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When it comes to addressing Black maternal health disparities, there is a tendency to focus on outcomes rather than structural implications. This neglects the systemic accountability that our institutions should be taking.

The social determinants of health are used in the 2022-2024 Onondaga County Community Health Assessment and Improvement Plan to describe some of the barriers to adequate community health. But this format can be extremely limiting and fails to take into account the historical legacy of structural oppression.

The term “social determinants of health” is frequently used alongside discussions of maternal health inequity in order to describe the causal factors that determine disparate maternal health outcomes. The Center for Disease Control and Prevention defines the social determinants of health as “the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life,” which translates to economic, food and housing security.

While these “forces” do shape reality for many people, the vantage point of this definition does not account for the roots of the systems the “forces” are built on.

Social determinants of health do not simply exist because of the circumstances that we are born into. They are carefully constructed by systemic barriers enacted in order to maintain hierarchies of class, race, gender and as a result, disparate levels of care on a structural level. Furthermore, using a definition of this term that does not include the causal factors of these inequalities promotes a diluted understanding of how the society that we live in punishes low-income people of color.

Jessica Roach, the founder of “Restoring Our Own Through Transformation” (ROOTT), a women of color led reproductive justice organization in Ohio, generated a theoretical framework called the Web of Causation between structural and social determinants of health and wellness in 2016. Their framework subverts the clinical and behavioral risk factors for individuals that are said to cause poor birth outcomes for birthing people.

Her methodology addresses structural determinants of health. According to a 2020 study on the generational impacts of housing discrimination, “Structural racism is defined as the macro level systems, social forces, institutions, ideologies and processes that interact with one another to generate and reinforce inequities among racial and ethnic groups.”

A structural angle reflects the ways that racism has impacted health in larger intertwined systems. This analysis addresses the ways in which America’s state-sanctioned racist past, including slavery, Jim Crow, mass incarceration and redlining have shaped availability and distribution of health for Black women and birthing people.

Sierra Zaccagnino | Design Editor

This analysis is vindicated by a reproductive justice framework: the human right to maintain personal bodily autonomy, have children, not have children and parent the children we have in safe and stable communities. In order for Black birthing people to maintain this human right, we cannot overlook the injustices that have created limited access to a healthy life.

A paradigmatic shift is also needed in order to reimagine the measurement of harm and systems of harm. The Onondaga Community Health Report primarily addresses birthing outcomes for women of color but fails to take into account patient experience and safety. Black birthing people, in particular, are more likely to experience violations of autonomy and dismissals of pain and other medical concerns at the hands of hospital personnel. By only including outcomes as a health issue, the experiences that are structurally put in place to perpetuate harm onto Black bodies is erased.

One of the ways that we can address this issue is by investing in community-based care. When structural systems fail, communities of color coalesce to form mutual aid networks, drives for necessities, carpools and other forms of care. Black birth workers have been critical to providing this care to communities with high instances of reproductive injustice.

Community-based birthwork refers to the unique, patient-focused scope of care that has been widely practiced in Black and Indigenous communities. Community-based doulas in particular possess an unparalleled skill set that centers individuals’ needs concerning perinatal healthcare, but also transportation, housing security and food security. They are often on call for health emergencies, but also for informational support, conflict mediation and resource attainment. They provide culturally congruent care, bridging language barriers and often coming from the same background and hometown.

As of Nov. 6, Governor Kathy Hochul announced the New York State Department of Health’s plan to cover doula services for all Medicaid enrollee’s beginning on Jan. 1, 2024. Expanding this access to doula services is an evidence-based measure to support families. While this is an incredible victory for communities in need of doula care, the community-based and person-centered nature of this work must be upheld.

We urge the Onondaga County Health Department to expand their 2022-2024 Health Assessment Improvement Plan to account for the structural determinants of health, in addition to patient safety to its section on “Healthy Women, Infants and Children.” Furthermore, we encourage the Health Department to uplift and center community-based birthwork as a vital component of improving the health of this community.

Mayannah Beauvoir, lecturer at Rutgers University Honors College and a research assistant for Village Birth International.

Village Birth International is the founding organization for the Sankofa Reproductive Health and Healing Center located in Onondaga County. VBI is a policy, training and advocacy organization.

Published on November 8, 2023 at 11:09 pm