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New research is digging further into reproductive health disparities among Black women in Mississippi. The findings aren’t new per se, but some of the nuance is. Family planning vacuums in Mississippi hit Black women harder than their white counterparts, even among women with insurance and birth control access. Controlling for women with and without children, the study surveyed women about access to reproductive health services, birth control use, pregnancy and income.
Reproductive health access is back in national news again this week after the Supreme Court decided employers can buck federal law by not covering birth control. Locally, the pandemic has disrupted priorities and funding at the Mississippi State Department of Health. In an interview with Mississippi Today last week, State Health Officer Thomas Dobbs said, “We are definitely going to have to do less reproductive health work … (like) service delivery that we do in certain communities. We have to prioritize our activities based on the reality of the resources that we have.”
As we see state and national resources limited, studies that dig into pre-existing barriers to care are more important than ever. The upshot: insurance does not equate to health care, especially among Black women, who tend to use family practitioners or health departments for their reproductive health care, rather than OB-GYNs trained in that specific service, says lead study author and University of Southern Mississippi public health professor Tanya Funchess. She says the research indicates the nature of complex barriers to culturally appropriate reproductive health, beyond known barriers like insurance and OB-GYN shortages.
When it comes to reproductive health disparities, health inequities are known among public health professionals, but there’s less consensus on how to mitigate them and pool resources effectively, says Funchess. “We have a lot of national data — sometimes statewide — but we don’t often have money to dig into the problems and ask, ‘Where can we penetrate?’,” she said. “We want to help all who need it, but we also want to make sure to target areas that need services the most and know how to use social capital in our communities. A lot of public health work is done in silos.”
This and other research suggest that education, like sex-ed and family planning counseling that often inform choice, should be areas of focus in the future. While Black women in the study were more likely to use birth control and say their prescription was covered in full, they were also more likely to have unintended pregnancies.
Income inequality is an important piece to dig into to understand that finding, says Funchess. Almost all of the 1,600 women in the study were employed, but Black women were almost three times more likely to have annual incomes under $25,000 — nearly three in four Black women, compared to fewer than one in three white women. Though the income disparity is not new, Funchess says the statistically significant difference is a layer that needs to be peeled back when looking at health disparities, especially those that are dependent on intimate decision-making like birth control choices. “If you’ve got to choose between paying for food, bills and dealing with everyday issues … poverty alters those priorities and how you access information. All these things get put in a ranking order and studies show when you live below the federal poverty line, you prioritize decisions differently.”
From the provider perspective, Funchess hopes more attention will be paid to provider training. “We all have implicit biases, we have to do more to acknowledge what they are so we can get over it and provide the care, because we can’t automatically fix health care overnight.”
This and other research show that Black women were less likely to use the most effective forms of birth control for preventing pregnancy, such as long-acting reversible contraceptives like implants and intrauterine devices, or LARCs. Funchess acknowledges that dictating “most effective” methods on women — especially Black women with children who’ve faced health care discrimination and involuntary sterilization — is not helpful, but she does want women to have robust access to learn about all methods and chose what’s best for them, all while reducing unwanted pregnancies and poor health outcomes. “We don’t want to push any particular method on minority women, there is a history of distrust there — but we do want to understand if women are seeing family practitioners or the health department, they’re more likely going to be prescribed moderate- and least-effective methods of contraception.”
“Women should have access to all options, so they can make an informed decision about their body,” she says, and that’s not happening across all levels of care. “Insurance is not health care. If women are not provided education regarding contraception or maternal care before, during and after pregnancy, if they’re not provided it continuously, they utilize what they know.”
– Tanya Funchess, lead author on the study
As for this moment in time with the nationwide reckoning around racial disparities: “I hope people are seeing a different lens around race now — that they are peeling back layers and are really seeing how the social determinants of health play a factor in disparities. Unless we do something, we will be here for another 100 years.” Changing symbols and acknowledging systemic racism are a good place to start, she says. “But we don’t want to just do that, we want to check those big boxes, like women below the federal poverty threshold getting services they need.”
This brief appeared in the round-up section of our monthly women and girls newsletter, The Inform[H]er.