1. Write a paragraph describing the extent to which an socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework? Consider drawing a DAG or a socioecological model (like the one shown in class for obesity) to illustrate your point (you can take a picture to post on the forum).
My research interests are in decision making around abortion and the intersection with race. The socioecological framework has been applied to racial disparities in abortion and abortion care, however there have also been limitations to the conversation. The discussion around disparities has focused on higher rates of unintended pregnancy, higher rates of abortion, higher gestational ages at time of abortion and higher abortion-related mortality among Black women. I think the ways in which the socioecological framework has been applied has actually been quite broad—on the macrosystem level the role of abortion laws and policy on abortion access and disparities in abortion. The role of cultural norms relating to abortion and assessing abortion stigma at the societal and interpersonal levels. Understanding the physical environment as it relates to abortion access by studying the impact of distance from an abortion provider. The limitations of the application of the framework, in my eyes, stems from isolating abortion from other reproductive decisions, pregnancy, birth, parenting. A lot of the ways in which we have tried to apply the socioecological framework just applies to access. The Reproductive Justice framework was developed by Black women to clarify basic human reproductive rights and broaden our understanding of reproductive rights beyond abortion access. I think this framework of reproductive justice can be used with a socioecological framework to understand many aspects of reproduction, including abortion.
2. In the WHO reading, the authors describe structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances. Pick 3 of these factors (at least one structural and one intermediary). Explain why you chose the factors (might use Braveman article to provide justification) and describe how each could be an important determinant of a health outcome of your choosing. The association could be reported in published research or it could be your hypothesized relationship. Consider whether how these factors might function over the lifecourse and/or intergenerationally..
Race/ethnicity. Racism at the structural level mediates disparities in domains including in income and education. Racism at the structural, interpersonal, and internalized levels can be mediators of chronic stress and disease. If thinking about disparities in maternal mortality and morbitidy, health in pregnancy is related to pre-pregnancy health conditions including high blood pressure, diabetes, obesity. Access to prenatal care is related to income and ability to afford medical care. Education may allow for a better sense of how to advocate for oneself during pregnancy and prenatal care. This list is by no means exhaustive, but all of these factors, which are mediated by race and racism are important determinants of pregnancy-related mortality and morbidity. Race ethnicity functions over the course of one’s life.
Income. Income is an important structural stratifier of maternal mortality and morbidity. Income can determine access to healthcare, healthy foods, stable housing, and safe communities.
Healthcare system is an example of an intermediary determinant of health as it relates to maternal morbidity and mortality. In some aspects, the healthcare system might act to prevent bad outcomes by identifying, treating, and preventing disease. In other aspects, the healthcare system may further marginalize communities of people the system is not as well equipped to serve. For example, a health system may be less equipped to treat diabetes in a patient with homelessness and food insecurity, and may further marginalize that patient by failing to recognize barriers to health and differences in definitions of health.