- [Tricia Kitzmann] Welcome everyone to the eighth installment of Building Health Equity Webinar series, Reproductive Health Equity in Iowa. The objectives for today's discussion are to: Learn about reproductive health equity issues currently occurring in Iowa. Explore successful strategies to promote equity and justice related to reproductive health and healthcare. Highlight how individuals and organizations can get started advocating for reproductive health equity. I'm Tricia Kitzmann. I am a program coordinator with the Institute for Public Health Practice at the University of Iowa College of Public Health. A little housekeeping information: This session will be recorded, so just so you're aware of that. You can find the chat box down at the bottom of your Zoom screen. You can - so put any questions that you have in there. You can also find the Q and A box, the question answer box. You can also put your questions in there, as well. Myself and Kathleen will be monitoring the Q and A and the chat box today. Also, if you're having any technical difficulties, feel free to direct message Kathleen in the chat section. Please feel free to introduce yourself, where you're from and what you do that so we have an idea of where everyone's from today who's joining us on this webinar that would be fantastic. I will now invite our guests to introduce themselves, and then we'll move into some of our discussion and question answers. So, Melissa, I'll let you kick it off.

- [Melissa Lehan Mackin] Okay, it's nice to be here. Thank you for inviting me. So, as you said, my name is Melissa Lehan Mackin. I'm an associate professor at the University of Iowa College of Nursing, and I'm one of the people at the University of Iowa that is extremely homegrown. I've been in Iowa my whole life. I grew up in small town Iowa. Population: About 1200 people. I came here in 1991 and never left. I was a nurse for 10 years at UHC. Most of that was with women with gynecologic cancers. And so, you know, my small town background and my work as a nurse definitely has informed my work in the area of sexual and reproductive health for underserved populations. I am a nurse scientist, as well, and I've done several projects under this umbrella that includes examining the knowledge and use of emergency contraception and college women as access to sex education and curriculum development for persons with intellectual and developmental disabilities, and understanding how Iowa's white health workforce interacts with black women seeking reproductive healthcare from the perspective of black women. So that's sort of in a nutshell about me.

- [Tricia] Awesome, thanks Melissa.

- [Destinee Woodris] Hi there. My name is Destinee Woodris. A use she/they pronouns. I am the director of community engagement for Planned Parenthood of North Central State. So that includes Iowa, Nebraska, North Dakota, and South Dakota with Minnesota. And so within the five we are ever live, I would say. So for Iowa, I moved there December, 2018 and moved away this year. So prior to this role, I was the Iowa Department of Public Health Project Evaluator for Suicide prevention, looking specifically at Substance Use Treatment Disorder Centers called the Integrated Provider Network, which is a network of 19 providers providing substance use disorder treatment across Iowa. So it was very interesting to get into this role at Planned Parenthood in North central States. What drew me to the role was that it was specifically looking at BIPOC and LGBTQ communities as it pertains to health equity, how we do our outreach, what are some ways that we're actually tracking how we're engaging and what that means ultimately for building with community rather than at. And so also just finished up my doctorate. So I have a doctorate in education now with leadership and innovation, and my research concentration was on BIPOC, well, black LGBTQ folks who live in Iowa wanted to know a little bit more about our story. And so I asked for folks for interviews in the structure of a podcast interview. So that will be launching here pretty soon. But there were perspectives from folks who are from here, folks who are transplants. And so we have two essentially natives and two transplants. And so it was very interesting just to kind of hear about what were some perceived barriers and stories of joy, which is all always important and sometimes often overlooked when thinking about equity or telling the story about BIPOC and LGBTQ folks. And so, and we'll go into the whole whole background. I know you all have plenty of questions, but I'm excited to be here in space with you in, in getting started. So thank you, Tricia.

- [Tricia] Yeah, thank you. Well, welcome and congratulations. A PhD is definitely no small feat, so congrats. That's awesome and I'm excited. I will definitely be touching base to make sure we can share the links to the podcast once they're, once they go live, we'll make sure we can get that word out as well. And I would love to make sure we share that with our distribution list. So definitely be sharing that with us. You guys have both kind of touched on this a little bit in your introductions, but wanna make sure I circle and give you full opportunity to share anything that you may not have addressed when we first introduced ourselves. So a little bit about your background. How did you get into this area of work? Like what kind of brought you here? And what exactly is it that you do to help ensure health equity with reproductive health rights? And I don't care who goes first. Melissa, you wanna jump in first?

- Sure, I mean, I think I shared, you know, some of how I got here and you know, and I think part of it is my personality. I've always been curious and I've always asked, I've been that person that asked really annoying questions. And so, you know, stepping into the role of a healthcare professional, I found that I did that a lot. You know, why are things happening the way they are? And that definitely set me on this journey to, you know, to answer those questions on a higher level through research. So I'd say that that's probably the biggest mechanism that I used to kind of get the word out about inequity and potential interventions to address those issues. Yeah, I'll leave it there and I'll let Destinee take over.

- Thanks Melissa. So how did I get here? Woo, honestly, the job description. Now I know it's cliche to look at all that job, it seems like it fits me, but as somebody who has a master's in industrial organizational psychology, which is the study of human behavior in the workplace, it should not go discounted on how valuable it is to write a job description that is informed by a job analysis. I won't get super nerdy on you all, but it really spoke to me that it called in my identities as a black person, a woman, somebody who's, you know, younger in the field getting going and working with community who are coming from all walks of life. And so it was a very attractive job posting that I just could not pass up and that I would still be living in the Midwest. So I think there is such a unique culture in any state broken down by regions when it comes to how we actually interact with black LBTQ folks and just staying within the five, it seemed very important, especially when people think about Midwest's culture and you know, what does nice mean? You know, what is Iowa nice? What is Minnesota nice? What does that actually mean for folks from different walks in its intersection with healthcare? And so I started to think about all of that. When I saw the job posting, I said, "You know what? This is something I can grow into." I felt like I checked off most of the boxes, but then there were definitely some growth potential areas, which I'm working through right now. So it is ever a challenge, but it's something that I'm invested in. So what I do on a day-to-day basis is this something at Planned Parenthood, this is one of our least favorite questions because we could go on and on or we might have radio silence, but I'm gonna see what I could do to have a happy medium today for you all. So right now in my role, and I started January 24th of this year, so that's important to note. So starting this year, I looked at, well, what are we doing to serve our community? So right now I'm working with internal staff on how we can have some tracking mechanisms on how folks are actually being reached, what are the perceived barriers, what are actual barriers to care, what does that mean for our training needs? So I'm asking a lot of questions of us so we have a better understanding of what it is that we're bringing out into the communities before we actually ask communities, what can we do for you all? What are we doing with you all right now that you like? What is it that you don't like? And doing it in a way that is intentionally centering their voices instead of asking at, we're really trying to build with. And so that's a little bit about what I do. I do a lot more strategic planning right now and figuring out what it is that we can build with community. So it's a reframe and a shift of how we had been operating, but it's something that's ever important and ever parent that we just need to keep doing, which is centering community voices. So that's a little bit about what I do and maybe not each day, each day looks a little bit different, but that's the crux of it all for me.

- Awesome, thank you both. So before we get into some of the weeds and more of the questions, I wanna make sure we're all on the same page, or at least be able for you guys to be able to share with our audience today, is what does reproductive health equity mean to you in your organization?

- So I'm not sure if I can speak to my organization, but I can speak to me.

- Okay.

- So for me, reproductive health equity means that everyone has the same access to services and resources that assist them to achieve optimal reproductive wellness. And this should apply to everyone regardless of gender, sexual orientation, disability, wealth, skin color or other identity. And I believe that this means that women get to choose when and if they want to be pregnant and have children. And that includes unmitigated access to abortion services.

- For Planned Parenthood North central states. We're in a really critical time right now where we are grappling with owning up. And so what that means for us is that we have a very colorful history of how reproductive health rights even got started as a old school white feminism lens mixed in with eugenics. Now we're trying to, I guess I would say correct what has been going on, but we can't do that without acknowledging what's already there, which was the past. And then some of the unintentional ways that we are systemically perpetuating how black folks and LGBTQ folks are being underserved. So right now, for us health equity means we have to own up to what's there and be able to build with, to figure out what are some ways that we can promote equity. You know, promoting equity in certain communities might look different than in others. And so for us, we are learning first. And so health equity, it means moving away from transactional care, which is, I have this thing give it here more towards transformational, which is, "Okay, please listen to me, I'm the expert of my body." You are the expert of your field. What are some ways that we can work together? Can you please listen to me as I'm telling you what is wrong? So I really like Melissa when you shouted out that, yeah, so one of my research areas is actually looking at how black patients interact with a traditionally or predominantly white healthcare system. So in some experiences, and I'll be a little bit personal here, I've actually had some doctors that said, "Oh, that's really not what's wrong with you. We're just listening to what we're saying on this." I'm just like, I respect your area of expertise and I need you to listen to what I'm saying. But yeah, but it's not, and so moving away from, intentionally in these instances, gaslighting people to actually building with and understanding where they're coming from is health equity and practice so folks can get the care based on who they are and what we're trying to build as a community.

- I know that's a huge shift for a lot of folks. A for the healthcare providers out there already serving patients, but us as patients, just feeling empowered to be able to say that, "Yes, thank you. However, not saying you're wrong, but..." How we can continue to empower folks to find their voice and be able to share? 'Cause you're right, we are the experts of our bodies, but it's finding that voice to be able to say that, especially if we're from a population that may not have been able to have a voice or have access to care. So being able to ensure that that's happening. So thank you. I really, that's powerful for me. So what are the current issues or concerns related to equity in reproductive healthcare in the state of Iowa?

- Destinee, you want me to go? So first of all, I think there's a lot of issues and concerns about reproductive health equity in Iowa, and I'm not sure we have enough talk to talk about 'em all, but certainly I think the recent policies in active in Iowa and the threat of the policies that have yet to come demonstrate that Iowa's hostile to the idea of reproductive health equity. And I'm talking about in 2017, the decision to leave the federal Medicaid family planning group so that a bunch of Title 10 clinics got closed as well as the restrictions on abortion care during the pandemic. And you know, although yesterday and Iowa judge blocked the ban that would eliminate most abortions, I think there's still so many restrictive policies that remain in place and I don't know if, well, I'll stop there and I'll let Destinee jump in.

- Okay, excellent points. Yes. And like anti LGBTQ bills that were introduced, they didn't pass, thankfully when I was on the scene and folks who kind of helped support and show up in that way. But that therein lies a larger issue here, which is we are in a very critical time where people are saying, "Oh my gosh, I can't believe this is happening." You got two different sides, I can't believe this has happened. And then the other side is, "Well, we were preparing, we were bracing ourselves." I'm just like, well there surely there has to be a middle, wasn't there a middle where folks are just trying to figure out where we could actually land? And I think that's one of the larger issues that Iowa has, but nationally, that's what we've got going on. Our people are really trying to find their foothold here. And speaking of old school feminism, I'm in groups with a lot of folks and one of the people that I hold near and dear to me, she's in her 80s now, but she was just like, Destinee, I think it's ridiculous that we're still having these conversations. I've marched, I've got arthritis for marching and we're still going through this. This is ridiculous to the new school going, "Well, here we are right now, what does advocacy look like today?" And so Iowa's issue is not a unique issue in that we're still trying to figure out what we can do to promote health equity in sexual reproductive health justice. But it's just ever scary. You know, one thing's, another issue that we have, and I don't know, and hopefully you all can kind of speak to this a little bit, when I was still living in Iowa, there was a teacher shortage. And in some of the schools, and I'm speaking even specifically for Des Moines, I'm like, "Okay, that's an issue for so many reasons. Who's teaching the students and what does this mean for the quality of the lessons and how they're showing up in space? So yeah, you have parents who are with their children at home for a portion, but the teachers have it the majority of the day they have them. And so if they don't have adequate resources to properly train and have the support from the state, their in lies is another issue there. So if so many layers to what Melissa was speaking to, we could go on and on, but one of the bigger ones is how are we funding schools and of the schools that are uncomfortable with broaching the topic of sexual reproductive health, how then can we partner with folks and organizations to provide that type of service? Because if students and young folks and communities aren't receiving that care from quality trained professionals, they'll find resources. We don't know how quality they are. And so therein lies is another issue. But anyway, I'll stop there. I get it Melissa, it's a challenge to kind of stop at the past here, but this is a really important question.

- Absolutely, absolutely. So I think you've touched on this, both of you have, but I wanna dig a little deeper into the populations that are being disproportionately affected by this issue. Who are they? what are things that you're hearing through your work of experiences that they've had and how do we start kind of addressing some of those populations that clearly are being disproportionately impacted, but how do we change that? What are some of the small steps? So first, who are they? What have you heard from these populations? If anything, and what are some of the steps that we may be able to start looking at as we talk about this today? You know, being able to give some action items possibly to some of our folks that are listening in, some things that they can do to maybe change or pivot in the work that they're doing vocally.

- So I think that, you know, as far as from a policy standpoint and just those examples that Iowa provided, we know that the impacts that's had on women as far as contraceptive seeking, that we know that women who are not receiving contraceptive care has doubled as well as people who are not using any sort of contraceptive method. And so, I mean, I think that that's like one consequence, in a grand number of them. And I think we know these things in general about Iowa, and then I also think we know that if that's the general consensus, we know that our communities of individuals who lack health insurance or live in poverty or people of color live rurally, have a disability that those people are affected disproportionately. And we already know things are bad for everybody and then things are worse for them. You know, just as an an example, you know, the likelihood of a black woman dying in Iowa from a pregnancy or childbirth is three to five times higher than a white person. I mean, I think that those are examples of very real consequences that result of exclusionary policies. And I could even provide an additional example. I have a child that identifies as transgender and from a family and not a researcher standpoint, I fear for their safety because of the context that these policies and attitudes have created. And I don't even know that we've seen the full consequences of that yet. Go ahead Destinee.

- Thanks Melissa. Who are they and where are they? A lot of times we are very, and I'll say we, as I'm putting my Iowa hat back on temporarily Des Moines centered, they're of the 99 counties, the majority of them are rural. So I'm even thinking about the rural communities that might not have a community youth concepts or food drives that are or mutual aid funds that are so well stocked. I'm thinking about the rural communities. So folks who are in rural communities might not even have a primary care doctor that has access to get some of the stuff that is standard, in larger cities. So a lot of times what's needed is coalition building and accessible coalitions and community advocacy groups. And sometimes when you think about rural communities, you don't necessarily think about, the black and brown folks that live there or the LGBTQ folks that live there. Sometimes they're just like, "Okay, everybody works at this one factory or everybody does this one thing." But there are some real opportunities there to really get in there and figure out, well, what are some things that we could tailor a bit or could work with? And so what I have been hearing from folks is that the rural islands are still there. They're still in existence and the realities that are faced county to county is not even regionally specific that it's very hard to have an approach where an outreach strategy is going to work unless you are actually building with the coalitions and community folks that are in there. So a lot of times it's trust building that's needed and in figuring out that you are not trying to go in there and tell them what they need. But rather you go in there and say, "Well, what do you need from us? Or what type of resources are working for you that you just might need more of?" So it is very community centered approach that we think about at Planned Parenthood North central states. And then I'm fortunate to have that lens of as the director of community engagement, but more importantly on a human level there are folks who have skills, everybody has a skill, but not everybody has the vehicle or the mechanism to be able to bring that up in spaces where it could actually be utilized for community good. And so what I'm hearing is, "Yeah, rural Iowa is definitely still here and there are black folks, brown folks, LGBTQ folks who live within those spaces who might not even feel safe enough to disclose who they truly are in their fullness. And so we've got a real opportunity there to even work with them, to work with community members to figure out what we can do to start there first.

- I love that. And you're right. It needs to start locally, right? 'Cause that's for multiple reasons to provide and continue to educate community members and those that work and live in those communities, but also just access, being able to have a conversation about that. 'Cause as you pointed out, 99 counties, the majority of our counties are rural in Iowa and we are not going to have a Planned Parenthood clinic in all 99 counties. That's just not gonna happen. And so how do we ensure that the providers and community partners that are in those communities are able to support and align and advocate for these populations that are having access issues or that are concerned of having a voice and being discriminated against or not being able to access the care that they need because of discrimination or bar other barriers that could be in existence in their communities. So, very valid points. Very valid points. I think you both have touched on this a little bit, but in your opinion, what is the impact of legislation on some of these issues? Now, I know there was one quote and quote possible win that we that the abortion was withheld, the fetal heartbeat was with upheld yesterday, so that was not, so that is still something that did not pass yet in the state of Iowa. But I think we are all fully aware that's probably something that's still gonna be continuously coming, raising its head and being brought forth for policy and legislation. What are other concerns or other areas that could be concerning or things that maybe you have an idea of a different piece of legislation that needs to be brought forward that could be beneficial in helping address some of these health equity issues?

- I have a lot of ideas for policy, but I'm not sure who wants to listen to them.

- Hey, clearly you've got, you've got some sort of platform. We're all here listening. So, but no, I completely understand.

- I mean, I think at the very kind of the basic level. I mean, we don't even have a schema for sex education for public schools, right? I tried for a class project back in, I tried to dig in into that and it is so confusing. Like, it says things like, "You should use evidence-based whenever possible, but also includes some of this other stuff about, you know, abstinence." So I think one of the policies is we need a really solid foundation for sex education that includes knowledge of contraception and how to prevent pregnancy, but also those things cause that kind of relate to kind of really depend on those things Destinee was talking about. But you know, gender affirming education, things that I think are definitely missing and I think could go a long way in creating awareness and accurate knowledge into allowing people at least to be informed about the decisions. We still have a number of other areas of things we have to address in terms of barriers to access to service and resources. But I think at the very basic level, that's something that we really need.

- Solid points, Melissa, the only thing I would add is I don't know about legislation needing to be introduced, but I can think about what it means for the types of legislation that's being that's introduced. People aren't seen, they don't feel seen yet. The fact that we are having to not only police bodies in this such a way, I'm just like, okay, you all realize this is like a very core human issue where you're not understanding that folks are the experts of the lived experiences in their bodies. We don't understand yet. When I say we, I mean collective we, like something is really missing and I'm not sure what it is going to take. So this question is not maddening, but it's maddening to think about the answer and what it really comes down to that people feel still that it is okay to tell somebody whether or not they're a boy or a girl or who they can marry or what do they need for their body. Listen to the folks, what are they saying? So yeah, I love the whole, yeah, we need a robust sex education system we do. We do need it in the schools and at a very human level, they need to understand that people are the experts of their lived experience. It's so I know that I started off this saying, "Oh yeah, there's a whole podcast coming out, but it the whole reason as to why and I'll say this really quickly so you all can have some warm and fuzzies. Well, I was still living in Iowa, I lived in the Drake Carpenter area. And so I lived in a house that I lovingly called old Okie. And I was set out there on my porch. And so that was the first house project that was done. It wasn't the most sensible project, but it was the most important to me. So folks could feel, seen on out in the community. So I would wave to my neighbors, say, "Hey." Eventually little kids would stop by neighbors right next door, "Miss Destinee, can we have a block party so we can get to know our neighbors?" I say, "Now what do you know about a block party? What in the hell you wanna do?" Listen, well we wanna get to know our neighbors because we don't know anybody and we wanna play in the street and have food and all the things who could say no to that? The the very next Drake Neighborhood Association meeting, I said, "Hey, little neighbors wanna have this block party." But what they didn't know was that before those little kids spoke to me, there were people walking down the street said, "We really need a block party." I said, "Universe, what are you saying?" So I couldn't ignore it when the kids said it. We eventually had our first one, October 24th, 2020, and the next one, the next year we had one ISIS cigarettes marched, Drake neighborhood got behind it, they started to paint the sidewalks and all the things, but basically at the core of it was getting to know your neighbors. And I feel like that is something that is missing. I know porch culture is traditionally thought of as a southern thing. Not necessarily have to be the case, but I think at the core of it, this legislation, people just aren't hearing, people just aren't feeling what is going on. So I appreciate the tangibles, here's the legislation that needs to be introduced and all the things 'cause we need that and we need to be able to have mechanisms where we can share our stories so people actually have an entry point to build with instead of talk to and down to.

- Absolutely, absolutely. What methods have you seen? Oh, before I jump into the next question, please, those that are listening in today, take an opportunity if you have a question or a comment or wanna share any thoughts, feel free to put those in the chat or the Q and A so we can make sure as we have our panelists here, your questions answers or any thoughts you wanna share with them, this is your opportunity. So please do ask questions if you have a question or have an opportunity even just to share comment or thoughts as you're listening into this today. That would be great. So next question, what methods have you seen successful in helping people who need reproductive health navigate the resources and the care that they need?

- Destinee, why don't you start this one? I feel like I've been going first for all them.

- Okay, so for what I've seen so far, planned Parenthood has patient navigators. And so if somebody is feeling like that, yeah, they know how to advocate for themselves, but they might not have the lingo or they just would feel like somebody else would be able to help them out. We have their patient navigators to kind of have the warm, I wouldn't even say a handoff because they're not really leaving them at a certain point, but we'll call a warm handoff for this instance. We're just like, "Okay, hey, we have this patient here, they're here for services. What, what do we need to do?" That has been really helpful even prior to folks getting services. It's just a matter of having the strength to get to the place where they're just like, actually I need the services and I know where to go. So a lot of times we don't see the patients yet. It's our marketing, it's the comms and it's outside of Planned Parenthood too. Like we're really big on figuring out who we can work with to provide services. Doesn't always have to be us and that's a whole thing, but in building with the community, it has been about what is our marketing and comm strategy? Can people find us? How are we getting the information out? So translation services are really big for us in the field and especially within sexual reproductive health when we know translation is huge, and not only translation, but okay, how do we follow up? How do we know the message is actually getting across? And so there's a whole communications plan, but you know, so we're trying to alleviate some of those barriers to care on the backend before we even see folks, before they even hit the office. But, so while they're in the office, there's a lot of, "Okay, what can we do to make it comfortable?" And also there's some real needs for us to do training on how we're engaging with folks, whether they're black LGBTQ folks who are traditionally underserved. And so there are definitely some training opportunities, but the things that are working well is probably the communication strategy that we have and once folks are in the door to actually feel supported and seen in this space.

- So I think in some ways about successful methods is, it's a tough question because I think if we did know we'd be doing it maybe, but, and so I'm not sure if this is the answer that people are looking for, but sometimes I think some of the most effective strategies are a little bit in the stealth mode. Like for example, when I've taught sex education, I try to empower the young people in my class and tell them that they are walking out of this class with more information than most of their peers. And so I encourage them that when you hear your friends talking about something that's not correct, gently correct them and give them the correct information and position yourself as a source of reliable information. And I mean, knowing what I know about adolescents and sexual health, their peer peer information is important. And so if you can actually manipulate that little bit, it's better. And the other thing that underscored this for me too is a few years ago my grad student did her dissertation research on women in non-core Iowa counties. So the most rural Iowa counties, and it was a qualitative study. There were 11 participants, but 10 out of the 11 participants sought care at Planned Parenthood because either up here or like an older student was over hood talking about it. And so they identified that that's where they could go, have their needs and resources met. And so we found that to be pretty powerful, in the domain when information sources are limiting, but here's this peer source of information that's playing this really important role. In fact we thought was hugely responsible for the fact that how many of these young women sought care at Planned Parenthood? It was because of this reference.

- I think it's interesting. So I probably haven't disclosed this yet. I can apply some folks though on the call now. So I currently work for the College of Public Health, but I come from local public health for 20 years. I work for the state for two or for five years, and then the last 15 years I was at the local public health level. And one of the things that we talk about is especially as we start looking forward in the future and we start talking about Public Health 3.0 really looking at collaborations, right? Like the health department can't do everything. We can't address all the health inequities that are going on within a community in all 99 counties. Some health departments, have a health department of one person. And so it's really about collaboration, working together, pulling resources in because they can't, nor should they be the expert on everything they need to have those resources, those partnerships with organizations in their community and even those organizations outside of those communities because like we talked about earlier, Planned Parenthood, the University of Iowa is not gonna be in all 99 counties. And so how do we provide some of those resources or supports for those folks and put the olive branch out there so they can reach us even if we aren't physically located within those communities. So ensuring that they have the accurate information to make sure that they have those partnerships and those taking the time. Destinee, I loved your neighborhood block party. I mean it really is, it's coming back down to listening to our patients, listening to the people we serve, listening to our community members who live, work, and play in our communities and hearing what their needs are and being able to be a voice for them if they can't find their own voice and or better yet helping them find their own voice. So it is in their own words, their needs being met. So as I think about that from a local public health perspective, I think something that would've helped me and several of my colleagues as we talk about sexual health, obviously, outside of reproductive rights and reproductive health, we also know from the pandemic, and this actually kind of started prior to the pandemic, was the rise of STIs, right? We're seeing a huge rise in STIs across not only the state of Iowa but the nation. It's a significant increase over the last several years. What do you think health departments, specifically local public health agencies can do to prioritize sexual reproductive health initiatives locally and center their voices of those who are most affected in their work? What would be some strategies or some ideas that you would want a local public health agency and maybe give an example of what they can do if they're in rural Iowa that don't have as many resources around to those that already maybe have such as Johnson County, Lin County, we have quite a bit of resources, Polk County, but doesn't necessarily, just 'cause we have resources doesn't necessarily mean they're doing a great job either. So what are those strategies, what are those tools and what are those steps that they should be taking to make sure that they're moving in that right direction?

- Okay, so I think, the whole climate surrounding reproductive equity in Iowa, I think it has compounded an existing problem that there's a lot of mistrust for health systems and organizations because of how we've his historically treated people who were more denied for example, black people, other people of color, LGBTQ plus folks, immigrants, non-English speaking folks. And so I think this level of mistrust exists and then the current climate just compounds that, and my friend and colleague Lynette Cooper says, "You have to go into that relationship assuming that the trust is broken and you start there." So public health workers may feel that they're executing these programs and initiatives and they're likely certainly a way to decrease disparities. But I think you have to remember that you represent the system that that has a long history of oppression and that you have to remember that you represent that system that's been doing that. And I think that that's especially true for people who look like me, who or have similar identities because I think you have to recognize beyond yourself what those particular circumstances and identities are that are contributing to distrust. I think that you have to go into any initiative and approach us thinking that you're not only gonna impact the reproductive health, but in an effort of taking time to know the community, their fears and concerns and goals is important to the success of that program. So I definitely think trust is a key issue that has to be addressed. I think you have to make strides just to step into other people's shoes and understand how their lived experience as a marginalized individual or group has impacted their health. And I think once you kind of have that understanding, then you can kind of step in and say, "Okay, what can we do about your reproductive health needs?" But honestly, I think there's some work that has to happen prior to that point.

- Yeah, well said. And the only other thing I would add is I know we have community needs assessments that we do at the local level that feed into the larger Iowa Department of Public Health or Iowa Department public Health and Human Services. I know there was a merger or something in progress.

- Iowa Department of Health and Human Services.

- There we go. And so I would even start with that and notice if there are any gaps in who we are thinking about asking, like are we asking the right questions? How do we know we're asking the right questions? Is there community advisory council that is actually informing the work in addition to just asking the questions. And so yeah, we will definitely need to have trust building for sure, but there's also a pretty good opportunity to reevaluate how we're actually asking the questions and if the questions are still valid. It could have been that the needs assessment, has it been assessed maybe five, 10 years ago, maybe something, there's a real opportunity there to work with it. So there probably could be a way to move forward with community though again, that's my whole message. If nothing else, you forget anything else. Remember the block parties and we need to build with the community. So yes, I think that would be the only thing in addition to what Melissa has already said, is to look at if you all are using China hip, whatever community needs assessments that you have, look if there are any opportunities to revamp them with the community and figure out if it's actually tracking and landing the way it's intended to.

- Right. Excellent point. Melissa, looks like there's a, Caitlin, thank you for your question in the chat. Can you see it, Melissa?

- Oh, if you're looking for yes, the moral life of Henrietta LAX is very eye-opening. And if we're talking about books, I will also recommend "Medical Apartheid" by Dr. Harriet Washington. It's a tough read, but if you're looking to view the world in a different light, it will certainly do that for you.

- There's also the question from Caitlin, what are the thoughts on providers prescribing both birth control as a method of regulating various conditions, PCOS versus focusing on a more holistic approach in figuring out underlying causes. Birth control is an amazing opportunity for women, but I personally think sometimes providers don't realize there are other options, methods to regulate certain conditions or some conditions. Excuse me. Any additional thoughts or feedback on that, Melissa or Destinee either one?

- So in some ways I think that's a clinical question that I don't quite have the experience, to answer definitively. But I think that the points that Destinee was making about having it be mutual decision making, and it's not just about the provider knowledge, it's doing a really full assessment of what are that individual's wants, needs and goals, and then from what you know about medications or contraceptives and matching that, I mean, it could certainly be that providers don't realize there are other options, but I think that's you're kind of recognizing part of the problem is that there needs to be this holistic assessment and mutual decision making.

- Yeah, and I read this question and I was thinking about it for a while. I would say for prescribing birth control, very personally, I will say I did take birth control at one point in time and I do have PCOS, so polycystic ovarian syndrome. It is not for the faint. And I started to notice, well, yeah, so it's working here, but God, I'm worse over here. So being able to work with a provider that will actually listen to you when you say, here's how this is working for me is critical, but that is definitely a clinical question. And shifting the culture of clinical practice means that, yeah, even though we know that something has worked in a particular setting for certain groups of people, it's not gonna work for everybody. So even just kind of shifting the culture of how we learn and learn with communities, it's something that's gonna be ever important, whether you're in clinical, especially in clinical, whether you're in clinical or if you are one of the boots on the ground as we have organizers. So there's definitely, again, there are just opportunities to learn here, but to figure out how we're actually connecting with the community on what are methods of care that will work. So again, allowing them to tell us what it is that they need. So if we're saying, "Hey, yeah, we got birth control." But maybe birth control's an always the go-to, we have an opportunity then putting my, I'm not a clinical provider, but if I were a clinical provider say, "Okay, I need X, Y, and Z professional development, or I really need to work with these experts to gain a deeper understanding." So a lot of that is gonna go back to the clinical staff.

- Which I think kind of leads into Jackie, thank you for your question. The question is there any work on educating doctors or medical practitioners on how to respect a patient's perspective? As you mentioned, many times the concerns are dismissed too easily, even though we are the experts of our bodies, or at the very least teaching young women to advocate for themselves when dealing with medical providers. I find many young women know nothing about their body, so they are not able to advocate for themselves. This is where sex ed comes in of course absolutely I think the key right there is the sex education piece and starting young and starting early is crucial for young ones to feel comfortable using the word penis and vagina and not being embarrassed that they have one or the other and being able to talk about it. I'm a huge advocate for sexual health and sexual education because I think our society already makes sex taboo. So if we are already ashamed to use the word or say the word penis in a webinar, then we need to address that we're not gonna get anywhere no matter how good we are anywhere else. No one's gonna feel comfortable being able to address this if I can't tell my own doctor that something is not right with my body and I don't know what my body parts are. But are either one of you aware of any type of additional training or opportunities for that are being offered to providers?

- I think that we're starting, at least in the healthcare arena, we're starting to see a little bit of a boom of some of these programs. I think what's problematic right now is that some of them are siloed with specific groups of providers, and I haven't seen one yet that is really expansive and conserve a broad audience. Although I think we're starting, we're gonna start seeing more of this. And I'm also know some colleagues who are starting to evaluate the outcomes of those programs. So I think that we're on the cusp of seeing more. But some of it also is going to require a change in how we educate providers. There's a very paternalistic hierarchal structure of Western medicine that permeates and so we need to get rid of some of that so that we can build on a model of more mutual decision making. And so some of it is going to be learning and some of it's gonna be unlearning as well I think.

- [Tricia] Well said.

- Very well said. And the other bit is, I don't know what's going on outside of Planned Parenthood and specifically how we're educating practitioners, but for us, what we're working on right now, one of my colleagues shout out to Tim, who's not on the call, has said, "Okay, Destinee, my role is gonna shift, not only am I gonna be training in community Education and engagement, which is the department that I'm in." He was like, "Now I'm looking at doing external stuff, like for clinical staff." I said, "All right, Tim, what are you up to?" And so he told me that he is working on revamping the clinical training model to include patient experience in with it. So how we're actually connecting with folks and how we're actually respecting them when they're saying, "Hey, X, Y and Z is going on." Whether they're BIPOC or LGBTQ, there are certain things that have been going on. I will say hypothetical example there may think of it and like this, there could have been a doctor that may have said at one point, "Oh my gosh, your hair is really pretty and is it heavy? Like, what are some things?" So then the doctor is sitting in themselves in the moment rather than on the patient's care and experience. I'm just like, "Okay, we can just stop thingify black women and black individuals and just BIPOC or LGBTQ folks and focus on the care. The research that you wanna do on hair afterwards I respect it here for it you should do that on your own time and not expecting me to be the expert for that or you in that moment when the care should be about me. So just wanna put that out there that there are certain situations to where that happens to people. So I can tell you what's going on with Planned Parenthood North Central states, that there is a training model that's being revamped as we speak, but what's going on outside of it, I'm not quite sure. But there is definitely room to grow with community and specifically medical practitioners.

- And I think I'll just take a minute and put in a plug for my research team. So I'm collaborating with Dr. Lynette Cooper, who is a clinical provider and a black woman as well as list Stasia Coleman, who is a midwife at the College of Medicine and also identifies as a black woman. And so the current study that we're doing where we're asking black women to tell their stories about when they sought reproductive healthcare, and we are creating stories that both represent gaps in their treatment in how they were treated. But the other question that we're asking them is how they would reimagine a clinical interaction. What would be a clinical interaction? How would you change this clinical reaction to be something that really met your needs? And our goal is to use that in education. That part of our plan isn't necessarily really filled out yet, but we have some of these ideas of how we can take the information that we gain the stories that women have told us and actually make change with them.

- Awesome. That's fantastic. Thank you for letting us know. We have a about three minutes, a little less than three minutes left. I'm gonna ask the last question so you can leave some parting thoughts. If an organization or individual has not been involved in reproductive health work before, but is interested and has a passion, Where do you recommend that they start?

- Sorry, I looked at the questions ahead of time, this is the tough one to answer for me, but I'll go ahead and and start it, unless you're really ready to go, Melissa.

- No, that's okay. Please go ahead.

- Okay, so for Planned Parenthood, we're pretty easy to find, but I would also challenge you in addition to Planned Parenthood, look at some local resources. There are folks already doing the work in your local community. So I would just try to find them if you were able to connect with them and figure out what of the resources that they have? What are some list services that you could be a part of and ask them how do I have critical conversations with family members they love that stuff. So yeah, Planned Parenthood is very, very well known. But also think about some folks who've been in your communities for a long time doing this type of work. It would make their day and it would help them make the local communities a lot stronger.

- And I would also say not only looking at Planned Parenthood, but also possibly reaching out to the, oh my gosh, I almost said Iowa Department of Public Health, Iowa Department of Health and Human Services. You know, they have an HIV Bureau, HIV and STI Bureau that does work on sexually transmitted infection prevention, HIV prevention. They have reproductive health, family planning. So, you know, even if they're at the state, they'd at least be able to make some of those connections for you. There's usually listers with information to be able to join as well. With that, I was very fortunate to be in a larger work and larger community, so usually kind of knew what was going on, but it doesn't necessarily mean, you have to be alone in that work. There's folks out there already doing some of those boots on the ground, so don't reach, create the wheel, reach out to partners or reach out to your neighboring health department or the larger health departments that you know, where some of that funding for some of those programming is going and asking them where did they start, because everyone starts somewhere. So it's just taking that first step of putting that olive branch out there.

- And I think some of the advice that I give my students that I teach is if this is, something you wanna elevate your voice and make change that aligning yourself with a known entity that's already advocating for this issue so they can provide tools, models, and then amplify your own voice. And I probably have I'm a little bit different. So as a private citizen, I have memberships, but then I also as an academic have memberships. But I recognize in that position of privilege, those things might not be as accessible to community workers. But I know that in Iowa, their groups such as Neural Pocho, Iowa, planned Parenthood advocates of Iowa, Iowa Coalition for Collective Change, or the Great Plains Action Society, and those are just a few organizations that I know have participated in activities supporting reproductive health equity in Iowa. And a lot of these may even have a voice at the national level. So kind of joining with them gives you a lot of bang for your buck to use a probably overused phrase. The only other thing I was gonna mention is that and as we've talked, reproductive health issues are very political in our nation and very much in Iowa. And I think that if you're going to be an advocate, you sort of have to prepare yourself that you're gonna run into somebody who is not gonna share your same ideas. So you just might wanna think about what your response might be, whether that's in person or on social media. So it's just a risk I think that you take when you're diving into issues that have the same political context that reproductive health does. So I just wouldn't want you to be surprised by that. And then feel like, feel, what's the word? demoralized, and then not continue your efforts. So I wanted to mention that.

- Absolutely. Thank you. Well, we are over our time. It's so clearly we had a very good conversation today. So thank you everyone. Melissa, Destinee, thank you so much for your time today. For everyone participating in the chat. There'll be a link to a survey to provide us feedback on how today's webinar went. Again, I encourage you to complete it. You'll there'll be a follow up email as well sent out with the same link. Again, thanks everyone for attending. Again, Thank you Melissa. Thank you Destinee. Again, fill out the survey, feel free to subscribe. To our email distribution list. We will have resources obviously out there as well about this webinar and of our other webinars that we've hosted. The register for the next one will be coming up that will also be in the chat. And the next webinar it is on January 11th and it is Renewable Energy Equity Practices in Iowa. So again, I encourage you to register for next month's webinar. Thank you again. Have a wonderful and happy and healthy holiday season everyone, and take care.