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The
Community
Psychologist

Volume 51   Number 4 Fall 2018

Cultural and Racial Affairs

Edited by Jesica Siham Fernandez, Santa Clara University and Dominique Thomas, University of Michigan

Bridging Academia and Practice: Decolonizing Community Psychology 

Written by Geraldine Palmer, PhD., Past-Chair, CERA

An expressed commitment of community psychology is to intentionally engage race, culture and ethnicity as key factors in community research and action (Cruz & Sonn, 2011). As a Council of the Society for Community Research and Action (SCRA), CERA (Culture, Ethnic and Racial Affairs) recognizes that to deepen emancipatory practices in community psychology (p. 203), and psychological science in general, it is important and crucial to include decolonizing efforts. These efforts must also be centered and the focus also on community psychology textbooks. CERA’s mission and goals include representing issues of cultural diversity and promoting the concerns of people of color as a focus of community research and intervention. To this end, a number of CERA members are authoring a chapter on Oppression and Power in an upcoming open-access, undergraduate textbook edited by Olya Glantsman and Lenny Jason. Chapter authors include Geri Palmer, Past-Chair, Jesica Siham Ferńandez, Chair, Dominique Thomas, Chair-Elect, along with members: Gordon Lee, Latriece Clark, Bianca Guzman, Ireri Bernal, and allies, Hana Masud, Catalina Tang and Sonja Hilson.

CERA is excited about this opportunity and thus far have nearly completed a first draft of the chapter! Oppression and Power will fall under the “understanding communities” section of the book. The chapter includes conceptualizations of oppression and power, impacts on communities and its members, decolonizing oppression and power in our communities, as well as, perspectives on liberation. Additionally, case studies, and quizzes for application and assessment will comprise the chapter. Look for excerpts of lived experiences, the inclusion of related social movements, and an overall style that is expected to enrich and enhance the studies of upcoming community psychology students and the professional development and training of budding community psychologists!

Reference

Reyes Cruz, M., & Sonn, C. C. (2011). (De)colonizing culture in community psychology: Reflections from critical social science. American Journal of Community Psychology47(1/2), 203-214. doi:10.1007/s10464-010-9378-x

Matters of Maternal Mortality: The Geographic Dispersion of Institutional Racism

Written by Najjuwah S. Walden, Founder, Earth and Her Flowers Project

In Missouri where I reside, and elsewhere in the United States, adverse pregnancy outcomes are epidemic to African diasporic populations (Creanga, Syverson, Seed, & Callaghan, 2017). The burden of maternal morbidity and mortality is estimated to be highest in low- and middle-income countries (Firoz, Chou, von Dadelszen, Agrawal, Vanderkruik, Tunçalp, & ... Say, 2013). However, death and acute or chronic illness due to pregnancy have been recognized as a national concern disproportionately affecting African diasporic populations in the United States since 1899 when W.E.B. DuBois published The Philadelphia Negro. While previous research has attributed high rates of adverse pregnancy outcomes to conditions of poverty (Handler, Rankin, Rosenberg, & Sinha, 2012; Posthumus, Birnie, van Veen, Steegers, & Bonsel, 2016; Zhang, Cardarelli, Shim, Booker, & Rust, 2013), rates for African diasporic women remain intertwined in the social condition of race. The maternal mortality and morbidity concern surpasses gynecological and obstetric understanding of reproductive health functioning by encompassing the forces of oppression and institutional racism interacting in the lives of African diasporic women.

As a student of reproductive health epidemics disproportionately affecting African diasporic women I must first ask, “Who are African diasporic women?” While African diasporic women identify with many ethnicities, dialects, religions, and cultural practices within the United States, the social condition of race composes nationally recognized subgroups of African diasporic women which do not coincide with the origins we use to differentiate ourselves. Further, I must recognize identities of African diasporic women exist through associations including, but not limited to, occupation, education, criminalization, marriage, and motherhood. Given the institutionalization of perinatal (i.e. pregnancy, labor and delivery, and postpartum) care in the United States, a complete understanding of the African diasporic patient includes an integrated analysis of associative identities defined by institutions of perinatal care and African diasporic populations receiving such care. Therefore, my complete study begins with analyzing the physical environments African diasporic women occupy and how we are defined in recognition of the spaces we occupy. However, the recognition of identities associated with African diasporic women is not simply an initial step but the foundation for differentiating disparities beyond the social construct of race.

The recognition of the maternal mortality and morbidity epidemic beyond the disparity of race instead increases our understanding of institutional racism within perinatal care. While racism is “the subordination of any person or group because of skin color or other distinctive physical characteristics,” institutional racism is “the use of specific policies and/or procedures of institutions [based on the socialization of racism] which consistently result in unequal treatment for particular groups” (Chaney, 2015). Institutional racism, as opposed to race, increases the scope from identities to interactions. To many Missouri born and raised populations, the African diasporic question can be reduced to the city-county divide. And if you live in St. Louis city or St. Louis County, the direction of north county or south city is enough to deduce experiences of racism among African Diasporic women. However, African diasporic populations in the rural counties of Missouri are not excluded from experiences of institutional racism within interactions with perinatal providers. Therefore, our understanding of the spatial disparity in perinatal care is not limited to institutional racism in urban environments, but the facilitation of institutional racism in any environment where perinatal care is provided. Historical and continued perinatal practices in urban and rural counties create the Missouri endemic. In prior research, our understanding of African diasporic outcomes has been limited due to restricted associations of Black or African American to poverty and urbanization. However, a visit to any county will remind anyone of the true dispersion of a state-wide epidemic concerning institutional racism.

The spatial dispersion and identities of African diasporic women will be used to explain the institutionally racist effects of the epidemic in the studies I conduct; however, most studies have not expanded into further inquiries required to obtain a complete understanding. “What are African diasporic women?” is not a question that should remain outside of our understanding of African diasporic women at-risk for experiencing maternal mortality and morbidity. The reason institutional racism is facilitated within healthcare environments is because this question exists within institutions who facilitate racist interpretations regarding African diasporic women while providing care. It is impossible for me to believe labels including but not limited to Jezebel, welfare queen, baby mama, and criminal do not interact in the minds of perinatal providers who create practices and policies with a limited context of in-group identity, interpretations, and cultural practices of African diasporic women. At this point, we must admit not all African diasporic people are poor and live in ghettos; but these opinions may largely overshadow perceptions of African diasporic women held by perinatal care providers.

Generations of individuals who have occupied these occupations have also operationalized these interpretations of “non-compliant” patients, without knowing the true cause of non-compliance. I can only assume the distance required to travel, previous relationships with medical providers, insurance status, ability to afford associated costs of travel, time off from work, time off from school, or the desire to gain a pregnancy experience independent from institutionalization may cause “non-compliance.” However, these systematic and institutional barriers have never been mentioned as causes of maternal morbidities and mortality. There are few academics and practitioners who recognize the social and systematic barriers to mobility which are attributed to institutional racism operating within housing, transportation, and healthcare policies and practices. Previous research has not compared the various forms of barriers to mobility for African diasporic women living in various geographies of a state. We should know whether the burden of maternal mortality and morbidity in Missouri is actually greater among rural African diasporic women. We should aim to gain further understanding of the spatial geographies where disparities are greatest within the African diasporic population opposed to assuming all disparity exists within urbanization and poverty. As populations of African diasporic people across Missouri continue to migrate, we can expect greater dispersion of the maternal mortality and morbidity epidemic.

The analysis of population migration, which leads me to believe maternal mortality and morbidity will disperse, will, therefore, require us to predict changes to the epidemic for African diasporic women. Previous research has been unable to predict what direction the maternal mortality and morbidity rates will be going for African diasporic women. Based on the historical existence of maternal mortality and morbidity as well as the current system of institutionalizing both racism and perinatal care, I can say “not in the direction of prevention” with certainty. Yet this certainty is limited to the current system which is not intended to prevent but respond. Prior to the institutionalization of perinatal care, women were able to avoid institutional racism, false identities, socialized interpretations, and spatial limitations to care. In the former system of perinatal care, births occurred in homes with members within the community; while the majority of present births occur in a hospital by a medical doctor. While the present system of obstetric and gynecologic medicine has yet to fully accommodate the identities, needs, and geographies of African diasporic women, most careful attention must be paid to the longitudinal development of the epidemic. The questions I have discussed not only lead to a current understanding of maternal mortality and morbidity but an integrated response to how the epidemic developed.

At this point, where my research currently exists, I cannot ignore my responsibility to enable the prevention of maternal mortality and morbidity. While the available research on the determinants of maternal mortality and morbidity for African diasporic women may be incredibly small, the existing body of research is a foundation to predict where the epidemic is going based on its formation. The most comprehensive and replicable research will require the participation of both African diasporic woman and perinatal providers who wish to understand and articulate who African diasporic women are, what African diasporic women represent, where the epidemic is going, and how we get to maternal mortality and morbidity prevention. While the current practices of perinatal care may currently operate with institutional racism, acceptance of the maternal mortality and morbidity epidemic should not be the normative response. Due to the operationalization of institutional racism within institutions of healthcare which provide perinatal care, the maternal mortality and morbidity epidemic among African diasporic women is different from simplified individual risk factors or prescribed procedures and surgical solutions. The social construct of race cannot generalize an entire population, and the practice of doing so has led to instances of maternal mortality and morbidity caused by institutional racism. It is not enough to know what differences exist due to the social construct of race if we do not understand the historical pathway from trend to epidemic. It is not enough to be aware of the epidemic if we do not know how it developed. This is the phenomena of African diasporic maternal mortality and morbidity which I am devoted to describing, analyzing, understanding, and preventing.

References

Chaney, C. (2015). Institutional Racism: Perspectives on the Department of Justice's Investigation of the Ferguson Police Department. Western Journal of Black Studies, 39(4), 312-330.

Creanga, A. A., Syverson, C., Seed, K., & Callaghan, W. M. (2017). Pregnancy-Related Mortality in the United States, 2011-2013. Obstetrics & Gynecology, 130(2), 366-373. doi:10.1097/AOG.0000000000002114

Du Bois, W. E. B. (1899). The Philadelphia Negro. University of Pennsylvania Press.

Firoz, T., Chou, D., von Dadelszen, P., Agrawal, P., Vanderkruik, R., Tunçalp, O., & ... Say, L. (2013). Measuring maternal health: focus on maternal morbidity. Bulletin Of The World Health Organization, 91(10), 794-796. doi:10.2471/BLT.13.117564

Handler, A., Rankin, K., Rosenberg, D., & Sinha, K. (2012). Extent of documented adherence to recommended prenatal care content: Provider site differences and effect on outcomes among low-income women. Maternal and Child Health Journal, 16(2), 393-405. doi:10.1007/s10995-011-0763-3

Posthumus, A. G., Birnie, E., van Veen, M. J., Steegers, E. P., & Bonsel, G. J. (2016). An antenatal prediction model for adverse birth outcomes in an urban population: The contribution of medical and non-medical risks. Midwifery, 3878-86. doi:10.1016/j.midw.2015.11.006

U.S. Census Bureau (2017). Current Population Survey, Annual Social and Economic Supplement, 2017, MO & Black Alone. Retrieved from https://www.census.gov/

Zhang, S., Cardarelli, K., Shim, R., Ye, J., Booker, K., & Rust, G. (2013). Racial Disparities in Economic and Clinical Outcomes of Pregnancy Among Medicaid Recipients. Maternal & Child Health Journal, 17(8), 1518-1525. doi:10.1007/s109