‘We are seeking not just equality, but equity’ in maternal health

First lady Tammy Murphy, maternal and infant care leaders on the goal of Nurture NJ campaign to address racial gaps in maternal health services, support 

NJ Spotlight News on Thursday hosted a virtual roundtable on maternal health in New Jersey, focusing on a new state plan that seeks to bring more equity to the services and supports available to all women, regardless of race or socioeconomic status.

The strategic plan, titled Nurture NJ, was unveiled by first lady Tammy Murphy the previous week, and Murphy made the opening remarks in the roundtable discussion.

 

Opening remarks:

First lady Tammy Murphy

 

Panelists:

Dr. Charletta Ayers, MPH, Associate Professor Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Wood Johnson Medical School, Rutgers University

Dr. Kimberly Boller, Chief Strategy and Evaluation Officer, The Nicholson Foundation 

Ronsha A. Dickerson, CD, Supervisor and Lead Doula, Community Doulas of South Jersey 

Dr. Vijaya Hogan, independent consultant, Adjunct Professor, Department of Maternal and Child Health, Gillings School of Public Health, UNC-Chapel Hill

 

Moderator:

Joanna Gagis, NJ Spotlight News Correspondent

 

Edited excerpts from the event:

First lady Tammy Murphy on the goal of Nurture NJ:

“At its most fundamental level, the plan meets the specific needs of women in their local communities, where they live, work, worship, play and love. The recommendations range from increasing prenatal care and support for women of color to creating a groundbreaking maternal health research and innovation center. And it makes broad reforms aimed at dismantling the structures that for generations have prevented women of color from living in environments that provide the resources needed to simply be healthy.

“New Jerseyans want to take care of one another. And there is no doubt that this issue is also a part of the national reckoning on racism that we have finally been facing together as a nation. In New Jersey, we are ready to make real changes that do more than make small improvements here and there. We are seeking not just equality, but equity. And as we work to implement the recommendations of the plan, we will be doing so together with a wide spectrum of partners.”

Dr. Vijaya Hogan on addressing the lack of equity in women’s health:  

“We need to acknowledge that we’ve been trying to tackle this issue for a generation or more, and we haven’t made progress. So we have to acknowledge that what we’re doing now isn’t working. We can’t just focus on changing behavior. We can’t just focus on the health care system. We can’t just focus on prenatal care. We need a much broader focus of when we intervene to improve the health of women by improving the conditions that support their health. But we also have to directly address the issue of racism, because the inequities that we see, the seven-time-higher rate of maternal mortality, it’s three or four times higher for infant mortality. That is something that we haven’t been able to budge on as long as I’ve been in this field, which is a very long time, too long. So the most important parts of the plans are designed to address those issues.

“The complex picture [of prenatal care] and the stories are as numerous as the women involved. What women reported repeatedly were things such as when they are insured by Medicaid, they have a really hard time getting providers to accept their insurance and therefore take them on for care. When they find the care, they usually find it in public spaces, public health clinics. And it takes a long time for them to get an appointment in those clinics, which puts them outside of the range of what is recommended for receipt of prenatal care. They talk about being treated like they’re in a factory when they’re in those spaces. … They talk about how providers often don’t respect their opinions. They don’t listen to their fears and their concerns. They are not acting on the issues that women raise when they feel pain or they feel that something is not right. And sometimes that ends up in tragedy.

“This is not just the health care system. This is across the board in every system. We don’t structure things to benefit the people with the most need. And the way to really understand that, an analogy that most people do understand is when you think about people with disabilities, we have curb cuts. We have ramps to facilitate people with disabilities, access into buildings. That’s called universal design. You design it for the benefit of the most needy, but everybody can benefit. So if there was a ramp, somebody with the bicycle can just as easily use the ramp as somebody with the wheelchair. So what we try to do is to design our interventions so that they address the needs of the most needy.”

Dr. Charletta Ayers on women of color feeling marginalized:

“One of the things that we’re hearing is that women say they’re not being heard; they’re speaking, but not really being heard; that their voices are being marginalized, that they are not being respected in their space, as one of my patients said. And what does that really mean? That means that, you know, they have concerns, but they’re being dismissed … When we talk about the racial issues here, Black women have an increased risk of maternal mortality. In the literature, it’s three times greater than in the general population. It doesn’t matter what their education is either … There was a study looking at Black college women compared to white women who had a high school education, and those Black college women had a four times greater risk of maternal mortality and morbidity than the white women who had high school or college education. What does that mean? That means this is a bigger problem.

“I think [Black and brown women] are more afraid to ask questions because sometimes they have never, never had that space to ask those questions. So it kind of saddens me when, at the end of my conversation, I go and say, do you have any questions? And initially they say no. And then they’ll think about it and they have a question. Then we’ll have a second or third question, because you open that gate. I think it has a lot to do with what I’m going to share with all the panelists, is that this is a real shift because you’re shifting the power away from the physician making all the decisions, to patient-centered care, really having the patient and the community coming to the table to say these are the things that my community needs and this is what I need. And how can we work together in an environment so that I have a safe delivery and my baby is going to be OK? I think that’s a reasonable question to have. But that also takes us in the medical community to take a step back, to be able to listen to that.”

Dr. Kimberly Boller on facing systemic racism head-on:

“When we think about social determinants of health, we’re talking about things as disparate as transportation, housing, access to high-quality foods and being able to be seen as someone who is able to access services, but that the whole community is supporting provision of those services … It’s our job to make sure that we face systemic racism, the biggest issue that others are looking at when they’re trying to access high-quality services. It starts way before a woman gets pregnant.

“We know that training on implicit bias, knowing that you have them, is really not enough. The question is, what do you do once you know that and addressing that in your everyday work and to speak to some of the things that were just raised? The issue is that people who look like me have had a lot of say in what happens on the ground in programs and so on. When you’re facing implicit and explicit bias, the question is really power shifting to communities that are most affected. So it isn’t just knowing or learning about implicit bias. It’s how you do a different shift in your work and making sure that those changes are pervasive and systemic in your organizations and translate into changed experiences on the ground. But part of what I think is hard for people is thinking that it’s a power situation. It’s how policies are formed that make a difference, not just knowing that you have an implicit bias.

“Find yourself in that plan. Dig in and act. There is a place to make a commitment on NJ.gov and sign that commitment form. We will work together. You’ll get on lists for emails, self organize. Philanthropy is working to do its part in this public and private venture. There are specifics in there, like a director position, like a collaborative fund, and those things are coming. They are going to happen. Find your recommendation, add to them and bring your creativity. We’re going to get this work done.”

Ronsha Dickerson on community engagement:

“In cities like Camden, where I come from, and in other cities we’re serving like Atlantic City, Newark and Trenton, they’re a part of New Jersey’s doula program. What we’re finding out on the ground right in the community is that most women, most families, are not invited, in a sense of informed or being able to be engaged enough to get to the table, number one. Once they get to that table, it does become an emotional reaction because we’re not used to the process. So if we are looking at community engagement as a word that we’re using to say we engage some folks from the community, we have input from the community, it has to be a conversation where number one, we’re taking a step back and saying, what does this community need first?

“Community doulas deal with the issues that are going on in a community — social economic issues, the disenfranchised that live in those communities. So we can connect to that. So if schools are closing, it’s affecting not only our children but our clients. If there’s no jobs, it’s affecting not only our clients but the whole community. In order for us to get to the other side of this, it requires us to not only look at policy, but look at the process of how we are engaging people to be at the table and informing them where they are experts.

“You go to a community like a Camden where women are afraid to go into hospitals or into their care provider because they’ve been treated pretty much like aliens, or as if they are a victim to a system that’s been created, that they had nothing to do with. You hear a woman tell these stories of ‘Every time I open my mouth to say I’m in pain, every time I open my mouth to say I need something, it seems like we’re trying to, we’re trying to get more, like, we’re being greedy.’ All women are saying on the ground is that ‘I just want to have a healthy pregnancy and a healthy baby.’”

 

Additional material:

Nurture NJ strategic plan

Nurture NJ commitment

 

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