Innovating Education in Reproductive Health

Learning Objective

Learners will explore how the structures of power and oppression manifest within healthcare systems and impact sexual and reproductive health outcomes.

Visit this link to open the course glossary in a new window!

Personal Reflection Questions

1. Think of the inequitable structures in your community or institution. How might they impact your patients?
2. What are a few potential targets for action that would address some of these inequities?
3. Did learning about these structures impact how you view your community?

Resources

_{Healthy People 2020}

_{Structural Competency} 

Citations

_{Racial residential segregation is associated with higher rates of preterm birth for Black women}

• _{Salow AD, Pool LR, Grobman WA, Kershaw KN. Associations of neighborhood-level racial residential segregation with adverse pregnancy outcomes. Am J Obstet Gynecol. 2018 Mar;218(3):351.e1-351.e7. doi: 10}

_{Physicians spend less time with clinically obese patients and fail to refer them for diagnostic tests compared to thinner patients.}

• _{Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015 Apr;16(4):319-26. doi: 10.1111/obr.12266. Epub 2015 Mar 5. PubMed PMID: 25752756; PubMed Central PMCID: PMC4381543.}

Learning Objective

Learners will identify implicit bias, privilege, and fragility regarding patient interactions, their relationship to structures of oppression, and practices for self-reflection and self-care.

Visit this link to open the course glossary in a new window!

Personal Reflection Questions

1. If you identified with any of the statements mentioned in this video, from “Unpacking the Invisible Knapsack”, think about which characteristics your privilege arises from. Do you feel defensive about these privileges? If so, why do you think that is?
2. Can you think of a time when your implicit bias affected your interaction with a patient?
3. Have you witnessed the impact of implicit bias during a patient encounter? How did it make you feel to witness that?

Resources

_{“Unpacking the Invisible Knapsack” by Peggy McIntosh}

_{Implicit Bias Test}

Citations

_{Implicit bias among providers}

• _{FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017 Mar 1;18(1):19. doi: 10.1186/s12910-017-0179-8. PubMed PMID: 28249596; PubMed Central PMCID: PMC5333436.}

_{Racial bias in pain assessment and treatment recommendations}

• _{Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press; Washington, DC: 2013.}
• _{Cleeland CS, Gonin R, Baez L, Loehrer P, Pandya KJ. Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Ann Intern Med. 1997;127(9):813–816.}
• _{Goyal MK, Kuppermann N, Cleary SD, Teach SJ, Chamberlain JM. Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. 2015;169(11):996–1002.}
• _{Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016 Apr 19;113(16):4296-301. doi: 10.1073/pnas.1516047113. Epub 2016 Apr 4. PubMed PMID: 27044069; PubMed Central PMCID: PMC4843483.}

Learning Objective

After learners have recognized their privilege, they will identify ways to center a justice framework and structural analysis as a tool to promote optimal health outcomes.

Visit this link to open the course glossary in a new window!

Personal Reflection Questions

1. What are three ways you can act at the institutional and/or individual level this week to become an agent of change?
2. What are some barriers you envision to becoming a change agent? How do you think you might overcome those barriers?
3. How will you encourage your peers and colleagues to also become change agents?

Resources

_{Community-informed models of perinatal and reproductive health services provision: a justice-centered paradigm toward equity among Black birthing communities}

_{Yo, is this racist?}

_{Black Women Birthing Justice}

_{Blueprint for Sexual and Reproductive Health, Rights, and Justice}

_{Freedom School for Intersectional Medicine and Health Justice}

_{Black Mamas Matter}

_{How do I … respond when I see racial abuse in public?}

_{Medical Legal Partnership}

_{White Coats for Black Lives}

_{Beyond Flexner}

_{Social Medicine Consortium}

_{Pod Save the People}

_{The Body is Not An Apology}

_{The New Jim Crow}

_{Disability Visibility Project}

_{Everyday Feminism}

Citations

_{Bronfenbrenner’s Social Ecological Model}

• _{Bronfenbrenner, Urie (1989). “Ecological systems theory”. In Vasta, Ross (ed.). Annals of Child Development: Vol. 6. London, UK: Jessica Kingsley Publishers. pp. 187–249.}