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Contact Information
David R. Buchanan, MD
Section
Head
Section of Social Medicine
1900 W. Polk, 9th Floor
Chicago, IL 60612
david_buchanan@rush.edu
Lisa Stevak, MA
Section Coordinator
Tel: 312-864-7333
Fax: 312-864-9500
lisa_stevak@rush.edu
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February 26, 2007
Presenter:
Robyn Gabel
Agenda
9:30-
9:35
Business Items: Update of Section
Member Activities
9:35-10:30
Executive Director of the
Illinois Maternal and
Child Health Coalition, Robyn Gabel works
to affect public policy in the areas of women and children's health
and economic
development. As a recipient of the
Chicago Community Trust
Fellowship in Community
Leadership, Ms. Gabel spent a year investigating the "Hispanic
Paradox," a
phenomenon in which Mexican immigrants give birth to healthier
babies than the second
generation of Mexican-American's born in Chicago.
Meeting Minutes
Business
We have not yet scheduled a speaker for our March 19th
meeting. Please contact Lisa if you would like to lead
a discussion.
Presentation
Thirteen people were in attendance from General Internal
Medicine, Obstetrics, and Nursing.
Robyn Gabel explained that the Chicago Community Trust offers a
Fellowship in Community Leadership to individuals who have been
not-for-profit leaders for more than 10 years. The fellowship is
designed to give recipients time to renew their commitment to
their fields and the public sector. During Ms. Gabel’s 13-month
fellowship, she studied the Hispanic Paradox as it pertains to
maternal and infant health, focusing on why first- and
second-generation, American-born Mexican-Americans give birth to
a greater number of preterm babies and to babies with a lower
birth weight compared with Mexican-born, first generation
Mexican-Americans. She also went to learn about healthcare in
France because it has the world’s best health system and England
because of health disparities research conducted there.
Ms. Gabel
reviewed the literature; interviewed health professionals and
lay workers, and pregnant or parenting Mexican-American women;
and lived and studied in Mexico to learn more about Mexican
culture and how it supports pregnant women. In Mexico, having
children is highly desired. When a woman is pregnant, the
family is very supportive and everyone lends a hand to see to
her well-being. One cultural belief found in Mexico is that if
the food cravings of a pregnant woman are not satisfied, then
the baby will be born with a birthmark. Thus, in many cases, a
pregnant woman needs only mention she would like a certain
something to eat and family members go out immediately to find
the desired food or the ingredients necessary to make it.
Mexican women tend not to do or take anything that might harm
the baby, including through the delivery. This means that
coffee and alcohol are avoided, substance use is not a problem,
and hard physical labor is not done. Additionally, the family
protects the pregnant woman from stress and expects her to
rest. Mexican immigrants to the U.S. bring these cultural
beliefs with them and continue to provide social support for
pregnant woman.
A literature
review revealed NO direct correlation between good nutrition,
social support, spirituality, and migrant status with birth
weight and preterm births among Mexican-American women.
However, a few studies have found that higher acculturation
combined with increased prenatal stress do seem to be more
commonly found among second- and third- generation Mexican
Americans and may account for lower birth weights and higher
preterm babies. In a survey Ms. Gabel conducted, she found that
both women born in Mexico and in the U.S. sought pre-natal care
early, ate nutritiously, abstained from drinking alcohol or
smoking, received family support during and after the pregnancy,
and walked for exercise.
Significant differences between the two groups were the age of
the first pregnancy and the level of discrimination
experienced. The average age of the first pregnancy for first
generation (Mexican-born) Mexican-American women was 21 years
versus only 17 years for U.S.-born Mexican Americans women,
although sexual activity starts at about the same age for both
groups. U.S.-born Mexican American women reported higher rates
of discrimination. Only 50% of first-generation Mexican
American women reported experiencing discrimination, and then
primarily because they did not speak English. In contrast, 90%
of U.S.-born Mexican American women reported having endured
discrimination or knowing someone who had been discriminated
against, mostly from police. One woman reported being stopped
by the police when she and her husband were driving one night.
The police officer asked the woman why she was out so late with
the man in the car. The woman replied that the man was her
husband. The police officer told her she had made a bad
choice.
Ms. Gabel made 4 recommendations:
- Treat
racial discrimination seriously, especially from the police
- Work to
reduce teen pregnancy, including making contraceptives
readily available and teaching about human reproduction in
school.
- Increase
institutional support for women who are pregnant by
decreasing stress and encouraging more rest among women who
are pregnant
- Help
women be more healthy before they become pregnant
Group
discussion focused on how schools in the Chicagoland area are
unwelcoming environments for teenagers who are pregnant,
regardless of their racial or ethnic group. Schools do not
accommodate pregnant teenagers by sending home homework when the
student misses class, understanding that the student might need
more rest and therefore need longer to complete class
assignments, or by providing affordable child care after the
baby is born.
Ms. Gabel then told us about what she had learned in France.
She noted that the age people become sexually active is similar
in both France and the U.S. However, in France only 20.2 births
per one thousand were to teenage moms compared with 83.6 in the
U.S. She accounts for this difference in two ways. First, the
provision of sex education in French schools is at an early age
and discusses birth control. Second, contraceptives are readily
available and no stigma is attached to their purchase.
France is a pro-natalist country. In the 1990s the healthcare
system became concerned about preterm births and developed the
recommendation that women not work upon entering the third
trimester of pregnancy. It was felt that the stress caused by
working and transportation affected birth outcomes. To promote
this recommendation, the government enacted legislation that
allows a woman to receive her full salary for six months (three
months before the birth and three months after). Moreover,
women receive financial support to stay home with their children
during the first three years after the baby’s birth. Public
pre-school is available to every child beginning at the age of
3. In order to make this policy affordable to employers, all
employers pay into a fund that is then used to fund this pro-natalist
policy. Women are paid from this fund while employers are able
to hire replacements for the length of time their employees are
at home. Unfortunately, France does not track health
disparities by race but by class. For example, professional,
more educated women have better access to quality prenatal care
than unskilled, lower-income women. We do know that
undocumented residents in France do not have access to health
care. The French government passed legislation to provide
prenatal care to illegal immigrants who are pregnant and
provided housing stability by allowing pregnant women to stay in
their residence throughout their pregnancy.
In England, birth outcomes by ethnicity have been tracked since
the 1990s. Immigrants and refugees are less likely to have
access to care and receive lower quality of care. To reduce
such disparities, Sure Start centers (similar to Healthy Start
programs here in the U.S.), are established in low-income areas
and provide a team approach to strengthen families and
communities and offer early and continuous prenatal care. These
centers are located in the community rather than the hospital.
Interestingly in England, OBs attend only 28% of births.
England’s 30,000 midwives oversee the majority of births.
Based on what Robyn Gabel learned in France and England, she
makes the following recommendations:
-
The U.S. needs some form of
universal health care
-
Systematic health policies
should promote healthy families and communities through a
team approach to health (much discussion about this occurs
in the U.S. but little is done)
-
Encourage early prenatal care
using peer outreach
-
Decrease teenage pregnancies
with health education and access to birth control
-
Institute a family allowance
to prepare for the baby and consider providing opportunities
for women to reduce stress while they are pregnant.
These minutes
were written by Lisa Stevak. Please report any errors to her at
lisa_stevak@rush.edu
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