Health Disparities Forum

1. After reading the article by Thomas et al., comment on where your research, or your research interests, fit into the generational framework for health disparities research. If your work is 1rst or 2^nd generation, comment on how your work could lead in the future to 3^rd or 4^th generation work.  If your work is 3^rd or 4^th generation, comment on what 1rst and 2^nd generation work was necessary as a foundation for your current work (or current interests).

My work fits into a 1^st generation framework.  We are just beginning to identify the frameworks, definitions, and conceptual models to measure the mistreatment of women in childbirth.  We have a wealth of qualitative data on the experience of mistreatment across different groups of women, but we don’t have disparity research at the group level.  I have also been involved in developing some of the first quantitative tools (scales) to measure mistreatment in childbirth.  This 1^st generation research (frequently of the cross-sectional and qualitative type), could lead to second generation prospective research that can draw out the causal connections between provider attitudes, women’s attitudes and beliefs about obstetric interventions, the mistreatment of women, and outcomes (interventions, perinatal, breastfeeding, short- and long-term maternal mental health).  Once the causal connections have been better determined, third generation interventions that target either provider or patients (or both?) to increase evidence based care and to decrease mistreatment of women will become possible. 

1. The barbershop hypertension intervention, while essentially a clinical services intervention operating at either the fence or safety-net level as described by Jones, has some engagement with the social determinants of health. What types of clinical interventions can you think of in your area of research that could similarly bridge levels of the socioecological model? 

I appreciated this fence, cliff metaphor.  There is evidence that having women accompanied by a family member, partner, or doula can result in less mistreatment of the woman and provision of more evidence based care.  This is similar to the fence and/or safety net examples.   The socio-ecological (life-course?) model would back us away from the cliff.  There is evidence from many areas of women’s health that women are not empowered to make decisions about the timing of pregnancy, use of contraception, and also the options surrounding childbirth.  Many women say they discover late in pregnancy that they have the right to make certain choices.  While many of these “choice” issue relate to structural determinants that limit women’s reproductive choices, some of the issue lies in women’s ability to make effective decisions for their own situations.  I wonder if taking the life-course perspective and starting with an empowerment intervention earlier (away from the cliff) in women’s reproductive lives will have spillover effects into their future reproductive decisions, rather than educating women about their options/rights when they are already in time-sensitive situations.  Is there a way to create enduring “reproductive habits” that would help women (and men) navigated sexual and reproductive situations in ethical and empowering ways?  Or, is the encouragement of these “reproductive habits” more effective when it happens close (at the cliff’s edge) in time to a potentially-empowering reproductive event (like STD screening, abortion counseling, and childbirth)?