Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB#7445, 27599-7445, Chapel Hill, NC, USA.
Mecklenburg County Public Health, 249 Billingsley Road, 28211, Charlotte, NC, USA.
Matern Child Health J. 2023 Jan;27(1):7-14. doi: 10.1007/s10995-022-03563-7. Epub 2022 Nov 9.
Long-acting reversible contraception (LARC) is encouraged as a strategy to address racial disparities in birth outcomes. Black woman-led organizations and stakeholders recommend a thoughtful integration of Reproductive Justice for any LARC programs. This paper will describe how one state-funded maternal and child health program reconceptualized an evidence-based strategy (EBS) focused on increasing access to LARC, to a broader strategy that incorporated principles of Reproductive Justice to improve birth outcomes.
In 2016, North Carolina established the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) program. As part of this program, five county health departments were awarded funding to "increase access to LARC". Noting community partners' concerns with this strategy, ICO4MCH leadership revised the strategy to focus on using the Reproductive Justice framework to improve utilization of reproductive life planning and access to LARC. Leaders modified the strategy by changing performance measures and scope of work/deliverables required by grantees.
Using quarterly reports and focus group data from ICO4MCH grantees, we identified key steps communities have taken to prioritize Reproductive Justice. Key findings include that sites hosted Reproductive Justice trainings for team members and changed language describing family planning services. These activities were tailored to fit community context and existing perceptions about reproductive health services.
The ICO4MCH program was able to modify a LARC EBS to better emphasize Reproductive Justice. Local agencies desiring to shift their LARC programs should include and value feedback from those with lived experience and partner with organizations committed to Reproductive Justice.
长效可逆避孕(LARC)被鼓励作为解决生育结果中种族差异的策略。黑人女性领导的组织和利益相关者建议在任何 LARC 项目中深思熟虑地融入生殖正义。本文将描述一个由州资助的母婴健康计划如何重新构想一个专注于增加 LARC 可及性的循证策略(EBS),以更广泛的战略纳入生殖正义原则,以改善生育结果。
2016 年,北卡罗来纳州建立了改善母婴健康社区成果(ICO4MCH)计划。作为该计划的一部分,五个县卫生部门获得资金,以“增加 LARC 的可及性”。ICO4MCH 领导层注意到社区合作伙伴对这一战略的担忧,因此修改了战略,重点是利用生殖正义框架来提高生殖生活规划的利用和获得 LARC 的机会。领导者通过改变受赠者所需的绩效衡量标准和工作范围/可交付成果来修改战略。
ICO4MCH 受赠者使用季度报告和焦点小组数据,确定了社区为优先考虑生殖正义而采取的关键步骤。主要发现包括,各站点为团队成员举办了生殖正义培训,并改变了描述计划生育服务的语言。这些活动是根据社区背景和对生殖健康服务的现有看法量身定制的。
ICO4MCH 计划能够修改 LARC EBS,以更好地强调生殖正义。希望改变其 LARC 计划的地方机构应包括并重视有经验的人的反馈,并与致力于生殖正义的组织合作。