Racial Justice, Difference, and the Peer-to-Peer Model

by Rachel Abramson, Executive Director of HealthConnect One

I am a child of the sixties, and a Jew who takes seriously the prophetic challenge to pursue justice. But my connection to the struggle for racial justice has become more personal for me through my work in health care and in public health.

In the mid-1980’s, I was a 32-year old postpartum nurse, and I was a breastfeeding mother. I worked in a teaching hospital in Chicago, where the postpartum unit had private rooms, semi-private rooms (2 beds), and a couple of “Medicaid rooms,” larger spaces that contained 4 or 5 beds. Postpartum mothers in the Medicaid rooms were primarily women of color, and very few of them breastfed their babies. I was in love with the power of breastfeeding, in my own life and for the families I was caring for.

I was also a feminist, and believed that I had a connection with women everywhere. I had been trained as a nurse that if I had the right information, the right strategy, and cared enough about my patients, that they would take my advice. The implication was that if they didn’t take my advice, they were not compliant, or didn’t care about their own health.

I can see it as clearly as the day it happened. I was standing in the largest Medicaid room, with five African-American women who had just birthed their babies. I was trying my hardest to convince one of the women to try breastfeeding. I could see her face harden and her eyes shift away from me, and I could feel the sweat dripping down my sides. It felt as if there was an invisible wall between us. It didn’t matter how hard I tried, or how I shared my own experience, or how much I tried to connect with her. I was a white, middle-class nurse with a husband and a job and a mortgage, and she could not see herself in my eyes. I was not the right messenger to convince her that she could breastfeed her baby, that she could be successful, that she would feel happy and proud for trying. I was not the right messenger to share with her the health benefits of breastfeeding. We were different, and that difference mattered.

This experience altered the course of my life. This woman showed me the limits of my role as a health professional in such an intimate area of health decision making. Our conversation taught me respect for the power of race, ethnicity and difference in every interaction and slowly, my own limitations as a white health care provider began opening my eyes to the power of real peer-to-peer support.

HealthConnect One was founded on this principle – on the power of community health workers to support families during pregnancy, birth, breastfeeding, and early parenting. The intuitive, close connection that is possible with someone who looks like you, shares your experience, and understands your assumptions, is a powerful force for health and change.

Now, I join with others to integrate breastfeeding peer counselors, community-based doulas, and other community health workers into communities — and into the health care team — and to value their work with salary.

I have had the great fortune to know and partner with so many community health workers during my almost thirty years of work with HC One. They are some of the smartest, most courageous, most talented, and most committed people I’ve ever met. They are absolutely the right messengers for promoting breastfeeding, healthy births, and responsive parenting in underserved communities. HC One has found that breastfeeding peer counselors consistently achieve at least 80% breastfeeding rates – even in communities with breastfeeding rates as low as 2%.  Community-based doulas are found to significantly lower c-section rates, and to achieve breastfeeding duration and exclusivity rates that exceed the Healthy People 2020 goals for exclusive breastfeeding at 3 months and 6 months. I have seen these astounding health outcomes achieved in tremendously difficult circumstances.

I have also watched how society, the health care system, and other health care professionals disrespect these effective providers and devalue them because of their race and ethnicity, their income levels, or their lack of formal education and certifications.

Difference matters. Our differences are complex, and hard, and they make us strong. Difference is not the problem.

The problem is discrimination, exclusion and oppression on the basis of these differences. This problem, this injustice makes us sick — and I find myself more and more feeling sick about it. What feels good is to speak up about it, and to work to change it. So for my own health — as a white, Jewish, middle-class nurse — I struggle for racial justice.

 

Rachel Abramson is a master’s-prepared nurse and an International Board Certified Lactation Consultant.  She has provided leadership for HealthConnect One since 1986, for which she has received numerous awards – including APHA’s first Maternal and Child Health Outstanding Leadership and Advocacy Award (2009), the National Healthy Mothers, Healthy Babies State Impact Award (2003), and the Start Early: Learning Begins at Birth Award (2003) from Voices for Illinois Children.  She is co-author of The Community-based Doula: Reclaiming Birth, Empowering Families, published by Zero to Three Press in 2006. 

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