of Black and Indigenous populations; and has the potential to improve intergenerational maternal child health outcomes.