Society: Equity in Teen Pregnancy Prevention: Social Determinants of Health

SOCIETY - REDUCING HEALTH INEQUITIES & RACIAL DISPARITIES IN TEEN PREGNANCY

WHERE WE ARE

The social determinants of health (SDOH) are life-enhancing resources, such as food supply, housing, economic opportunity, family and social relationships, transportation, education, and health care, whose distribution across populations effectively determines length and quality of life. Recently, the American Academy of Pediatrics specifically added racism to the factors affecting the health of adolescents. Several SDOH have been identified as particularly relevant to teen pregnancy and adolescent sexual health behaviors, among them: education and employment opportunities, neighborhood characteristics, community-level economic structures, and access to quality health care. The absence of positive resources has a negative effect on teen pregnancy.

Dallas County’s public health hospital, Parkland Hospital, released its Community Health Needs Assessment in 2019, highlighting strong evidence of health disparities that are significant in Dallas County: 1) Dallas County has one of the highest uninsured rates among all urban counties in the nation. This can drive up hospital costs for insured and uninsured alike.

2) Dallas residents have persistently low rates of health literacy, presenting challenges for people trying to enroll in and use health insurance coverage, adhere to treatment plans and provider instructions, and navigate the health care system. These issues are particularly acute for racial and ethnic minorities, who sometimes find that services are not culturally or linguistically accessible. 3) The most significant health disparities are by race, ethnicity and geographic location in Dallas County, with African American and people living in ZIP codes in Southeast Dallas experiencing the highest burdens of disease and mortality.

The SocioNeeds Index Map below, taken from the Parkland Community Health Assessment in 2019, shows that the zip codes that Ntarupt seeks to work with most closely have been most impacted by historical segregation and inequalities that have become systemic. This impact is seen through the measures of poverty, income, unemployment, occupation, education and language. The darker the coloration on the map, the greater the impact across the six areas.

SOCIONEEDS INDEX MAP PARKLAND COMMUNITY HEALTH ASSESSMENT 2019

DO YOU HAVE A HIGHER RES VERSION?

In addition to these hurdles, the spread of COVID-19 virus in our world, nation and local community has had an immense, immediate and injurious impact on our most vulnerable communities: communities of color. As a result of the COVID-19 pandemic, Dallas’ families are losing jobs and have and unprecedented need for rent and food assistance. Teens separated from physical school often lack computers and reliable internet, making it hard for them to access digital learning. And as always, unsupervised teens with time on their hands tend to be more sexually active. Now, more than ever, teens need access to information and resources so that they can make the best choices for themselves.

The impact of COVID-19 on reproductive health services became apparent as early as mid-June of 2020, 5-6 months into the pandemic. The table that follows shows the impact that even a small decline in health care service usage can have on individuals, families, and communities.

TABLE 1. Potential annual impacts of a 10% proportional decline in use of sexual and reproductive health care services resulting from COVID-19–related disruptions in 132 low- and middle-income countries15

Disruption in essential sexual and reproductive health care

10% decline in use of short- and long-acting reversible contraceptives

10% decline in service coverage of essential pregnancy-related and newborn care

Impact

48,558,000 additional women with an unmet need for modern contraceptives

15,401,000 additional unintended pregnancies

1,745,000 additional women experiencing major obstetric complications without care

28,000 additional maternal deaths

2,591,000 additional newborns experiencing major complications without care

168,000 additional newborn deaths

The diagram that follows, provided by Social Impact Architects, is one way of looking at the impact of social determinants of health “downstream” and “upstream” when working to reduce health inequities within the SDOH framework.

FIGURE 5: FRAMEWORK FOR REDUCING HEALTH INEQUALITIES

WHAT WE KNOW WORKS

A number of strategies help to build health equity and reduce the disparate impact of teen pregnancy. » Expansion of access to child health insurance, and access for all to reproductive healthcare » Ensuring all teens get medically accurate reliable reproductive health information » Narrowing the disparities between white parents’ employment rates and the rates experienced by Black, LatinX, and American Indian parents » Reducing preterm birth rates, which are associated with perceived racial discrimination and maternal stress and are disproportionately experienced by Black mothers » Ensure that pediatricians, obstetricians, and gynecologists working with teens and young adults deepen their understanding of and improve their ability to screen for the effects of racism on their patients of color- resulting inculturally competent, anti-racist healthcare » Advocate for policies that diversify the pediatric and educational workforces » Livable wage job availability,

WHERE WE ARE

“[T]eenage motherhood is not a single issue, but a phenomenon that in America is deeply entangled with contemporary and historical issues of race, poverty, and marital status. The intersectional approach embraced by the reproductive justice perspective demands that teenage mothers be viewed with respect to their multiple marginalized social identities and understood through the social, political, and historical contexts in which they live and raise their children.”16 --Hans, S. L., & White, B. A. (researchers)

As an organization, Ntarupt embraces Reproductive Justice.

SisterSong defines Reproductive Justice as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.”

While Ntarupt focuses its core work in creating access to information about reproductive health and supporting teens to make the best choices for themselves, supporting safe and sustainable communities leads Ntarupt to support ongoing efforts to create an equitable Dallas.

The good news is that Dallas County’s public health provider, Parkland Health and Hospital System, has identified and is working on some of the factors that create health disparities – Dallas is poised for change.

I WOULD SAY THAT IT IS OF LESS INTEREST TO MOST COMMUNITY CITIZENS BECAUSE… IF THEY ARE NOT TOUCHED BY IT AND IF THEY DON’T HAVE TO SEE IT, IT CAN BE OUT OF SIGHT, OUT OF MIND...” –BUSINESS COMMUNITY INTERVIEWEE

WHERE WE ARE GOING & NECESSARY PARTNERS BECAUSE WE LIVE IN DALLAS Ntarupt must be responsive to community needs and COUNTY, WE LIVE IN A community voices in the work it does. This means SPACE WHERE THERE ARE AN supporting initiatives that would create equitable access INSURMOUNTABLE AMOUNT OF to the social determinants of health in the neighborhoods ISSUES AND PROBLEMS THAT ARE most affected by racism and poverty. AFFECTING OUR YOUNG PEOPLE. Starting in late 2019, Ntarupt became part of Dallas Truth TEEN PREGNANCY… GETS THROWN Racial Healing & Transformation – Racial Equity NOW IN THE MIX. AND THERE’S A LEVEL OF Cohort. Ntarupt has worked to set its own racial equity RESILIENCY, ON THE POSITIVE SIDE, outcome: To eliminate racial disparities in unintended teen OR ALMOST COMPLACENCY… FEELING birth rates for Black and LatinX young women ages 15-19 in Dallas County by 2030. This ten-year goal will involve: LIKE IT’S JUST A PART OF THE REALITY THAT WE LIVE IN. SO, OFTEN TIMES 1) Changing the way Dallas understands how COMMUNITY MEMBERS WITH A LOT racism impacts economic and health outcomes OF THESE SOCIAL PROBLEMS, THEY having a direct impact on teen pregnancy. THROW THEM ALL IN A BUNCH AND 2) Providing transformative reproductive health education to all students. THEY SAY IT’S JUST A PART OF THE ENVIRONMENT. IT’S JUST SOMETHING THAT HAPPENS OR SOMETHING THAT 3) Ensuring that young women of color WE’RE USED TO.” have equitable access to trustworthy --EDUCATIONAL PROFESSIONAL INTERVIEWEE reproductive health care. Ntarupt will work with local providers to increase accessibility to anti-racist and culturally competent care in geography, convenient hours, and affordability.

Ntarupt has studied Young Women United (YWU), an organization that leads reproductive justice organizing and policy initiatives by and for self-identified young women and people of color in New Mexico, and affirms that “Young people, including young parents, need accurate information and basic respect — so that they may have what they need to be who they are, and to thrive. It’s crucial that justice minded allies, advocates and policy makers invest in the resources, education, and information young people need to make decisions about their own bodies and lives, while moving away from problematic and harmful teen pregnancy prevention approaches. We must stop blaming young people in general—and young parents in particular—for systemic inequities.”

Systems and services that are geared toward teens need to equip them with what they need, either in preventing teen parenting or best situating them when and if they do become parents, but these are not systems that teens control. Parents and health care providers recognize that teens are not getting the information they need to delay pregnancy and parenting.