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April 10 RJF Presentation

The document discusses establishing a Reproductive Justice Fund and outlines its history, purpose, and goals which include improving access to reproductive healthcare, education, and justice. It analyzes reproductive health gaps and recommends using the fund for upstream, midstream, and downstream initiatives to strengthen community health.

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sheath
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7K views

April 10 RJF Presentation

The document discusses establishing a Reproductive Justice Fund and outlines its history, purpose, and goals which include improving access to reproductive healthcare, education, and justice. It analyzes reproductive health gaps and recommends using the fund for upstream, midstream, and downstream initiatives to strengthen community health.

Uploaded by

sheath
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Reproductive

Justice Fund
FY 2024
Reproductive Justice Fund History
• City Council allocated $500,000 on Sept.
14, 2023, to establish a Reproductive
Justice Fund.
• Similar funds exist in Austin, Harris County,
St. Louis, Chicago, Columbus, New York
City, Seattle and Portland, as well as six
states (OR, CA, NM, MN, NJ, NY).
• Purposes have included clinic capacity-
building for maternal and reproductive
health, community outreach, and abortion
access.
• Allocated to Metro Health, whose portfolio
includes a Black maternal and mental
health priority.

Metropolitan Health District 2


Reproductive Justice
“Reproductive Justice means the human right to control our sexuality, our gender, our
work, and our reproduction.” - National Black Women's Reproductive Justice Agenda

• Right to have children

• Right not to have children

• Right to nurture the children we


have in a safe and healthy
environment

• Framework and a movement


founded by Black women in 1994

Metropolitan Health District 3


A Frayed Safety Net
• Texas leads nation in uninsured women (1 in 4)

• For low-cost/no-cost family planning services, cancer screening and STI testing:
• Federal Title X program is one-third of its former size
• Healthy Texas Women and Family Planning Programs: More applications were
denied than approved in 2020-21

• Lawfully present immigrant adults


are barred from Medicaid

Metropolitan Health District 4


Reproductive Health Gaps
Geographical Distribution of Ob-Gyns and Midwives
in Bexar County

1. Access to Contraception: 1 in 2 U.S.


residents at less than 250% of Federal
Poverty Level cannot access their
contraceptive method of choice (Healthy
People 2030, 2015 data)

Map from Access to Health Care During the COVID-19 Pandemic, Metro Health. Data Source: American Med. Assn.
Metropolitan Health District 5
Reproductive Health Gaps

2. Access to Prenatal Care: 1 in 4


pregnancies in Bexar County
began prenatal care after the first
trimester (CDC, 2022 data).

From 2018 to 2021, Bexar


County fared better than the
state and the nation, but that
trend reversed in 2022.

Map from Bexar Data Dive, CI: NOW. Data Source: Metro Health

Metropolitan Health District 6


Reproductive Health Gaps

3. Screening and Care for


Sexually Transmitted
Infections (STIs): 1 in 5 U.S.
residents on any given day has
an STI (CDC, 2018 data).

Congenital syphilis in Bexar


County occurred at 4 times the
national rate in 2021.

Metropolitan Health District 7


Reproductive Health Gaps
Bexar County Abortions by
Race/Ethnicity, 2017-2022
6000 4. Access to Abortion: 1 in 8 U.S.
pregnancies ended in abortion
5000
before Dobbs (CDC, 2019 data). Texas
4000 reported 52,495 abortions in 2021,
compared to 52 from Jan.-Oct.
3000
2023 (Texas Department of State Health
2000 Black
Services).
Hispanic

1000 White

0
2017 2018 2019 2020 2021 2022

Source: Texas Department of State Health Services

Metropolitan Health District 8


Metro Health: Limited Clinical
Women’s Health Services

• STI Care
• HPV Vaccination
• Health Education and Ancillary
Services
• Coalition Support
• Ambulatory clinics transferred to
University Health in 2008

Metropolitan Health District 9


Recommended Well Woman Care1
General Health
• Screenings: Blood pressure, diabetes, lipids, depression/anxiety, healthy diet & activity,
alcohol/tobacco/substance use, partner violence, folic acid use, osteoporosis, urinary incontinence
• Family planning

Infectious Disease
• STIs: Chlamydia, gonorrhea, syphilis, HIV, Hepatitis B & C; TB if indicated
• Immunizations including Varicella, MMR, HPV, Tdap, COVID, flu, RSV in pregnancy

Cancer Screening
• Cervical, breast, colon. Others only as indicated.
Pregnancy & Postpartum: Items above plus breastfeeding counseling, pre-eclampsia
screening & prevention, folic acid, Rh blood typing, healthy weight, bacteriuria screen

Comprehensive, low-cost women’s health care is offered at


University Health, CentroMed and Communicare
[1] Women’s Preventive Services Initiative (American College of Obstetricians & Gynecologists, American Academy of
Metropolitan Health District Family Physicians, American College of Physicians, Nurse Practitioners in Women’s Health) 10
Return on Investment
• Family Planning Visits: $4.02 saved
per $1 spent (CDC, 2003)

• Prenatal Care for People at High Risk:


Up to $3 per $1 spent (Institutes of Medicine,
1985)

• Community Health Workers: $2.47


saved per $1 spent (U. Penn, 2020)

• HIV Testing: $1.95 saved per $1 spent


(CDC, 2011)

Metropolitan Health District 11


What Other Cities Are Doing

Health Education Ob-Gyn Access & Abortion Access


Wraparound Care
Harris Co.: part of $6 million Harris Co: part of $6 million Columbus, OH: $1 million
Austin: $200,000 New York: $2.2 million St. Louis: $1 million*
New York: $250,000
St. Louis: $161,852 Chicago: $500,000
Seattle: $250,000
St. Louis: $288,721
Portland: $200,000

Metropolitan Health District 12


Public Health’s Upstream Focus

Access to trusted medical care

Direct services

Strengthening upstream initiatives can reduce the need for downstream services
Metropolitan Health District 13
Reproductive Justice Fund:
Current Needs
• Support capacity-building initiatives by
partners and strategic messaging by Health Upstream
Equity Network (Policy & Civic Engagement
Office):
• Food insecurity
• Housing security
• Access to respectful care

Metropolitan Health District 14


Reproductive Justice Fund:
Current Needs
• Reproductive health-focused Midstream
CHWs, care navigators and patient advocates

• Sexual health education for youths

• Contraception training for family medicine providers


in priority geographic areas (e.g. $56K would train
150 providers)

• Navigation to insurance and Texas programs, well


woman care, family planning

• Showcasing accessible, respectful providers


of quality women’s health care (e.g. CARE Initiative
- $20K)

• Doula training scholarships

Metropolitan Health District 15


Reproductive Justice Fund:
Current Needs

• Home pregnancy tests Downstream


• Emergency contraception

• Transportation to prenatal care


• Subsidized doulas
• Black maternal mental health care visits

• Telehealth visits for STIs


• STI home test kits

• Transportation to abortion care

Metropolitan Health District 16


RFP Criteria
All organizations will need to meet City Procurement, contracting and audit
criteria. Preference will be given to organizations that:

• Serve and empower those most affected by reproductive health disparities


• Provide culturally and linguistically appropriate services in priority
geographic areas
• Include upstream/midstream approaches

Metropolitan Health District 17


RFP Allocation
Staff Recommends:

Metropolitan Health District 18


Timeline

Winter '24-'25:
Summer 2024: Fall 2024: FY25-26:
Contracts
RFP Council Action Implementation
Executed

Metropolitan Health District 19


THANK YOU

Dr. Claude Jacob


[email protected]
Questions?
Dr. Junda Woo
[email protected]

Metropolitan Health District 20

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