While many decisions about women’s health are determined at the state or federal level, cities have unique opportunities to dramatically impact women’s access to health care as well as the social and physical determinants of their health. The everyday stressors of life have been shown to play a huge role on a woman’s long-term health, especially during their most vulnerable periods of life, such as during pregnancy. These everyday stressors are further compounded for women of color, who also face the tangible health impacts of racism.
Some of the social determinants that cities control that tend to disproportionately impact women include:
- access to reliable, efficient public transportation to attend medical appointments, especially during pregnancy;
- protection from and prevention of intimate partner violence;
- access to health care and the prevention of hospital/health care deserts
- support in navigating the complex health care system, including Medicare/Medicaid services
Additionally, empowering women to make their own reproductive choices has a foundational impact in setting the overall direction for their lives. Ensuring culturally appropriate education around reproductive health also serves as a huge opportunity for cities.
What Cities Can Do
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Unintended Teen Pregnancy
While many cities and school districts provide some form of pregnancy prevention resources, some cities are leading a new wave of culturally competent education campaigns that recognize the need to respect personal body autonomy. New York City’s “Maybe the IUD” campaign aims to increase awareness around long-acting reversible contraceptives (LARC’s), while still respecting a woman’s right to decide whether to prevent pregnancies or when to give birth and parent children.
Detroit, MI offers another example of this through the health department’s iDecide Detroit initiative, a comprehensive effort aimed at reducing unintended teen pregnancy with an emphasis on empowering teens to take charge of their own lives and future.
Crisis Pregnancy Centers
Hartford, CT is one of the only cities in the country to take the proactive step of regulating crisis pregnancy centers (CPCs). Their ordinance requires better signage that indicates whether medically licensed staff is on site and also bans deceptive advertising practices. Some pregnant women seeking reproductive healthcare face the dangerously misleading influence of crisis pregnancy centers (CPCs). The majority of these centers have no licensed medical providers onsite and aim to promote only non-abortion options to their clients, even when that results in providing medically inaccurate information to pregnant women about their health.
Intimate Partner Violence
To address intimate partner violence, Milwaukee, WI has established under one roof a one-of-a-kind partnership between the City, local service providers and non-profits, Children’s Hospital of Wisconsin, Milwaukee Public Schools, the Milwaukee Police Department’s Sensitive Crimes Unit and the district attorney’s office, among others.
Comprehensive & Interdisciplinary Approaches
Prioritizing equity in transportation is a key factor in protecting women’s health, as getting to and from doctor appointments proves incredibly difficult for many low-income pregnant women, in particular. Columbus, OH recently launched the Prenatal Trip Assistance project, making it easier for pregnant women and new mothers to get to appointments.
New York City also leads the charge on a number of other issues, from menstrual equity (promoting access to menstrual products) to improving Black maternal mortality rates, and many of their programs offer scalable models for smaller cities.