To Tackle Reproductive Care Under Covid, These Providers Had to Think Bigger

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Photo credit: SOPA Images – Getty Images

Terri Lee-Johnson was a lactation consultant when she founded Birth Strides, a Memphis-based reproductive justice organization that works with expectant parents. She’s currently a doula and the organization’s co-executive director. Her goal is to serve her predominantly-Black clientele in a holistic manner—an aim that has become complicated in the aftermath of COVID-19.

“In every single aspect, we want to be community based,” she explains. “I'm including where we are located.” The clinic is currently based in a domestic residence. “We want to have a house [to operate from]. We don't want to be in a commercial space, because we don't want anything that reads institutional. [Black women are] in and out of enough institutions, especially during pregnancy. We want something that reads warm and homey.” Lee-Johnson continues, “It's a pop-in space for Black pregnant folks to come in. And, you know, if they're still pregnant, they can come in and just get a reprieve. They don't necessarily have to need something. This is, ‘Hey, I'm just popping in to hang out with y'all. What are y'all doing, or what are y’all watching?’ You know, we'll have a TV with Netflix hooked up and YouTube, where we can watch birth videos and things, and use that as a way to do some education and just, again, have people. I want to have a Crock-Pot going with some lentil soup.” Lee-Johnson’s vision acknowledges the need for support outside the birth room.

Reproductive health and justice organizations serving predominantly Black communities faced new challenges during the COVID pandemic as they tried to provide essential services such as family planning and maternity care to their clientele. Comprehensive health care for Black communities has always been difficult to access, but those obstacles were compounded during the pandemic. The need is there, but Dr. Jamila Perritt, president and CEO of Physicians for Reproductive Health, notes that “what has changed is the ease with which people can or cannot access that care.” For clients who lost employment during the pandemic, securing transportation to and from appointments became more complicated. Patients had to contend with a lack of childcare while planning to receive the health care they needed.

In order to be as useful as possible, reproductive health and justice organizations have had to expand the way in which they support their communities. For the women at the organizations I interviewed, part of providing compassionate health care is recognizing what Johnson has—that their work expands beyond the medical room and must be holistic.

Kwajelyn Jackson, executive director at Feminist Women’s Health Center in Atlanta, found that FWHC spent most of 2020 “being an emergency funding provider,” in addition to offering its usual services, which range from abortion care to comprehensive reproductive health care to civic engagement. This meant assisting clients with necessities such as rent, groceries, and transportation. “Being able to identify that need relatively quickly, fundraise, and then turn that money back around to put in people's pockets so that they can continue to eat and feed their families was really important, and is not the kind of typical work we've done. But we know it's a reproductive justice issue.” At Birth Strides, Lee-Johnson partnered with another local reproductive justice organization to provide clients in dire financial situations with gift cards to cover necessities. It is this ability to reframe and expand what comprehensive care means, particularly in a pandemic, that allows these people and organizations to effectively serve their clients and communities.

Neither FWHC nor Birth Strides suspended services at any point during the pandemic, which underlined just how essential their work is. FWHC’s clients are just over 50 percent Black. Jackson affirms that “abortion is essential work and it is urgent; it is time sensitive, and people need it even in a pandemic.” Birth Strides’ clientele is entirely Black and located in “zip codes that are most heavily affected by infant mortality'' in Tennessee, according to Lee-Johnson. While the work these organizations do is vital, Perritt notes that many of the “onerous restrictions that were disproportionately placed on health care providers and health care facilities that provide contraception and abortion care made it nearly impossible for folks to be able to get in to get the care that they needed.”

The United States is still dealing with the aftereffects of the Trump administration’s many efforts to eliminate reproductive rights access, but the women I spoke to observe that policies have not changed much since President Joe Biden took office in January. With the recent “bounty law” passed in Texas and the upcoming Supreme Court ruling on Roe v. Wade challenges, it can feel disorienting to understand how we got here. “I think it's important that we talk about the assaults on reproductive rights as a long-standing issue,” Perritt tells me. “Without question, the past administration has made the situation worse. We see that show up in the Supreme Court composition, which is going to have long-reaching effects and impacts on voters’ ability to access comprehensive reproductive health care, including abortion.” She continues, “There's a lot of work not just to undo what happened in the last four years, but what has been happening in this country for the last 40 years.”

Photo credit: Ira L. Black – Corbis – Getty Images

Jackson found that local policy was what affected her work most directly. “The state legislature is where we spend most of our energy, like tracking policy and following what's happening, because those are the places where the kinds of clinical compliance restrictions come from. Those are the places where some of the worst anti-abortion legislation come out,” she says. “So we want to make sure that folks are not just focused on, like, is abortion legal. But, what are the conditions that actually have to be in place in order for people to have more uncomplicated lives—that an abortion can be one part of that, but making sure that folks are looking at the bigger picture. As we're thinking about a reproductive justice lens, that's actually the frame.” This, Jackson explains, is the importance of a holistic framework when approaching reproductive justice. Focusing on eliminating restrictive laws is crucial, but it is just as important to make sure that the people who need to access these services most have support in all aspects of their lives.

There will always be a need for reproductive care, regardless of whether or not there is a pandemic. However, COVID did require a shift in their approaches to taking physical care of their clientele. For example, doulas at Birth Strides had to find ways to be supportive outside the hospital room. Because clients were allowed to have only one person with them as they were giving birth, and they often chose their partners, their doulas had to find creative ways to remain accessible during births. FWHC implemented tools such as forehead thermometers. Frontline staff at the organization also received hazard pay through June of this year in recognition of the risks involved in working in an environment that requires constant in-person interaction.

The tenacity and flexibility displayed by reproductive rights workers in places where they were absolutely indispensable during the pandemic highlighted their necessity. Reflecting on this, Perritt says, “COVID did not create these inequities in access to care. The only thing that it did was really show us so clearly where our fault lines are. My hope is that it'll be a lesson for us to be able to move forward in a way that is going to be more comprehensive, more inclusive, and more supportive of folks who need to access this care.” Services such as mutual aid show that these organizations are thinking of ways to set up their clients for long-term success, and the lessons learned in this pandemic have informed their approach to supporting their clients in the future.

Perritt left me with one more thought: “I think that if you talk with anyone who cares for communities that have been historically left out of traditional structures, what COVID has done is really just told us what we already knew. We knew that there were faults in the system, we knew our communities weren't being served, we knew that we weren't having access to care.” In the work of these organizations, however, Black reproductive health care providers are showing what concrete changes can happen when they challenge current and imagine new systems.

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