Cultivating Vital Conditions For Perinatal Well-Being And A Sustained Commitment To Reproductive Justice.

Perinatal mental illness is a leading cause of death during pregnancy and the first postpartum year in the United States. Although better acute care services for mental health conditions are desperately needed, urgent services alone cannot create the conditions to thrive. Cultivating well-being requires a sustained commitment to reproductive justice, "the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities." To support reproductive justice for pregnant and birthing people, the Rippel Foundation's Vital Conditions for Health and Well-Being framework offers a holistic approach comprising seven domains: a thriving natural world; basic needs for health and safety; humane housing; meaningful work and wealth; lifelong learning; reliable transportation; and, central to all of these, belonging and civic muscle. Here we review the evidence for each of the vital conditions as key drivers of perinatal mental health, and we outline how this public health approach can advance well-being across generations.

Examining the Role of Women, Infant, and Children in Black Women Breastfeeding Duration and Exclusivity: A Systematic Review.

Background: African American women continue to experience low rates of breastfeeding initiation as well as low rates of exclusive breastfeeding for 6 months. Research has indicated that there are several social determinants that impact breastfeeding rates, but there is a dearth of literature that allows African American women to give voice to their experiences. In addition, research has shown women, infant, and children (WIC) participants to have lower breastfeeding rates than non-WIC eligible women. Research Aim/Question: The aim of this systematic review was to examine the relationship between WIC program participation and breastfeeding initiation and duration among non-Hispanic African American/Black women. Methods: The approach for this review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Four online databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, MEDLINE, and SCOPUS, were used to search for peer-reviewed articles and grey literature. Results: Two hundred eighteen articles were retrieved through the database search and underwent initial screening, yielding 59 potential eligible articles. Full-text articles were further reviewed and 11 met the inclusion criteria and were included in this systematic review. Conclusions: Included studies show mixed results regarding the association between WIC participation and breastfeeding initiation, but there is a general negative association between WIC participation and breastfeeding duration, especially among Black women.

Challenges and lessons learned birthing during the COVID-19 pandemic: A scoping review.

Background and Aims: The impact of the COVID-19 pandemic on the healthcare system facilitated a change in policies to redress the consequences of increased demand and fear of disease transmission. Restrictive measures throughout the healthcare system limiting access to accompanying partners of birthing people in addition to fears of contracting COVID-19, an increasing number of birthing people chose to have an out-of-hospital birth. Out-of-hospital births are not prevalent in the United States. However, in recent years the percentage of out-of-hospital births has been steadily increasing. COVID-19 was a novel virus imposing a unique birthing situation for millions of women, complicated by lack of integration and varied policies in the U.S. Methods: To better understand the challenges of birthing people during the pandemic a scoping review was conducted to explore the literature during the first wave of the pandemic related to out-of-hospital births. The approach for this review made use of the methodology manual published by the Joanna Briggs Institute for scoping reviews. All manner of publications (i.e. peer-reviewed published articles, grey articles, conference proceedings, webinars, editorials, and textbook chapters) were included in the review. Results: Articles retrieved from the database search yielded sixty-three articles, after duplicate removal forty-six records were available for screening. Articles were further excluded using the PRISMA process, yielding thirty-one remaining records. From the thirty-one records twelve themes emerged, which were collapsed into four meta-themes. Conclusion: These meta-themes focused on (a) advocacy, (b) homebirth infrastructure, (c) support networks, and (d) uncertainty during the pandemic. COVID-19 has accelerated this movement to birthing at home and thought must be given to how the healthcare system is going to support and integrate this mode of birthing.

Cultivating a Sense of Belonging in Allied Health Education: An Approach Based on Mindfulness Anti-Oppression Pedagogy.

To address accreditation standards and to meet a need due to a disparity in health care providers engaged in direct patient care, many institutions of higher education have focused on initiatives to increase the numbers of ethnic and racial minority populations. Despite these efforts, there remains a dearth of diversity in health care. For many underrepresented minority populations (URM), numerous barriers exist to becoming a health professional. Greater levels of discrimination and bias reduce belonging and agency in URM students impacting recruitment and retention. Research has shown that discrimination and bias are antithetical to feeling a sense of belonging on college campuses for URM students. The sense of belonging for URM students has been positively linked to retention and other academic outcomes. Faculty interaction and campus environment have been correlated to sense of belonging. Thus, faculty members as mentors, advisors, and shapers of campus climate have an important role to play in supporting URM students. However, due to socialization in an oppressive society, narratives about race and racism can become entrenched. The entrenchment of racial ideologies, without tools to examine, deconstruct, and reflect, leads to little forward progress. Incorporation of mindfulness anti-oppression pedagogy provides a needed paradigm shift for allied health educators to act with intentionality as they cultivate spaces of belonging for URM students.

Addressing Black Infant Mortality Through Harnessing the Power of Community.

In Hamilton County, Ohio, the infant mortality rate is above the national average and the Black infant mortality rate is more than 3 times the white infant mortality rate. These racial disparities in infant mortality cannot be explained through other socio-economic characteristics like education, income, housing, or medical insurance. Research has shown that racism, not race itself, is the driving force behind the high disparity in infant mortality rates in Hamilton County and the nation as well. The World Health Organization (WHO) and the Institute of Medicine have long cited institutional/structural racism and cultural racism as a key factor in health disparity. A paradigm shift needed to occur to address the consequences of racism within the lives of Black women, namely disempowerment and agency. The Commission on Social Determinants of Health (CSDH) model was which engaged Black women and positioned them as an asset, to share in the process of strategizing, creating, and implementing a plan. Queens Village was founded to implement the CSDH model and address the upstream determinants of infant mortality through cultivating a sense of community.

Exploring the Breastfeeding Experiences of African American Mothers Through a Critical Race Theory Lens.

Background: Data from the Ohio Department of Health for Hamilton County reveal that the rate of breastfeeding steadily increased for non-Hispanic white babies from 72% initiation in 2006 to 79.8% initiation in 2018. Over the same time period, the rate of breastfeeding initiation increased from 52% to 65.7% for African American babies. Despite positive gains in breastfeeding for the African American community, significant disparities remain. Research Aim/Question(s): Our aim was to gain insight into the breastfeeding experiences of African American women and professionals working primarily with African American women to promote and support breastfeeding. Methods: In this study, a critical race theory approach was used to explore the lived experiences of African American women and health care providers who serve African American communities through the analysis of breakout conference sessions. Breakout sessions were semistructured, with questions developed in a strengths, weaknesses, opportunities, and threats analysis format aimed at obtaining information related to sociocultural factors impacting breastfeeding initiation and duration, with the goal of developing actionable community objectives to address breastfeeding disparities for African American women. Results: Three themes emerged stereotypes and microaggressions, representation, and provider support. Conclusion: Qualitative analysis of the conference proceedings reveals insights that can be developed into an action plan to address breastfeeding disparities in Hamilton County.

African American Women and Obesity Through the Prism of Race.

BACKGROUND: There are minimal studies focusing on African American women and obesity, and there are even fewer studies examining obesity through a critical race theoretical framework. African American obesity research has largely focused on individual and community interventions, which have not been sufficient to reverse the obesity epidemic. PURPOSE: The purpose of this study was to examine the relationship between race and body mass index (BMI) for African American women. METHOD: Previously collected data from the National Survey of American Life Self-Administered Questionnaire, 2001-2003 (NSAL-SAQ) was analyzed for this study. The NSAL-SAQ dedicated a section to the exploration of group and personal identity, along with having anthropometric data and health habit questions to be able to conduct analyses for associations between the racial identity dimensions and obesity. RESULTS: Multiple linear regression was used to examine the constructs of racial identity on BMI comparing standardized coefficients (ß) and R2adj values. Results indicated participants ascribing more to the stereotype of "Blacks giving up easily" (ß = 0.527, p = .000) showed an increased BMI. Additionally, the negative stereotype of "Blacks being violent" (ß = 0.663, p = .000) and "Blacks being lazy" (ß = 0.506, p = .001) was associated with an increased BMI. CONCLUSIONS: Based on these finds high negative racial regard is associated with increased weight. This study contributes uniquely to the scientific literature, focusing on the construct of racial identity and obesity in African American women.