President Obama spoke this month to the Urban and Metropolitan Policy Roundtable. His remarks focused on economic revitalization of metropolitan areas, but also touched on health in these communities. With many reproductive health indicators, residents in urban areas experience worse reproductive health outcomes compared to the national average. AIDS incidence rates in cities are twice that of the national average. Rates of infant mortality, babies born of low-birth weight, unintended pregnancy, and the percentage of teenage mothers are also higher in large cities, especially among low-income women. The President noted in his remarks that, “Instead of waiting for Washington, a lot of cities have already gone ahead and become their own laboratories for change and innovation, some leading the world in coming up with new ways to solve the problems of our time.” I agree with the President and think he might be onto some rich common ground here.
During the George W. Bush administration, for reproductive rights advocates, the fight was not about common ground, but losing ground. Many state legislatures, emboldened with resources and priorities set by the federal government, blocked pro-choice legislation and pursued a legislative agenda that included “fetal personhood” initiatives, abstinence-only education policies, and mandatory delay and biased counseling requirements for abortion procedures. Meanwhile, against this state and national backdrop, in cities and counties across the country, local advocates and elected officials were (and still are) working together to improve reproductive health programs and policies on a new common ground: their own backyards.
Rather than focusing on the broad ideological debates, local officials on both sides of the abortion issue have found common ground by responding to the needs they see every day in their communities. Along the way, they have improved not only the reproductive health but the overall health and potentially the economic outlook for the people they represent. The Urban Initiative for Reproductive Health, a project of the National Institute for Reproductive Health, is a multi-year initiative to create and promote real policy solutions to address the reproductive health challenges facing cities today. Some examples include:
• Cuyahoga County leaders provided support for the Cleveland Metropolitan School District to institute a comprehensive sex education program which provides information about abstinence and safe sex andis showing results;
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• New York City provides free emergency contraception and NYC branded condoms and has modernized care for women facing miscarriage as well as the training physicians receive in miscarriage management;
• Based on the recommendations of the Mayor’s Task Force, the Boston Public Health Commission, through its Center for Health Equity and Social Justice, has invested in over 50 community and health institutions addressing reproductive health;
• Pittsburgh passed strong local buffer zone legislation to protect clinic staff and patients from aggressive protesting;
• Denver created a public-private partnership to offer a pregnancy prevention program targeting youth and their families;
• Los Angeles County has launched an innovative home based STI testing program to address rising rates of Chlamydia and gonorrhea among young women.
How have these localities been successful in creating reproductive health policies around common goals? In our Urban Initiative work, we have found that there are many committed, progressive, pro-family planning elected and public health officials who have the political will and influence to improve the health of families living in their municipalities. Local officials are often more accessible and more accountable to the communities they represent than state or federal officials. Constituents are more likely to have access to their City Council member, and be heard (as we have done) than their State rep. In addition, because the reproductive health challenges facing individuals in urban settings are so inextricably linked to other social inequities, there is a great opportunity to work across different movements and issue areas to find common ground solutions and to create a stronger, more diverse coalition dedicated to improving the reproductive health of urban communities. Working locally also allows for targeted interventions at the community level to provide tailored resources and support where they are needed most.
The quickest route to common ground is where the interest isn’t to debate whether abortion is right or wrong but to take action on issues that affect us most. The most effective common ground is when communities come together to prevent teen pregnancy, stop the spread of HIV and STIs, provide pre-natal care and reduce infant and maternal mortality, eliminate environmental toxins, address racial and ethnic health disparities, and improve care for low-income families who are disproportionately lacking healthcare access. This common ground starts where we all live, where the grassroots work takes place, where all politics is local. These innovative efforts are continuing, even in the midst of the current economic crisis, and I encourage the Obama Administration to consider the role cities and counties can play in doing the real common ground work on reproductive health. The President’s recently created Office of Urban Affairs has the potential to spearhead these efforts to improve the health of our cities.
In addition to investment through the stimulus, other forms of investment in local areas could have an enormous impact on reducing reproductive health disparities and ensuring access. A share of the Federal money being allocated for comprehensive sexuality education could be given to urban cities and counties, instead of just to states. In this way, cities and counties can create local models that can be tested and evaluated, and those most effective can be replicated nationally. Cities can be, as the President said, incubators or “laboratories” for change. And, also, for common ground.
For more information on the Urban Initiative for Reproductive Health, please visit www.urbaninitiative.org
Thanks to Emily Alexander and Angela Hooton who contributed to this article.