The full spectrum of reproductive health — from decisions about conception through maternity care and birth — was the subject of a lively discussion among the panel of clinical and policy experts NJ Spotlight News brought together for an online roundtable last week.
The event — titled Maternal Health and Family Planning in New Jersey: Working Toward Better Outcomes — began with a keynote message from first lady Tammy Murphy, who has championed maternal and reproductive health through her Nurture NJ campaign. The campaign has highlighted the enormous racial gaps in New Jersey’s maternal health outcomes and Murphy noted in her remarks that Black women are seven times more likely to die as a result of pregnancy or childbirth than white women in this state.
In the discussion that followed, moderated by NJ Spotlight News health care writer Lilo Stainton, leaders in the state’s efforts to expand access to reproductive and maternal health care discussed the impact of the COVID-19 pandemic on their work, progress toward improving clinical outcomes and what else is needed to ensure all individuals can get the services they need to plan and grow their family.
The following are edited excerpts from the Oct. 27 discussion:
First Lady Tammy Murphy on the Reproductive Freedom Act, a legislative proposal she and Gov. Phil Murphy have championed, which would codify abortion rights in state law, expand insurance coverage for the procedure and make other changes to ensure access:
“This act explicitly ensures all New Jerseyans have the right to make their own personal health decisions when it comes to birth control and pregnancy-related care. These issues are all interrelated because the truth is that they are not matters of morality. They are matters of health resources and personal autonomy. And as Phil said several times that day, your body belongs to you. All these initiatives are symbols of our unyielding commitment to the women and families of the state and to a stronger and fairer New Jersey for everyone.
“There is no denying that money is tight this year and the need for support has grown exponentially. But even as we address the new and changing obstacles of COVID19, we cannot forget the maternal and infant health crisis that plagued our state, especially our Black mothers and babies, well before the pandemic even began.”
Leslie M, Kantor, Chair of the Department of Urban-Global Public Health at Rutgers University’s School of Public Health, on the full spectrum of reproductive health:
“If you think about maternal mortality … you have this intersection of racism and sexism that is leading to this terrible outcome. I think the other thing that we can be doing more of is talking about sexual and reproductive health across the lifespan. And one mistake that’s often made on these issues is we almost separate women who are trying to prevent pregnancy from women who get pregnant and give birth. And the truth is, it’s just women at different points in our lives. So I have spent a lot of my career on issues like sex education, making sure that we can set young people up for a lifetime of success. And interestingly, while I think there is a ton to compliment New Jersey for, it was actually the first state in the country to have a mandate for sex education.
“[In] the most recent youth risk behavior survey, we actually have the lowest percentage of teens using any birth control method other than condoms. Fiftieth, we are dead last — lower than Alabama. So we know that there are places where we can improve not only in terms of our sort of labor-and-delivery outcomes, but all the way through the life course (of reproductive health.)”
Linda Sloan Locke, midwife, social worker and board member at the New Jersey Health Care Quality Institute and the NJ Perinatal Quality Collaborative:
“I think one of the most encouraging things I see is that we are now addressing the systemic issues that we’ve talked a lot about, social determinants of health — those things (like) where we live, where we are born, where we grow up, where we’re educated. But I do think what’s been missing until recently is looking at the structural determinants of health. Those are the big-picture items, those upstream policies and systems and practices like racism, ableism, sexism, those things that impact and have an effect on (how) those social determinants play out for people in our state.
“One of the things that is hopeful right now (is that society) is beginning to understand that it is our systems issues that we need to work (to change) and those big-picture things that we really haven’t addressed in the past.”
Brittany Lee, social worker with the New Jersey Health Care Quality Institute, lead of the New Jersey Reproductive Health Access Project, on the true meaning of access to reproductive care:
“We talk about the word ‘access’ a lot and what does that really mean? Right? If an individual has insurance coverage for some contraceptive care, if they can maybe find a provider that can see them just at 10 a.m. on a weekday when they have work and child care transportation to figure out, is that true access to the full spectrum of contraceptive services and reproductive health care in New Jersey?
“And that’s not even getting into the issue of, ‘Can I afford it’? Can I get to the pharmacy to refill it? … So I think in New Jersey, we have an amazing health care system, an administration that’s very supportive of family planning services and wonderful advocates and providers, that we really can get to a place where everyone in New Jersey should be able to access the full spectrum of reproductive health care. We’re not there yet, but there are a lot of steps that we can take to get there.”
Dr. Damali Campbell-Oparaji, Department of Obstetrics, Gynecology and Women’s Health, Rutgers New Jersey Medical School, affiliated with University Hospital, Newark; on the importance of listening to women:
“This is really personal to me and (it is) important to listen to women. I think that, yes, we can say, as providers, that we really want to provide better care and the best care. We can’t do that unless we know what women want, unless we know what their goals are. And that requires us to do a little listening as providers. We have a lot of power and I think we have to yield some of that power and just learn to listen…
“These terms (like) shared decision-making; they’re not just terms. They are where things are really about someone’s life. And we can’t get there unless I, as a provider, really have an understanding of what the (patient’s) goal is, what her fears are. For the first time in my 20 years, I had a woman tell me this year, ‘I don’t want to die; I don’t want to. I want to make sure that you know that I want you to save my life.’ That was like (a wake-up call.) All I could do is tell her, ‘Of course I am going to do everything to save your life.’ But in 20 years, I never had a woman tell me, ‘I want to make sure you know. But I want you to do everything to save my life.’”
First Lady Tammy Murphy
Dr. Damali Campbell-Oparaji, Assistant Professor, Department of Obstetrics, Gynecology, and Women’s Health, Rutgers New Jersey Medical School, affiliation University Hospital, Newark
Leslie M. Kantor, PhD, MPH, Professor and Chair, Department of Urban-Global Public Health, Director, Urban Public Health Concentration, Director, Maternal Child Health Certificate, Rutgers School of Public Health
Brittany Lee, LSW, New Jersey Health Care Quality Institute, Lead of the New Jersey Reproductive Health Access Project, Licensed Social Worker
Linda Sloan Locke, CNM, MPH, LSW, FACNM, Board Member, New Jersey Health Care Quality Institute, NJ Perinatal Quality Collaborative Steering Committee
Lilo H. Stainton, NJ Spotlight News Health Care Writer