The Dose - What Support for Women and Families Really Looks Like

Episode Date: July 7, 2023

Even though the U.S. has the highest maternal mortality rate of any developed country, federal programs that have been proven to improve maternal health outcomes are often the target of budget cuts. This week on The Dose podcast, guest host Rachel Bervell speaks with Dr. Jamila Taylor, president and CEO of the National WIC Association, the nonprofit voice of the federal program that provides nutritious foods to more than 6.3 million women, infants, and children. They discuss the potential policy and funding solutions that can advance health for women, especially women of color. Their conversation ranges from the debt ceiling legislation’s impact on WIC to the pending “Momnibus” package of measures for improving health equity and quality of care for Black mothers. “Those essential programs are always the first to be on the chopping block,” Taylor says. “That's something that we really need to change in our approach to funding.”

The Dose is a production of the Commonwealth Fund, a foundation dedicated to healthcare for everyone. Hey everyone, welcome back to The Dose. My name is Joel Bervell, and I'm super excited today to have a special guest host, my own sister, Dr. Rachel Bervell. Rachel, I haven't seen you in like two months. I know. Hi. Thank you for having me, Joelle. It's really nice to see you, obviously, because you're my baby brother, but also because

we get to talk about something we both love. Yeah, I think back to when I kind of first started my social media channel and talked to Rachel Bices in Medicine. And I don't know if you remember this, but I was home over winter break and I came over to your room and we started just kind of listing out all these different disparities and biases that we both witnessed at our different levels. You being a resident and then me being kind of just starting out in medical school. I think now it's full circle to bring it back here. Absolutely. And it's funny because now I see it everywhere I go. I'm so excited for you to be on this show because I couldn't think of a better person to be a host.

And being a little brother, I got to brag a little bit about you. You've done so much within the space of reproductive health already. You co-produced a podcast with Johnson Hopkins for Public Health on call about the Black maternal health crisis. That was incredible. You run a Black OBGYN Instagram page, and even the National Medical Association recognized you as a top physician under 40. So I'm so excited for you to be hosting this episode.

But can you tell us who you're bringing on the show today? So my guest today is Dr. Jamila Taylor. She is the president and CEO of the National WIC Association, and she supports the interests of the Special Supplemental Nutrition Program for Women, Infants, and Children here in the United States. That's the nutritional voice for over 6.3 million mothers, children, and infants. She sounds amazing. I'm so excited to hear your conversation with Dr. Taylor. Absolutely. So let's get into it. And here's a little bit of context before we do. Right now, the United States has one of the highest maternal mortality rates among developed countries, and the gaps continue to

widen. The Centers for Disease Control and Prevention reported last fall that 80% of maternal deaths are preventable, and that's despite medical advances and technology in health care. Plus, racial and ethnic disparities persist. This past year, the challenges for women of reproductive age around fertility, choice, food security for families have all only become more urgent. And the problems are complex. I wanted to know and to share with you all the insights of Dr. Taylor. Where do we go and where do we begin to fix this? To dismantle the structural barriers preventing women, and especially women of color, from quality care. That's why I invited her to join me for this conversation.

Because she is doing the work. Dr. Taylor, thank you so much for joining me today. Thank you so much for having me. I have been really excited to talk to you for a lot of different reasons. But first on my mind, a couple of weeks ago, the Biden administration and Congress prevented the country from defaulting on its debt obligations. I'm curious, though, what will be the impact on women and children? How did the relevant appropriations fare in the resolution of the debt crisis? Well, first and foremost, I think I want to acknowledge the important work that had to happen behind the scenes to get a

compromise across the finish line in the first place. I will say that from the perspective of the Special Supplemental Nutrition Program for Women, Infants, and Children, WIC, which is what we focus on here at the National WIC Association, we are concerned about the spending caps that were included as part of the plan, right? And so what we're anticipating is that due to those spending caps, we could see a shortfall in the services that we are able to insure families that are part of the WIC program. So this could translate into waiting lists, something that we haven't seen in over three decades as part of the WIC program. We could see cuts to the fruit and vegetable benefits that families are enjoying as part of the program right now. And it could also lead to a whole host of other challenges, particularly for our members who represent WIC staff from across the country, folks who are so dedicated to this program

and the families we serve and the ability to ensure that they have nutrition and supports that they need, including access to health care referrals, infant formula, a whole host of other supports. What needs to happen now is that it's going to be incumbent upon appropriators in Congress to think through what those allocations are going to look like within those spending limits, right? Absolutely. You know, when I hear about money at the federal level, I got worried that things aren't being put to the populations and the demographics that need it the most. And this is one of those examples of that, where you have Congress really changing what

happens for populations that are in an area of need. But Congress is doing something right now that's really exciting. And that is from the Black Maternal Health Caucus in the form of the Momney Bus, which we know was introduced by Congresswoman Alma Adams, as well as Congresswoman Lauren Underwood. I'm curious how the new debt ceiling resolution is departing from some of the proposals that were put forward in the Momnibus. What makes the Momnibus different than what you were trying to do with WIC through the other funding? Well, I think the Momnibus is such an important tool in how we sort of think about the Black maternal health crisis as a whole, right? It is a comprehensive package of bills, you know, that really aim to address almost every dimension

of the Black maternal health crisis in this country. So everything from nutrition, you know, WIC is an essential piece of the Black maternal health monobus. You know, there's a bill that is focused on ensuring that postpartum eligibility as part of the WIC program extends from six months to two years, which would be so important for our families and support the continuum of nutritional support, but also access to important healthcare services. So that's one piece. But the Momnibus also works to address issues like the climate impacts on the maternal health crisis, ensuring that moms have access to vaccinations, the social determinants of health, which is really important as we sort of think through and ground the conversation around health disparities in this country and particularly what the most vulnerable families need in order to make sure they have the support, right? Like a lot of the conversation around healthcare centers on things like insurance coverage and even access to services, which we know is really important in the context of these conversations,

but so are things like access to safe, affordable housing, access to transportation. So the momnibus is really, you know, this comprehensive approach to what we need to ensure that Black families, as well as other families that may be impacted by poor maternal and infant health outcomes have what they need. And so the momnibus is broader in its approach than some of what we're seeing through these funding conversations, but also intricately linked, right? Because this is an authorizing piece of legislation, whereas the funding bill makes sure that we have the funding to be able to implement programs that, like those that are in the momnibus. And so they're closely linked together. But at the same time, when we're sort of in a situation where we're in some ways having to shortchange the most

vulnerable families in our country, that puts us in a hard position when it's time to implement programs that are comprehensive in nature. And one more thing that I want to add to as someone who has worked in Washington for decades, including a long stint on Capitol Hill, one of the things that baffles me is that whenever we're in a situation where we have to think closely about how we're funding programs and having to make some concessions, the concessions always lie with the programs that are serving the most vulnerable families. You know, why do we go to those programs first when it's time to make cuts or rethink how we're, you know, funding programs across this country?

And so that is something that continues to, quite frankly, concern me because those are the very families that need the most support, you know, in challenging times. But those essential programs are always the first to be on the chopping block. And so that's something that we really need to change in our approach to funding, supporting the programs that vulnerable families need. And I'm curious, what can we do to stop that? Well, first off, I think it's important to recognize that we need the right, we need leaders in place that care about these programs and these families, and they actually center these programs and families in how they do their lawmaking, how they think through the decisions they're making in Washington or in any other sort of government center across the country. So I think that's the first thing. Then I also think, too, that we need to continue to think through how these decisions have impacts on broader communities, our economy.

We know that women drive this economy, right? I mean, there's no question about that, whether we're stay-at-home moms helping to support our families in the boardroom, running universities, a whole host of wonderful things that women do, running for Congress. And so anytime you have programs, being doctors like yourself, so anytime that we're shortchanging programs that support moms and families, that also means that we're shortchanging the progress that we can make in that's been a real challenge since the pandemic started. Cuts to child care, you know, sort of this downfall of the sort of child care industry has had a major impact on moms and women to the point that some women have decided to leave the workforce. They aren't able to support their families the way that they would like to. It's also been a challenge for young children who need that care and support so mom can work. And so all of these things are closely linked. And I think we need to continue

to center women in these conversations. So when programs don't work for our benefit, it has an impact on broader communities and the country as a whole. Yeah. You know, as you're talking about that, I just think of how COVID exposed so many of these issues and laid them bare in a way that we had just never seen before. But at the same time, with these issues came some solutions, right? So obviously, you're pointing to areas of improvement, things that we could have done, things that fell through the cracks. But from my understanding, what you're doing with WIC is a great example of seeing problems that were exposed during COVID

and making a new solution. And I'm specifically talking about the online shopping, right, with WIC. I'm wondering why that's happening, how it's happening, you know, how transformative will this be? Why did you guys decide that this was the moment now? Absolutely. So the WIC program has been around for almost 50 years. This program is evidence-based. We know that it helps and supports families with the nutritional support they need, and then just also to support their general health and well-being.

And so it's been such a centerpiece of this sort of broader social safety net that we have at our disposal to support particularly low-income families, women, and infants. And part of what we saw as a response to COVID was several innovations to the WIC program. And so, as you mentioned, online shopping is something that we continue to work on. This would ensure that families have the opportunity to use their WIC benefits to shop online for their grocery needs, which is amazing. But we've also seen remote certifications under the program. So before COVID, families had to come into the office physically to sign up for WIC or

talk to counselors and WIC staff about their benefits. And now they can do a lot of that online or through mobile applications, which is really great. But it needs to be something that's broad based across the country. We don't have it happening in all places and WIC is everywhere. So that's really important because there are so many reasons why online shopping and having these mobile applications and opportunities available to families makes sense. For one, it helps to reduce stigma that can be associated sometimes

with having to ask for help or making it easier if you're a working mom who is trying to fit in the opportunity to go into a clinic physically and sign up for WIC or go to the grocery store with her benefits. And so having online shopping also makes it more flexible for moms that need it. And then it's also an issue around equity and accessibility, right? And so we can make this available to all people. Granted, they must also have access to a smartphone and applications that they can use, which is another conversation as well. We know that some families, particularly those living in rural areas, may sometimes not have access to the tools that they need to access the internet. And so that's an important part of the conversation as well. I also want to add to

transportation continues to be an issue for many of our families. And so having to, you know, at least be able to have these tools in place to help support families that may be having challenges with having transportation to get to WIC clinics or even the grocery store is also important. So we are not there yet. We still have a lot of work to do to ensure that this is something that's broadly available across the country in WIC, but we are working hard to ensure that there's actually a proposed rule that was introduced not too long ago on WIC online shopping. And we're making sure that folks were weighing in with USDA and relevant government actors to ensure that that actually crosses the finish line. Then on our end and what we do at NWA, we'll be helping to support

our members to make sure they're rolling that out in an effective and smart way for families. I love that. What I'm hearing is that you're really targeting these non-medical drivers of health by rolling out what seems to be so simple, an online shopping program, but you're addressing so many needs, and I hope that it's duplicated and replicated in other spaces of health care. I have just a couple of questions left. And the first one that comes to mind is while we are trying to make deliberate change in policy and be more collaborative with the many advocates that are doing the work, especially when it comes to reproductive justice, the one thing I think gets left out is how do we make sure we give respectful care to

the people that are at the center of the narrative, which are these women, these children, these infants? How do we make sure that they are receiving respect, that they are valued, and that they are seen? I'm glad you asked that question because I was thinking before this conversation is over, I want to talk to physicians about what they could be doing, right? Because, you know, and obviously it's not just physicians. I don't want to put everything on positions. It's really everyone working in sort of the health sector and the healthcare workforce, everyone interfacing with patients, whether it's the front office people or the back

office people, paraprofessionals. And so I just want to say too, I think it's so important to center patients when it comes to their healthcare. For those of us that work in health equity and think about the best approaches to disparities. We know that it's not just about healthcare, right? There are these other issues and challenges that particularly the most vulnerable among us are grappling with. And just an acknowledgement that folks aren't only coming to you with that health condition or annually for a physical or a well woman checkup, right? There are other things happening in the background that are important contributors to that person's mental and physical health. And so I think

approaching patients with empathy and respect is important. Even something as simple as how you talk to someone or how you welcome them into your space is so essential. And then the other thing I want to mention too, is that there's a concept called cultural humility. And it's so important for us to think about in the context of the interaction between a patient and their healthcare provider, right? And part of that is recognizing that both the patient and provider, there should be a balanced approach to the power dynamics in that relationship. The healthcare provider is not up here and the patient down here, right? Really interacting in a way that shares the power in terms of that interaction, that conversation, the decision

making when it comes to a patient's health care. And I think that is an important place to start. I think because you sort of, we have historically had this sort of hierarchy when it comes to those interactions between patients and clients, particularly when it comes to people of color, interaction with the health care system that has led to a whole host of issues. And to me, that is the very essence of why there are times that patients don't feel valued in their interactions with the healthcare system or their providers. And so I think that power balance is important to address and deal with. And this place to start is really how you interact, you know, being welcoming and supportive, showing empathy to patients,

acknowledging some of the other factors that are important contributors to their health, I think is a place to start. Absolutely. That is so important. I just want to end on something that's a little bit more tangible. The next few years, we'll be seeing an election. And I'm curious how we can take all of that empathy that we want and expect from our health providers and all of the movement that we're expecting from our policymakers. What is realistic in the next few years? What can we actually get done to improve maternal health, to improve reproductive well-being, to make sure that we're achieving strides? Well, I think a realistic goal in the next three to five years is passing the Black Maternal Health

Momnibus. I mean, I think that that is real for us. And part of that is, you know, since you mentioned we have an election coming up, it is important for us to be educated on candidates before we go to vote. If issues around health equity and access to quality, affordable health care is important to you, you need to be thinking about that when it's time to select your representatives in Congress, local and state elected officials, obviously, as well as whoever you put into the White House. And so I think that is important because it really does matter. All of these decisions, right? We even had a conversation earlier about the Supreme Court. We know that we don't necessarily elect them, but the people that we elect appoint them

and put them in place. And so elections matter. And we have time, right, to do our due diligence and do our research and think through who we're putting into these coveted positions. You know, these folks work for us. Yes. So at the end of the day, we have the power. We have the power to decide what happens when a debt ceiling is looming. We have the power to decide how we address our maternal health crisis. We have the power to decide whether or not folks in our country have access to quality, affordable health care, whether or not families have access to fresh fruits and vegetables and the nutritional support they need. We have the power of all of these things. And so I think, yes, the momnibus is within reach. I think having the funding and support to support programs that matter to families is also in reach. And again, all of that is connected to who we elect to serve and lead us in this country. conversation reminding folks that we can level this playing field. Like you said at the beginning

of the conversation, this is not a hierarchy, right? Just because you're a provider, you're a politician, and you're a patient, it's not an up-down thing. We are all in it together. And voting is one way that you can show your power and show that you're making some sort of movement and change in maternal health and well-being. Well, I'm looking at the time, and I know that we're at the end of our hour together. I am so humbled to have been able to talk to you, to have learned from you. I want to say thank you and really love that you are using this leadership and improving the health and nutrition and well-being of women and their children all around the nation. And I'm really looking forward to learning from you again in

the future. Great. Thank you so much, Rachel. And, you know, the folks at The Dose for having me, really appreciate you all for having me. This episode of The Dose was produced by Jodi Becker, Mickey Kapper, and Naomi Leibowitz. Special thanks to Barry Scholl for editing, Jen Wilson and Rose Wong for art and design, and Paul Frame for web support. Our theme music is Arizona Moon by Blue Dot Sessions.

If you want to check us out online, visit the dose.show. There you'll be able to learn more about today's episode and explore other resources. That's it for The Dose. I'm Dr. Rachel Brevell. My brother, Joel, will be back with a new episode next week. Thank you for listening. Music