The United States has poorer health and decreased longevity compared to other nations in the world. This chapter addresses clinical care from the framework of social determinants and proposes strategies grounded in the literature of healthcare, public health, and the social sciences. Disrupting undermining social determinants needs to be the paradigm of care. This paradigm is presented from four vantage points: embracing equity; safeguarding respectful birth and physiologic care; reducing cesarean birth; and preventing and managing risk. The chapter describes how maternal health in the United States can be enhanced by providing an environment of social justice and equity and discusses priority areas of clinical care essential to addressing the social determinants of the maternal health crisis in the United States. It describes selected evidence-based initiatives to promote equity and standardization of care in the prevention of maternal mortality and the management of severe maternal morbidity in the United States.
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Clinician’s Guide to LGBTQIA+ Care:Cultural Safety and Social Justice in Primary, Sexual, and Reproductive Healthcare
This book provides a perspective for providing clinical care for all people through the lens of racial, economic and reproductive justice. It provides examples, guidance, and case scenarios based on our collective experience as well as the most up to date evidence-based guidelines for Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual, + more (
LGBTQIA+) patient populations. However, this book is not intended to be comprehensive on any topic related to LGBTQIA+care and is not meant to be used as a stand-alone reference for medical care, but rather as a foundation for building an inclusive and justice-oriented practice. The book can serve as a tool that the clinician can use alongside a variety of other tools. Language about gender, sexuality, intersex health and asexuality will also always be in a constant state of necessary flux. Language must shift in order to frame ideas and change cultural concepts.” Clinicians rarely learn about LGBTQIA+history, systems of oppression, or racial/economic/disability justice in our foundational or continuing education. To begin to understand our LGBTQIA+patients and care for them safely within the oppressive institutions that the clinician works, he must pull from the humanities, social sciences, as well as community activism to understand the realities of lived experience of our patients. The book introduces the reader to the multiple ongoing efforts to achieve health equity as well as racial, economic, and reproductive justice across multiple institutions, including health care. It intends to provide the reader with a primer on some of these concepts, drawing from various resources that most clinicians are not aware of. The book dives deeper into several areas of clinical care that the clinician can apply to their practice immediately regardless of their area of expertise or specialization.
The idea of cultural sensitivity focuses on the basic awareness and willingness to learn about cultural differences. Cultural safety emphasizes patient-centered and community-centered care that takes into consideration the intersecting and ongoing processes of oppression that impact Lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual or allied (
LGBTQIA+) people every day – especially people of color. The chapter enables the reader to list three ways that cultural safety differs from cultural competence and clinical care modifications supporting the cultural safety for LGBTQIA+patients. It helps the reader to self-reflect on personal biases which prevent provision of culturally safe care. Keeping cultural safety at the forefront of clinical practice guides clinicians in culturally informed, conscious and mindful care that acknowledges a patient’s narrative and history of oppression. Maintaining a mindful clinical practice brings LGBTQIA+patients one step closer to health equity and justice.