COVID-19, birth outcomes, and vaccinations: A public dialogue led by community voices

 

Watch the full event

Key Takeaways: 

  • Providers need to make time and the space to address concerns rather than enforce vaccination. 
  • Researchers, scientists, and clinicians should practice cultural humility and acknowledge that the pandemic has evolved (and will continue to evolve) in ways that were unpredictable. 
  • Recognize that racism and colonialism have led to a narrow understanding of health and continue to harm Black people in their experiences with medical institutions.  

 

New research on COVID-19's impact on birth outcomes is emerging. The latest findings indicate that COVID-19 infection is related to an increased risk for preterm birth, and that those infected have a higher risk of hospitalization and death from the virus than do non-pregnant people.  

Although we are starting to have a clearer picture of COVID-19 and birth outcomes, pregnant people’s opinions about COVID-19, its impact on birth outcomes, and vaccination vary widely. For our September Collaboratory, we forged a space for authentic dialogue for these opinions to be shared with respect and dignity.  

“We always talk about a need to meet women really where they are and understand that people have questions and that not everyone wants to get vaccinated right now. People are in different timelines. People have different needs. It’s really important to meet people where they are and have those discussions,” said speaker Laura Jelliffe-Pawlowski, Professor of Epidemiology and Biostatistics in the UCSF and Director of Precision Health and Discovery at PTBi.  

    Women sitting in a church discussing the vaccine

    During the event, Yvette Robles, PTBi Community Engagement and Partnership Program Manager, welcomed the audience to accept and consider “different ways of being in the world” and uplifted social histories as a mechanism of survival and adaptation. “In essence, to fail at acknowledging the role of social history and its impact on our lives is to fail at doing no harm, to fail at equity, compassion, and love,” she said.  

    Prior to the Collaboratory, a community listening session was held to collect questions and concerns. A panel of clinicians, public health professionals, and community leaders were then given the opportunity to address the questions, comments, and concerns. Topics raised were everything from lived experience during the pandemic and a lack of cultural humility on the part of providers to experiences of bullying, shaming, and racism. Below are a few highlights. 

    We lacked the courage and the cultural humility to acknowledge that going into this pandemic, systems and structure of public health and health care had already created hierarchies of human value...

    Dr. Karen Scott

    Panelist Member, Associate Professor, Humanities & Social Sciences at UCSF

    Healthcare Mistreatment and Violence 

    “[There’s a] history of oppression against melanated people, specifically Black women and a lot of Latina women on the border have faced secret sterilizations and forced abortions. Not everyone should be told to do this because there’s a lot of trauma in community,” community expert Vanessa shared in the listening session. “Why would you force something when there’s all this unresolved trauma around medical [mistreatment] and pregnant women?” 

     

    Bri Taylor, PTBi Program Manager, reminded the audiences that the concerns arising from Black communities are not the result of ignorance or apathy for their children, but the result of colonization and racism. “Black and Brown people have been subjugated into conforming to Western ways of being as it related to health and healing since the beginning of colonialism. Our ancestral and indigenous ways of healing are criticized and vilified,” she said. “The current medical systems was never designed to cure us or to heal us. Medical harm continues to this day, ranging from experimentation to genocide through sterilization and medical error.” 

    Lived experience during the pandemic 

    At the beginning of the pandemic, community expert Kiki noted that COVID-19 felt like a movie, and no one knew what was right or wrong. She recalled feeling like she didn’t know if walking out of the house was safe. The panel of community experts shared that it was hard to protect their families because there was no clear guidance.  

    Providers working in COVID-wards were living away from their children, and not allowing partners into birthing rooms. Dr. Martha Tesfalul, Maternal-Fetal Medicine Fellow, admits that those restrictions around labor and deliveries were harmful, but providers and professionals did not have a clear picture of what was going on at the time. She recalls seeing people with no risk factors being put on a ventilator and family members having to make challenging decisions at a distance.  

    In addition, Dr. Karen Scott, Associate Professor, Humanities & Social Sciences at UCSF, noted, “We lacked the courage and the cultural humility to acknowledge that going into this pandemic, systems and structure of public health and health care had already created hierarchies of human value that predetermined who got to actualize and defend their right to life, liberty, and the pursuit of happiness, health, and wellness.”

    Bullying, shaming and racism 

    Dr. Malcolm John, Director of the HIV/AIDS Program at UCSF, counseled the audience on giving patients grace and humility. He shared that patients often run into doctors who do not pause and ask the question, ‘What is your major concern?’.  

    “I don’t really aim to convince people to get the vaccine, but rather to provide information. To help people move and make a decision not out of fear or anger — because that’s when we make bad decisions in general — but to make decisions with power and strength,” he shared  

    Moreover, John noted that we are not as urgent or hands-on about all the other disparities Black communities are facing, including the maternal mortality and infant mortality crises.  


    Take Action

    • Reflect upon your practice as you provide guidance and counseling to patients making health decisions, including but not limited to COVID-19 vaccines. 
    • Pause and educate yourself on the history of racism that continues to harm BIPOC people today.  
    • Acknowledge and accept that the choices your patients make may not be the same ones that you would make for yourself or your family.