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Health Equity ; 4(1): 505-508, 2020.
Article in English | MEDLINE | ID: covidwho-960465

ABSTRACT

Racial disparities in both obstetrics and COVID-19 are well documented. Troublingly, implicit biases and related testimonial injustice potentiate adverse outcomes for women of color whose voices and concerns have been historically discredited by the medical establishment. In the context of COVID-19, the restriction of hospital visitors for infection prevention and control in a labor and delivery setting may disproportionately burden black women by eliminating or severely limiting access to essential in-person advocacy, which threatens to exacerbate existing disparities in maternal and neonatal outcomes. The potential disproportionate impact of visitor restrictions on women of color should inform the ongoing pandemic response.

4.
Hastings Cent Rep ; 50(3): 40-43, 2020 May.
Article in English | MEDLINE | ID: covidwho-619431

ABSTRACT

Common hospital and surgical center responses to the Covid-19 pandemic included curtailing "elective" procedures, which are typically determined based on implications for physical health and survival. However, in the focus solely on physical health and survival, procedures whose main benefits advance components of well-being beyond health, including self-determination, personal security, economic stability, equal respect, and creation of meaningful social relationships, have been disproportionately deprioritized. We describe how female reproduction-related procedures, including abortion, surgical sterilization, reversible contraception devices and in vitro fertilization, have been broadly categorized as "elective," a designation that fails to capture the value of these procedures or their impact on women's overall well-being. We argue that corresponding restrictions and delays of these procedures are problematically reflective of underlying structural views that marginalize women's rights and interests and therefore threaten to propagate gender injustice during the pandemic and beyond. Finally, we propose a framework for triaging reproduction-related procedures during Covid-19 that is more individualized, accounts for their significance for comprehensive well-being, and can be used to inform resumption of operations as well as subsequent restriction phases.


Subject(s)
Abortion, Induced/ethics , Contraception/ethics , Coronavirus Infections/epidemiology , Elective Surgical Procedures/ethics , Pneumonia, Viral/epidemiology , Reproductive Rights/ethics , Betacoronavirus , COVID-19 , Developing Countries , Female , Humans , Pandemics , SARS-CoV-2 , Time Factors , Women's Health
5.
Matern Child Nutr ; 16(4): e13033, 2020 10.
Article in English | MEDLINE | ID: covidwho-378015

ABSTRACT

The World Health Organization (WHO) has provided detailed guidance on the care of infants of women who are persons under investigation (PUI) or confirmed to have COVID-19. The guidance supports immediate post-partum mother-infant contact and breastfeeding with appropriate respiratory precautions. Although many countries have followed WHO guidance, others have implemented infection prevention and control (IPC) policies that impose varying levels of post-partum separation and discourage or prohibit breastfeeding or provision of expressed breast milk. These policies aim to protect infants from the potential harm of infection from their mothers, yet they may fail to fully account for the impact of separation. Global COVID-19 data are suggestive of potentially lower susceptibility and a typically milder course of disease among children, although the potential for severe disease in infancy remains. Separation causes cumulative harms, including disrupting breastfeeding and limiting its protection against infectious disease, which has disproportionate impacts on vulnerable infants. Separation also presumes the replaceability of breastfeeding-a risk that is magnified in emergencies. Moreover, separation does not ensure lower viral exposure during hospitalizations and post-discharge, and contributes to the burden on overwhelmed health systems. Finally, separation magnifies maternal health consequences of insufficient breastfeeding and compounds trauma in communities who have experienced long-standing inequities and violence, including family separation. Taken together, separating PUI/confirmed SARS-CoV-2-positive mothers and their infants may lead to excess preventable illnesses and deaths among infants and women around the world. Health services must consider the short-andlong-term impacts of separating mothers and infants in their policies.


Subject(s)
Breast Feeding , COVID-19/prevention & control , COVID-19/transmission , Infectious Disease Transmission, Vertical/prevention & control , Patient Isolation , SARS-CoV-2 , Breast Feeding/adverse effects , Breast Feeding/psychology , Female , Humans , Infant , Infant, Newborn , Milk, Human , Mother-Child Relations/psychology , Mothers , Patient Isolation/psychology , World Health Organization
6.
J Addict Med ; 14(4): e1-e3, 2020.
Article in English | MEDLINE | ID: covidwho-268088

ABSTRACT

: The COVID-19 health crisis joined, rather than supplanted, the opioid crisis as the most acutely pressing threats to US public health. In the setting of COVID-19, opioid use disorder treatment paradigms are being disrupted, including the fact that methadone clinics are scrambling to give "take-home" doses where they would typically not. The rapid transition away from in-person examination, dosing and group therapy in an era of social isolation calls for adjustments to clinical practice, including emphasizing patient-provider communication, favoring new inductees on buprenorphine and leveraging technology to optimize safety of medication treatment.


Subject(s)
Coronavirus Infections , Infection Control/organization & administration , Narcotic Antagonists/therapeutic use , Opiate Substitution Treatment/methods , Opioid-Related Disorders , Pandemics , Pneumonia, Viral , Substance Abuse Treatment Centers , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/psychology , Organizational Innovation , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Public Health , SARS-CoV-2 , Substance Abuse Treatment Centers/methods , Substance Abuse Treatment Centers/organization & administration , Substance Abuse Treatment Centers/trends , United States/epidemiology
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