Sexual and Reproductive Justice: New York City s Approach

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1 Sexual and Reproductive Justice: New York City s Approach George L. Askew, MD Deputy Commissioner of Health Division of Family and Child Health New York City Department of Health and Mental Hygiene Title X National Grantee Meeting Washington, DC August 18, 2015

2 Overview NYC DOHMH Commitment to Community Engagement NYC DOHMH Frame for Health Equity Social Justice Framework for Sexual and Reproductive Health Lessons Learned

3 As New York City's Health Commissioner, I feel a strong moral and professional obligation to encourage critical dialogue and action on issues of racism and health. Ongoing exclusion of and discrimination against people of African descent throughout their life course, along with the legacy of bad past policies, continue to shape patterns of disease distribution and mortality. Dr. Mary T. Bassett #BlackLivesMatter A Challenge to the Medical and Public Health Communities Supplement to the N Engl J Med 2015; 372:

4 4 Health Equity and Health Disparities Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; or other characteristics historically linked to discrimination or exclusion - Healthy People 2020 Source: HealthyPeople.gov. Disparities [ cited 2015 Jan 22] Available from URL:

5 NYC Health Department Overarching Framework for Health Equity Achieve health equity Inequities in health are unfair, unnecessary and avoidable. A more deliberate effort to name and address these disparities will frame all that we do Center for Health Equity Build an organization that reflects NYC Engage communities to achieve change Communities have expertise of their own and further engagement is vital to closing the gaps 5

6 Division of Family and Child Health Vision The vision of the Division of Family and Child Health is that every child, woman, and family has the opportunity and is empowered to reach their full health and development potential. Priorities Early Childhood Health and Development Unintended Pregnancy Division of Family and Child Health Office of School Health Bureau of Early Intervention Bureau of Administration Bureau of Maternal, Infant and Reproductive Health

7 History of the Sexual and Reproductive Justice (SRJ) Framework Developed to articulate the needs of communities of color that face multiple forms of sexual and reproductive oppression Need for an intersectional analysis defined by the human rights framework -- based on the practice of self-help -- that would be inclusive and applicable to everyone

8 Key Principles of Reproductive Justice The belief that every woman has the right to: 1. Decide if and when she will have a child and the conditions under which she will give birth; 2. Decide if she will not have a child and her options for preventing or ending a pregnancy; 3. Parent the child(ren) she has with the necessary social supports in safe environments and healthy communities, and without threat of violence from individuals, organizations or institutions of the state.

9 What does the framework include? Reproductive Rights Social Justice Human Rights Recognition that all individuals are part of families and communities aims to transform power inequities and to create long-term systemic change SRJ exists when all people have the social, political and economic power and resources to make healthy decisions about their gender, bodies and sexuality for themselves, their families and their communities

10 What led us to incorporate the SRJ Framework? Challenged to be bold and innovative to incorporate health equity in our work and ensure all New Yorkers have equal access to quality services New five-year public awareness campaign focused on increasing awareness, access, utilization, and coordination of a continuum of sexual and reproductive health services including the full range of birth control options As we developed the first year of the Maybe The IUD campaign, we learned about community concerns around promotion of contraception considering the historical context of oppressive policies and practices

11 How is the SRJ Framework informing our work? Helping us to: Recognize and bring attention to the social determinants of health that influence people s choices - such as violence, structural racism, poverty, housing, built environment, education Acknowledge the history in our country of reproductive oppression - from forced breeding among African American women during slavery to nonconsensual sterilization Create a narrative that supports people s choices make the easy choice the healthy choice Challenge the way we collect and use data - its important to hear the voices of the community

12 What has been our approach? Goal To establish relationships with local sexual and reproductive justice advocates and diverse communities to engage them in DOHMH s ongoing work Weekly meetings with consultants who are leaders in the SRJ movement Internal staff training Hosted one day strategy meeting- June 23, 2015 Formed community engagement group

13

14 Strategy Meeting June 23, 2015 Advancing Health Equity: A Community Dialogue on Sexual and Reproductive Justice 97 participants representing 63 organizations attended Themes: Transparency Genuine bi-directional partnership More inclusivity History and anti-oppression Language and stigma Engaging men Intersectionality

15 Strategy Meeting June 23, 2015 Advancing Health Equity: A Community Dialogue on Sexual and Reproductive Justice DOHMH is taking a vital step forward and I hope will invest even more in deepening their own analysis, engage communities honestly. There is a history of mistrust to overcome but great first step welcoming community groups. If we are not addressing health disparities we are not doing reproductive justice work.

16 Strategy Meeting June 23, 2015 Advancing Health Equity: A Community Dialogue on Sexual and Reproductive Justice All of us play a role in building up men, how they grow up. Only until we change our messages to them, will we be able to transform them. We are committed to working with you and community over time. a We ask that access to safe housing and education is part of RJ.

17 Results? Formed a Community Engagement workgroup Goal: - Using a health equity and sexual and reproductive justice framework, we would like this group to inform the work of increasing access, awareness, and informed utilization of sexual and reproductive health services for all New Yorkers. 33 Community stakeholders completed interest forms at the strategy meeting 21 attended the first meeting and provided valuable input on the public awareness campaign Next steps Hire consultant to facilitate community engagement group Create joint strategic plan

18 What impact has this approach had on our other initiatives to date? Quality Improvement Network for Contraceptive Access (QINCA)- Collaborative Working with NYC maternity hospitals over the next 3.5 years to increase access to all contraceptive methods in post-partum, primary care and post-abortion settings Developed Ten Steps to Excellence including training all staff to ensure reproductive decisions are made free of coercion (Step 4) Introduced SRJ Framework and conducted values clarification exercise with participating hospital staff at first learning session Exploring development of a SRJ training module that can be used to train hospital staff

19 What impact has this approach had on our other initiatives to date? Expanded Clinical Assessment and Guidelines (CAG) - in development Target audience for the expanded Clinical Assessment and Guidelines are women and men of reproductive age, including teens Includes policy and clinical practice recommendations crafted to promote sensitive, patient-centered care in primary, post-abortion, and pregnancy-related care settings Includes resources for educating staff and providers on reproductive coercion and the SRJ Framework

20 What impact has this approach had on our other initiatives to date? Expansion of CAG allows us to better integrate a Sexual and Reproductive Justice framework. For example, Survey now assesses providers ability to offer comprehensive SRH care to adolescent and adult women and men, in line with the principle of SRJ as a framework inclusive of experiences across the life-course. Additionally, new recommendations and resources have been added to the emphasizing the importance of training staff in: SRJ, patient-centered contraception counseling, and values clarification in order to promote care provision that centers and empowers patients and reduces the potential influence of provider bias. The guidelines and survey are currently under review in our Bureau and hope to be released this Fall.

21 Lessons Learned in Engaging Communities Develop a plan to engage community from the beginning of your project Important to look at community needs as well as strengths Capacity building is important Transparency establishes credibility, trust and respect The work is difficult but worthwhile and rewarding

22 What have we learned? Disparities in health are a result of injustice and bad policies, not biology Overall positive health trends do not automatically lead to reductions in health disparities targeted action is needed To take action we need strong evidence. That requires both sound theoretical models, and better methods

23 Thank you

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