Nov 18, 2019

Prioritizing Equity in Contraceptive Access

UCSF Person Centered Contraceptive Care Framework
UCSF Person Centered Contraceptive Care Framework

A few weeks ago, Dr. Jamila Perritt and I represented Washington Area Women’s Foundation’s DC Family Planning Project (DCFPP) on a panel at the annual Society of Family Planning (SFP) Conference. The panel was about prioritizing equity and community engagement in contraceptive access work.  We told attendees that the progress of the DC initiative so far is as much about what we have decided not to do as it is about what we have decided to do here in DC.

Let me explain!  Our DC initiative is among a small minority of contraceptive access projects nationwide that have decided not to center our work or define our success based on increasing uptake of long-acting reversible contraceptives (methods of birth control that provide effective contraception for an extended period without requiring user action — including injections, intrauterine devices (IUDs) and subdermal contraceptive implants). Instead, we are trying to learn more about what DC residents want and need with respect to their reproductive health and then to define success around how we can contribute to adapting health care service delivery to meet those needs.

To provide some background regarding where the DCFPP started and where we are now …. the idea for a DC contraceptive access project came from an initiative in Colorado that was designed to improve access to LARCs. The Colorado project provided training, operational support, and low- or no-cost LARCs to low-income women statewide.  Colorado reported significant increases in LARC uptake and reductions in unintended pregnancy and abortion.  Many states followed suit with similar initiatives — focusing on LARCs, targeting low-income women, and measuring success by increases in LARC uptake and decreases in unintended pregnancy.

When a similar project was discussed in DC, concerns were raised about a “one size fits all” approach to contraceptive access.  So, The Women’s Foundation, in partnership with a coalition of local funders and providers,  commissioned a DC Family Planning Community Needs Assessment, which was conducted by the GW Milken Institute School of Public Health.

Through the needs assessment, we learned that reproductive health services and contraceptive methods (including LARC methods) actually already are widely available in DC; however, there is a disconnect between the availability/accessibility of these services and the utilization of them.  We also learned that a significant number of sexually active adolescents and young women in DC are not accessing health care services at all.  Additionally, the results showed low knowledge levels, negative perceptions, suspicions, mistrust and safety concerns about birth control methods (especially LARC methods) – particularly among young women of color from low-income households.

Given the study results, we realized that we needed to assess, understand and mitigate potential unintended harm to our community if we initiated a LARC-focused project directed at low-income households, which predominately include people of color in DC.  It became clear that there are many issues other than the ability to access highly effective birth control methods or a desire to reduce unintended pregnancy that are impacting contraceptive and reproductive health care decision making in our community.

There is a long history of reproductive coercion and abuse against African Americans in the U.S., including nonconsensual medical experiments, compulsory sterilization, the Tuskegee Untreated Syphilis Study, and — more recently, unconstitutional, coercive laws proposed to incentivize or require welfare recipients to use the contraceptive implant, Norplant; disproportionate marketing to Black women of the injectable contraceptive Depo-Provera; and judges offering inmates reduced sentences if they agree to be sterilized or use contraception.

As a result of the DC needs assessment findings, our reproductive health/racial equity research, and recognition of how historical injustices and resulting mistrust may affect reproductive health care decision making, we believe that:

  • method-effectiveness is not necessarily the main priority in all patient’s decision-making regarding contraception;
  • some patients do not want LARC methods for a variety of reasons;
  • access barriers are not necessarily as simple as method availability and having enough clinicians trained to provide them; and
  • unintended pregnancy is not universally viewed as a problem that needs to be prevented.

We also believe that the community the DC initiative is intended to serve should guide the identification of the problem(s) to be addressed, as well as the potential solutions that best fit the needs of the community.  Thus, we are focusing on whether people are able to access the services they need and want, and whether they experience those services positively, and ultimately whether their reproductive quality of life improves.

Admittedly, these outcomes are harder to quantify and thus, more difficult to fund. Yet, we believe this is the right approach for our community.

We currently are partnering with like-minded contraceptive access initiatives from Mississippi, Chicago, Boston and Utah, in collaboration with the UCSF Person Centered Reproductive Health Program, to form a national collaborative to develop a “principles of quality” document that describes our collective vision of what person-centered sexual and reproductive health care should look like, as well as to develop shared evaluation measures for our contraceptive access work that do not focus solely on LARC devices and unintended pregnancy prevention. We hope to jointly develop shared language; to strengthen our messaging to funders regarding the value of investing in equity/justice/quality-focused contraceptive access initiatives that go beyond LARC access to tackle wider quality issues; and to better identify and articulate how we can define success with this work.

Circling back to a key takeaway from the SFP Conference, in order to move toward more equitable reproductive health care for all people, more philanthropic organizations must be willing to invest in people-centered contraceptive access initiatives that are built from the bottom up rather than the top down.  These endeavors require “thinking outside the box” and a willingness to fund projects that are lifted up by the communities meant to be served to solve problems identified by the communities meant to be served through promising interventions conceived and designed by the communities meant to be served.  In order to live our values regarding racial equity in reproductive health, we must be willing to change the systems and practices that hold racial inequities in place.

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Aug 19, 2019

#CountDMVIn

The Census 2020 working group we are part of organized a conference for Grantee Partners and non-profit organizations serving hard-to-count populations. Participants had the opportunity to network and connect with members of the Complete Count Committee of their jurisdiction, brainstorm strategies to count vulnerable populations, and learn about the consequences an inaccurate count will have on the distribution of federal funds the next ten years.

We kicked-off the day with a keynote speech by Vanita Gupta, President and CEO of The Leadership Conference on Civil & Human Rights. In her remarks, Ms. Gupta talked about the unprecedented challenges and threats to accuracy the 2020 Census is facing. A last minute introduction of a citizenship question—still being contested—will make the population harder to count, but so too will major demographic changes over the past decade, a lack of predictable funding, and changes in the process that have not been tested adequately.

She assured attendees now is the time to get involved, to identify and engage trusted messengers in the community, and to spread the word about the importance of a fair count. While she acknowledged that the concerns of immigrant communities are very real, she also warned that boycotting the census is not the answer. It would only reinforce a concerted effort to construct a whiter electorate, diminishing diverse communities’ political voice and shared funding. For immigrant communities, participating in the census is about not being invisible. It is a way to say, “I am here, I count.” Ms. Gupta ended her statement making a call to philanthropy to join the effort and to invest in building capacity to engage in census outreach in community organizations that serve populations at risk of underrepresentation.

The Census 2020 working group is aware that funder engagement in support of the census is more important than ever. It is creating a space for funders to learn, strategize, and plan investments together and is actively creating resources and opportunities for grantee partners and non-profit organizations in our region to encourage participation among their staff, clients, families, and communities.

To keep the momentum going the working group wrapped-up the conference by opening a request for proposals for the fund Count DMV In, which will support projects related to outreach, education, and direct assistance focused on hard to count communities. It also released a set of fact sheets with information on basics you need to know about the census next year, including a timeline, ways you can help, and data on census tracks at risk of undercounting in each jurisdiction of the greater Washington region.

May 21, 2019

The Rock Star Fund Launch

Through our Young Women’s Initiative, we launched the Rock Star Fund to elevate the leadership of cisgender, gender-expansive youth, and transgender young women of color between the ages of 12 and 24 in DC. The Rock Star Fund provides a one-time award of up to $2,000 to invest in the learning, leadership, ideas, and community projects of cisgender, gender-expansive youth, and transgender young women of color living in DC. It goes beyond traditional grantmaking, it allows Young Women's Advisory Council fellows the opportunity to review applications and decide awardees. This strategy engages young women of color as agents of change in their communities on both ends of the grantmaking process. On one end, young women decide which projects to invest in, on the other, young women receive an award to make those projects happen.

The Rock Star Fund affords young women and girls the opportunity to engage in innovative problem-solving to address some of the most pressing issues affecting them including poverty, homelessness, education and workforce development, healthcare, violence, mentorship, and documentation and residency. It connects women of color mentors with awardees to provide them with the support and connections they need to advance their own development and/or community projects.

We’ve awarded 4 young women of color during this cycle. Their transformative projects are working to shift narratives and cultivate belonging; provide gender-responsive, culturally competent, trauma-informed youth-friendly services; lift up the lived experiences of young women of color; tap into the leadership of young women of color by engaging them in decision-making processes; and provide guidance and mentorship.

A culture of participatory grantmaking is important to advance gender and racial equity, center the experiences of young women of color, and to allow more funding at the grassroots level.

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