#UMNMCH student Haley Lipo Zovic (she/her/hers; MPH 2023) wrote this reflection on how her deployment with the Minnesota Prison Doula Project has not only influenced her academic work throughout her first year but also facilitated her MCH and social justice involvement outside of the classroom.

BACKGROUND

If you would have asked 18-year-old Haley what her 10-year plan was, she would have promptly and confidently answered: “first college and then right to medical school.” Younger me would have also included a Master of Public Health (MPH) somewhere in that journey, but it would never have been the end goal; it would have been a stepping stone to medical school MPH, the MD’s sidekick. Fast forward eight years, and here I am, starting my second year in the Maternal and Child Health (MCH) MPH program after having taken five years to finish undergrad and two years to work post-grad as a Bilingual Reproductive Healthcare Assistant at Planned Parenthood in Milwaukee. Over the last few years as a student, patient, advocate, and provider, I have become disenchanted with the medical system and am no longer interested in pursuing a medical degree. Instead, I plan to use my knowledge of and passion for public health to continue to learn about and address the sociopolitical determinants of health and the factors driving health inequities, particularly among marginalized pregnant populations. Although my plans have changed, I write this without a doubt in my mind that I am where I am supposed to be.

GETTING INVOLVED WITH THE MINNESOTA PRISON DOULA PROJECT
Shortly into the fall semester of 2021, a professor told me about MCH Program alumni (2016) and Center faculty member, Dr. Rebecca Shlafer, and her work as the Research Director for the Minnesota Prison Doula Project, a justice-oriented organization that provides pregnancy and parenting support to folks impacted by incarceration. I reached out to set up a time to talk with Dr. Shlafer about her work. During our conversation, her devotion to her research and work serving incarcerated populations inspired me, and I felt grateful for her willingness to share that work with me. What started as an informational interview ended as a deployment opportunity.

FOR CONTEXT – THE SURPRISING TRUTH ABOUT BEING PREGNANT IN PRISON
Compared to the general pregnant population, pregnant people experiencing incarceration are at a much higher risk of adverse pregnancy outcomes including low birthweight, preterm delivery, and stillbirth. This reflects what common sense would indicate: the heightened stress of being incarcerated while pregnant is not safe and does not improve birth outcomes. However, in a study that compared a group of pregnant people experiencing incarceration to a similarly marginalized group of non-incarcerated pregnant people, the authors found certain aspects of prison to be health-promoting for some high-risk pregnant people.  Marginalized pregnant populations are considered “high-risk” because of the barriers they often face to achieving positive pregnancy and birth outcomes, including but not limited to: economic and/or housing instability, lack of access to quality education, limited social support, chronic health conditions, substance use disorders, mental health issues, and experiences of racism, violence, and discrimination, These factors reflect the harmful implications the sociopolitical determinants of health have on marginalized populations, and are the same factors that put these populations at risk of incarceration in the first place. It is hypothesized that once incarcerated, these determinants decrease because people are placed in a more “stable” living environment, free from addictive drugs, away from violent partners, and where food and pregnancy-related care are “standard.” Unfortunately, the misunderstanding that prison is a protective factor for high-risk pregnant populations has justified punitive methods like incarceration as valuable strategies due to the collateral effect of forcing pregnant people to modify risky behaviors, thereby improving birth outcomes. But without sufficient health interventions and social services, punitive methods are bound to backfire when the same marginalized individuals return to the communities from which they came. The idea that incarceration may mitigate some of the risk of adverse pregnancy outcomes for some individuals by no means supports incarceration as a solution. Rather, it provides a unique and important opportunity for public health leaders to address the sociopolitical determinants of health to reduce the risk of incarceration and adverse birth outcomes among marginalized pregnant people.

BRIEF YET MEANINGFUL STUDENT DEPLOYMENT
Historically speaking, pregnant people affected by incarceration have been routinely stripped of their dignity, whether it is from being shackled during labor or from having their babies taken away from them just moments after delivery. Separating a new parent from their child immediately after birth has numerous short- and long-term adverse impacts on their mental well-being, physical development, and social well-being. In an effort to address and amend the inhumane reality of being pregnant in prison, the Healthy Start Act was enacted. This monumental piece of all-women sponsored legislation was recently signed into Minnesota law and allows pregnant people in prison to be released to community-based alternatives to incarceration for the duration of their pregnancy and for up to one-year postpartum. The overarching goals are to increase access to prenatal and postpartum care, reduce recidivism, improve parenting practices, enhance child wellbeing, and strengthen communities. But if prison offers high-risk pregnant people some level of ‘protection’ from environmental risk factors, then what changes must be made at the community level to ensure the goals of the Healthy Start Act are met and that the pregnant people are served in the way that is intended? Dr. Shlafer gave me the opportunity to conduct a rapid literature review about the resources and practices pertaining to improving birth outcomes among high-risk pregnant populations to answer this question. In my research, I included literature that specifically examined populations of lower socioeconomic status struggling with substance use. I categorized the results into three themes: medication assisted treatment for substance abuse and opioid use disorders, midwives as primary care providers, and group prenatal care. As brief as my time working for the MN Prison Doula Project may have been, this work has profoundly impacted my life and studies.

NOW WHAT?
Since submitting the literature review for the MN Prison Doula Project, I have continued my own research about pregnancy and the disparities our inequitable system inculcates; in PubH 6630, Foundations of MCH Leadership, I conducted a more exhaustive literature review on evidence-based practices that serve to improve birth outcomes of marginalized pregnant populations, and in PubH 6606, Children’s Health: Life Course and Equity Perspectives, I spent the semester looking into the Black-white disparity in low birthweight. The deeper I dive into these topics, the more frustrated I become. Even though there is plenty of data to suggest that social and environmental structures (e.g., racism, classism, ableism, etc.) play a large role in creating and perpetuating racial disparities, limited large-scale efforts exist to address these inequitable structures. At the same time, the deeper I dig, the more motivated I become to get involved with groups and organizations that are committed to equity and transformative justice.

​​BIOGRAPHY
Haley Lipo Zovic is a second-year Maternal and Child Health Master of Public Health student with minors in Sexual Health and Health Equity. She received her Bachelor of Science from the University of Wisconsin-Madison, where she majored in Spanish and minored in Global Health and Gender Studies. Since the completion of her deployment, Haley has started an internship with the Reproductive Health Alliance and is learning among an interdisciplinary team of fierce reproductive health leaders about what it takes to ensure access to high quality and equitable reproductive health care. She volunteers her time as a community health worker at the Phillips Neighborhood Clinic and also as one of the podcast editors for the Perspectives podcast, part of the U of M’s Public Health Review, where she and her co-editor explore different public health-related topics with experts from the field. As a member of Human Impact Partners’ Abolitionist Public Health Student Network, Haley is connecting with students and activists across the country to build capacity for abolition as a public health intervention. Aside from all things public health, Haley enjoys spending time doing crosswords, cooking with friends and family, and running along the river and around Minneapolis. What lies ahead post-MPH is uncertain, although Haley is committed to incorporating her MCH knowledge into whatever work she does in order to help create equitable solutions to reproductive health disparities and dismantle the oppressive societal structures creating such disparities.

REFERENCES

Jackson GL, Powers BJ, Chatterjee R, Bettger JP, Kemper AR, Hasselblad V, et al. Improving patient care. The patient-centered medical home. A systematic review. Ann Intern Med. 2013;158(3):169–78. 

Bronfenbrenner, U. (1974). Developmental research, public policy, and the ecology of childhood. Child development, 45(1), 1-5. 

McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377. https:/ doi.org/10.1177/109019818801500401 

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