Two years ago, Sherika Trader was denied tubal ligation after an emergency caesarean section at a Mississippi hospital. The trader, now 33, was told she needed her second child or her husband’s permission to tie her fallopian tubes, even though she wasn’t married.
Jasymin Shepherd had heavy menstrual cycles due to oral contraceptives prescribed after the birth of her son 13 years ago. The symptoms persisted even after he stopped taking the medicine. Last year, Jackson’s doctors recommended Shepard, 33, have a hysterectomy, but she didn’t want it.
The experience made women feel like their donors were behaving like “robots” or, worse, stereotyped. Black women already face significant barriers to access to healthcare, including lack of providers and racial biases rooted in the healthcare system.
But contraceptive care that deals deeply with a patient’s personal preferences also has to contend with providers who ignore their concerns. Decisions about whether or when to have a baby and how to prevent pregnancy are not as standardized as care for other conditions. Still, health care providers make prescriptions and recommendations ignoring a patient’s specific circumstances, he said.
Late last year, the White House made new recommendations for federal programs to fund free birth control pills, health checkups, and certain cancer screenings. Health officials want to regain the trust of patients like Trader and Shepard. These patients feel that doctors do not always listen to them. The goal of the Title X program, which distributes grants to states and other groups for family planning, is to help patients determine the care they want, said Jessica, deputy undersecretary for population affairs at the U.S. Department of Health. says her Marcella. Human She oversees the service and the Title X program.
“It is our belief, and that of the family planning field, that respecting the interests, needs and values of our clients is essential. , she said, patients shouldn’t be denied a particular method because they might want more children.
“What we don’t want is for health care providers to create trauma or cause unintentional harm,” Marcella said.
In Mississippi, efforts to implement that approach began with changing who controls Title X funds. That responsibility was removed from the state and given to Converge, a four-year-old nonprofit based in Jackson. The Biden administration’s decision this year to give Converge his $4.5 million grant marks the first time in his 40 years that the Mississippi Department of Health did not win a federal family planning grant.
Converge does not provide family planning services. Instead, the group funds a network of clinics across the state, organizes training for health care providers, helps clinics meet technical challenges, and stocks supplies. For example, when health care providers were having trouble printing out surveys patients took about their contraception preferences, Jamie Bardwell, co-founder and co-director of Converge, sent wireless printers to clinics. rice field.
But across the South, attempts to change the culture of family planning care face old and new obstacles. Some are deeply rooted in the healthcare system, such as the prejudices that black women and other women of color have faced for a long time.Also, contraceptive care is restricted in conservative South, overturning Supreme Court’s June ruling Law vs Wade Access to abortion is restricted in large parts of the region.
Black women often feel neglected and dismissed by their healthcare providers, according to Kelsey Holt, associate professor of family and community medicine at the University of California, San Francisco. She co-authored her study, which was published in her Contraception journal in 2022. In this study, dozens of black women in Mississippi were interviewed about their experiences with obtaining contraceptives.
The women told researchers they had trouble getting appointments, faced long wait times, and had to put up with condescending behavior. Despite having options, the donor did not inform them of an alternative to the contraceptive Depo-Provera, a progestin injection given once every three months.
Attempting to undo decades of such damage, and rethinking the way health care providers deliver family planning care, will lead to Supreme Court rulings and the closure of abortion clinics across the South. All of a sudden, women in Mississippi, Alabama, and about a dozen other states couldn’t get an abortion.
“Key services have been cut off,” said Usha Ranji, KFF’s associate director of women’s health policy. Title X funds cannot and have never been used to pay for an abortion. It hinders our ability to provide the comprehensive counseling that is required.
Many Mississippians cannot afford to travel across the state line to end an unwanted pregnancy. In 2020, 84% of US Title X clients earned 200% or less of their federal poverty level, and 39% had no insurance. Even women in Mississippi with mobility will face hurdles in neighboring states such as Georgia and Florida, where abortion is not outright banned but access is curtailed.
Even before the Supreme Court ruling, accessing family-planned care in Mississippi was fraught with hurdles and judgments.
In 2017, when Mia, who didn’t want to use her last name for fear of legal and social repercussions, became pregnant for the second time, she called the local health department in Hattiesburg for advice on abortion. asked. She had a daughter, but she wasn’t financially or emotionally ready to have another child. A health department contact sent Mia to a religion-based abortion prevention center.
“I felt judged,” Mia said of the call. Ultimately, she ended the pregnancy in Jackson, about 90 miles away, at the state’s only abortion clinic, which closed in July. . “In the end, I did what was best for me,” said Mia, who went on to have her son years after her abortion.
The loss of abortion care in Mississippi puts pressure on family planning providers to win the trust of patients, said Converge co-founder Danielle Lampton. Patient-centered care is “the foundation of what we do,” said Rampton.
Both Trader and Shepherd are members of Converge’s Patient Experience Council and receive occasional scholarships for offering their perspectives to nonprofit organizations.
Dr. Christine Dehlendorf, a family physician advising Converge and a UCSF researcher, said providers should force or pressure low-income patients to use long-term contraceptives, such as intrauterine devices, to prevent pregnancy. says it’s not.
The pressure on black women to use IUDs, implants, and other long-term contraceptive methods is reminiscent of the history of black women being sterilized against their consent. It has been shown that women of color are more likely to be pressured to limit family size and recommend IUDs. These women also struggle to get their providers to remove their devices and take out insurance to cover the cost of removal, Dehlendorf said.
Wyconda Thomas, a family nurse who lives near the Arkansas border, often sees patients who are skeptical of contraception because of bad experiences. Many of her patients continued Depot Her Provera injections even after gaining dangerous amounts of weight.
Even when patients come in for other reasons, Thomas talks about family planning “whenever the opportunity arises.” Established a medical center. Clinics will receive Title X funding through Converge. Still, Thomas does not force contraception on his patients. She respects their decision to give up pills, patches, or implants.
But the Title X funds will help Thomas stock up on a variety of birth control methods so patients don’t have to worry about driving to another pharmacy.
“My job is to make them understand that there are more ways and no ways at all,” Thomas said. “And that’s a complete visit by itself.”
|
|
.
