What Support for Women and Families Really Looks Like

JOEL BERVELL: Hey everyone. Welcome back to The Dose. My name’s Joel Bervell, and I’m super excited today to have a special guest host — my own sister, Dr. Rachel Bervell.

Rachel, I haven’t seen you in like two months.

RACHEL BERVELL: I know. Hi. Thank you for having me, Joel. It’s really nice to see you, obviously cuz you’re my baby brother, but also because we get to talk about something we both love.

JOEL BERVELL: Yeah. I think back to when I kind of first started my social media channel and talked through racial biases in medicine. And, I don’t know if you remember this, but I was home over winter break and I came over to your room, and we started just kind of listing out all these different disparities and biases that we both witnessed at our different levels: you being a resident, and then me being kind of just starting out in medical school. And I think now it’s full circle to bring it back here.

RACHEL BERVELL: Absolutely. And it’s funny because now I see it everywhere I go.

JOEL BERVELL: I’m so excited for you to be on this show because I couldn’t think of a better person to be a host. And being a little brother, I gotta brag a little bit about you. You’ve done so much within the space of reproductive health already. You coproduced a podcast with Johns Hopkins, “Public Health On Call,” about the black maternal health crisis. That was incredible. You run a black ob/gyn Instagram page, and even the National Medical Association recognized you as a top physician under 40.

So, I’m so excited for you to be hosting this episode, but can you tell us who you’re bringing on the show today?

RACHEL BERVELL: So my guest today is Dr. Jamila Taylor. She is the president and CEO of the National WIC Association, and she supports the interests of the Special Supplemental Nutrition Program for Women, Infants, and Children here in the United States. That’s the nutritional voice for over 6.3 million mothers, children, and infants.

JOEL BERVELL: She sounds amazing. I’m so excited to hear your conversation with Dr. Taylor.

RACHEL BERVELL: Absolutely. So let’s get into it. And here’s a little bit of context before we do: Right now, the United States has one of the highest maternal mortality rates among developed countries, and the gaps continue to widen. The Centers for Disease Control and Prevention reported last fall that 80 percent of maternal deaths are preventable, and that’s despite medical advances in technology and health care. Plus, racial and ethnic disparities persist. This past year, the challenges for women of reproductive age around fertility choice, food security for families, have all only become more urgent, and the problems are complex. I wanted to know and to share with you all the insights of Dr. Taylor. Where do we go and where do we begin to fix this? To dismantle the structural barriers preventing women and especially women of color from quality care. That’s why I invited her to join me for this conversation because she is doing the work.

Dr. Taylor, thank you so much for joining me today.

JAMILA TAYLOR: Thank you so much for having me.

RACHEL BERVELL: I have been really excited to talk to you for a lot of different reasons, but first on my mind, a couple weeks ago, the Biden administration and Congress prevented the country from defaulting on its debt obligations. I am curious though. What will be the impact on women and children? How did the relevant appropriations fare in the resolution of the debt crisis?

JAMILA TAYLOR: Well, first and foremost, I think I want to acknowledge the important work that had to happen behind the scenes to get a compromise across the finish line in the first place. I will say that from the perspective of the Special Supplemental Nutrition Program for Women, Infants and Children — WIC — which is what we focus on here at the National WIC Association. We are concerned about the spending caps that were included as part of the plan.

What we’re anticipating is that due to those spending caps, we could see a shortfall in the services that we are able to ensure families that are part of the WIC program. This could translate into waiting lists, something that we haven’t seen in over three decades as part of the WIC program. We could see cuts to the fruit and vegetable benefits that families are enjoying as part of the program right now.

It could also lead to a whole host of other challenges, particularly for our members who represent WIC staff from across the country. Folks who are so dedicated to this program and the families we serve, and the ability to ensure that they have nutrition and supports that they need, including access to health care referrals, infant formula, a whole host of other supports.

What needs to happen now, is that it’s going to be incumbent upon appropriators in Congress to think through what those allocations are going to look like within those spending limits, right?

RACHEL BERVELL: Absolutely. When I hear about money at the federal level, I got worried that things aren’t being put to the populations and the demographics that need it the most. This is one of those examples of that, where you have Congress really changing what happens for populations that are in an area of need.

But Congress is doing something right now that’s really exciting. That is from the Black Maternal Health Caucus in the form of the Momnibus, which we know was introduced by Congresswoman Alma Adams, as well as Congresswoman Lauren Underwood.

I’m curious how the new debt ceiling resolution is departing from some of the proposals that were put forward in the Momnibus. What makes the Momnibus different than what you were trying to do with WIC through the other funding?

JAMILA TAYLOR: Well, I think the Momnibus is such an important tool in how we think about the Black maternal health crisis as a whole. It is a comprehensive package of bills that really aim to address almost every dimension of the Black maternal health crisis in this country, so everything from nutrition . . . you know, WIC is an essential piece of the Black Maternal Health Momnibus. There’s a bill that is focused on ensuring that postpartum eligibility as part of the WIC program extends from six months to two years, which would be so important for our families and support the continuum of nutritional support, but also access to important health care services. That’s one piece.

But the Momnibus also works to address issues like the climate impacts on the maternal health crisis, ensuring that moms have access to vaccinations. The social determinants of health, which is really important as we think through and ground the conversation around health disparities in this country. And particularly, what the most vulnerable families need in order to make sure they have the support.

A lot of the conversation around health care centers on things like insurance coverage and even access to services, which we know is really important in the context of these conversations. But so are things like access to safe, affordable housing, access to transportation. The Momnibus is really this comprehensive approach to what we need to ensure that Black families as well as other families that may be impacted by poor maternal and infant health outcomes have what they need.

The Momnibus is broader in its approach than some of what we’re seeing through these funding conversations, but also intricately linked. Because this is an authorizing piece of legislation, whereas the funding bill makes sure that we have the funding to be able to implement programs like those that are in the Momnibus, and so they’re closely linked together. But at the same time, when we’re in a situation where we’re, in some ways, having to shortchange the most vulnerable families in our country, that puts us in a hard position when it’s time to implement programs that are comprehensive in nature.

One more thing that I want to add too, as someone who has worked in Washington for decades, including a long stint on Capitol Hill. One of the things that baffles me is that whenever we’re in a situation where we have to think closely about how we’re funding programs and having to make some concessions, the concessions always lie with the programs that are serving the most vulnerable families.

Why do we go to those programs first when it’s time to make cuts or rethink how we’re funding programs across this country? That is something that continues to quite frankly concern me because those are the very families that need the most support in challenging times. But those essential programs are always the first to be on the chopping block. That’s something that we really need to change in our approach to funding, supporting the programs that vulnerable families need.

RACHEL BERVELL: I’m curious, what can we do to stop that?

JAMILA TAYLOR: Well, first off, I think it’s important to recognize that we need leaders in place that care about these programs and these families, and they actually center these programs and families and how they do their lawmaking, how they think through the decisions they’re making in Washington or in any other government center across the country. I think that’s the first thing.

Then I also think too, that we need to continue to think through how these decisions have impacts on broader communities, our economy. We know that women drive this economy. There’s no question about that. Whether we’re stay-at-home moms, helping to support our families in the boardroom, running universities, a whole host of wonderful things that women do, running for Congress.

RACHEL BERVELL: Say that again, right?

JAMILA TAYLOR: Being doctors like yourself. Anytime that we’re shortchanging programs that support moms and families, that also means that we’re shortchanging the progress that we can make in our economy as a whole. Even when we think about issues around the childcare crisis, which is also something that’s looming and that’s been a real challenge since the pandemic started.

Cuts to childcare, this downfall of the childcare industry, has had a major impact on moms and women to the point that some women have decided to leave the workforce. They aren’t able to support their families the way that they would like to. It’s also been a challenge for young children who need that care and support so mom can work.

All of these things are closely linked, and I think we need to continue to center women in these conversations. So when programs don’t work for our benefit, it has an impact on broader communities and the country as a whole.

RACHEL BERVELL: Yeah. As you’re talking about that, I just think of how COVID exposed so many of these issues and laid them bare in a way that we had just never seen before. But at the same time, with these issues came some solutions. Obviously, you’re pointing to areas of improvement, things that we could have done, things that fell through the cracks.

But from my understanding, what you’re doing with WIC is a great example of seeing problems that were exposed during COVID and making a new solution. I’m specifically talking about the online shopping with WIC. I’m wondering why that’s happening, how it’s happening. How transformative will this be? Why did you guys decide that this was the moment now?

JAMILA TAYLOR: Absolutely. The WIC program has been around for almost 50 years. This program is evidence-based. We know that it helps and supports families with the nutritional support they need, and that just also to support their general health and well-being. It’s been such a centerpiece of this broader social safety net that we have at our disposal to support particularly low-income families, women, and infants. Part of what we saw as a response to COVID was several innovations to the WIC program.

As you mentioned, online shopping is something that we continue to work on. This would ensure that families have the opportunity to use their WIC benefits to shop online for their grocery needs, which is amazing. But we’ve also seen remote certifications under the program. Before COVID, families had to come into the office physically to sign up for WIC or talk to counselors and WIC staff about their benefits. Now they can do a lot of that online or through mobile applications, which is really great, but it needs to be something that’s broad based across the country.

We don’t have it happening in all places and WIC is everywhere. That’s really important because there are so many reasons why online shopping and having these mobile applications and opportunities available to families make sense. For one, it helps to reduce stigma that can be associated sometimes with having to ask for help. Or making it easier if you’re a working mom who is trying to fit in the opportunity to go into a clinic physically and sign up for WIC, or go to the grocery store with her benefits. Having online shopping also makes it more flexible for moms that need it.

Then it’s also an issue around equity and accessibility, if we can make this available to all people. Granted, they must also have access to a smartphone and applications that they can use, which is another conversation as well. We know that some families, particularly those living in rural areas, may sometimes not have access to the tools that they need to access the internet. That’s an important part of the conversation as well. I also want to add too, transportation continues to be an issue for many of our families.

Having to at least be able to have these tools in place to help support families that may be having challenges, with having transportation to get to WIC clinics or even the grocery store is also important. We are not there yet. We still have a lot of work to do to ensure that this is something that’s broadly available across the country in WIC. But we are working hard to ensure that there’s actually a proposed rule that was introduced not too long ago on WIC online shopping.

We’re making sure that folks were weighing in with USDA and relevant government actors to ensure that that actually crosses the finish line. Then on our end and what we do at NWA, we’ll be helping to support our members to make sure they’re rolling that out in an effective and smart way for families.

RACHEL BERVELL: I love that. What I’m hearing is that you’re really targeting these nonmedical drivers of health by rolling out what seems to be so simple, an online shopping program, but you’re addressing so many needs. I hope that it’s duplicated and replicated in other spaces of health care.

I have just a couple questions left. The first one that comes to mind is: While we are trying to make deliberate change in policy and be more collaborative with the many advocates that are doing the work, especially when it comes to reproductive justice, the one thing I think gets left out is how do we make sure we give respectful care to the people that are at the center of the narrative, which are these women, these children, these infants? How do we make sure that they are receiving respect, that they are valued, and that they are seen?

JAMILA TAYLOR: I’m glad you asked that question because I was thinking before this conversation is over, I want to talk to physicians about what they could be doing. Obviously, it’s not just physicians, I don’t want to put everything on physicians. It’s really everyone working in the health sector and the health care workforce, everyone interfacing with patients, whether it’s the front-office people or the back-office people, paraprofessionals.

I just want to say too, I think it’s so important to center patients when it comes to their health care. For those of us that work in health equity and think about the best approaches to disparities, we know that it’s not just about health care. There are these other issues and challenges that particularly the most vulnerable among us are grappling with.

Just an acknowledgement that folks aren’t only coming to you with that health condition, or annually for a physical or a well-woman checkup. There are other things happening in the background that are important contributors to that person’s mental and physical health. I think approaching patients with empathy and respect is important. Even something as simple as how you talk to someone or how you welcome them into your space is so essential.

Then the other thing I want to mention too, is that there is a concept called cultural humility. It’s so important for us to think about in the context of the interaction between a patient and their health care provider. Part of that is recognizing that both the patient and provider, there should be a balanced approach to the power dynamics in that relationship. The health care provider is not up here and the patient down here. Really interacting in a way that shares the power in terms of that interaction, that conversation, the decision making when it comes to a patient’s health care.

I think that is an important place to start, I think because we have historically had this hierarchy when it comes to those interactions between patients and clients, particularly when it comes to people of color interacting with the health care system. That has led to a whole host of issues. To me that is a very essence of why there are times that patients don’t feel valued in their interactions with the health care system or their providers.

I think that power balance is important to address and deal with. This place to start is really how you interact, being welcoming and supportive, showing empathy to patients. Acknowledging some of the other factors that are important contributors to their health, I think, is a place to start.

RACHEL BERVELL: Absolutely. That is so important. I just want to end on something that’s a little bit more tangible. The next few years we’ll be seeing an election. I’m curious how we can take all of that empathy that we want and expect from our health providers, and all of the movement that we’re expecting from our policymakers. What is realistic in the next few years? What can we actually get done to improve maternal health, to improve reproductive well-being, to make sure that we’re achieving strides?

JAMILA TAYLOR: Well, I think a realistic goal in the next three to five years is passing the Black Maternal Health Momnibus. I think that that is real for us. Part of that is, since you mentioned we have an election coming up, it is important for us to be educated on candidates before we go to vote.

If issues around health equity and access to quality, affordable health care, is important to you, you need to be thinking about that when it’s time to select your representatives in Congress, local and state elected officials. Obviously, as well as whoever you put into the White House. I think that is important because it really does matter, all of these decisions. We even had a conversation earlier about the Supreme Court.

We know that we don’t necessarily elect them, but the people that we elect appoint them and put them in place. Elections matter and we have time to do our due diligence and do our research, and think through who we’re putting into these coveted positions. These folks work for us.

RACHEL BERVELL: Yes.

JAMILA TAYLOR: At the end of the day, we have the power. We have the power to decide what happens when a debt ceiling is looming. We have the power to decide how we address our maternal health crisis. We have the power to decide whether or not folks in our country have access to quality, affordable health care. Whether or not families have access to fresh fruits and vegetables and the nutritional support they need. We have the power for of all of these things.

I think, yes, the Momnibus is within reach. I think having the funding and support to support programs that matter to families is also in reach. Again, all of that is connected to who we elect to serve and lead us in this country.

RACHEL BERVELL: Absolutely. What I love is that you just ended our conversation reminding folks that we can level this playing field. Like you said at the beginning of the conversation, this is not a hierarchy. Just because you’re a provider, you’re a politician, and you’re a patient, it’s not an up-down thing. We are all in it together, and voting is one way that you can show your power. Show that you’re making some movement and change in maternal health and well-being.

Well, I’m looking at the time and I know that we’re at the end of our hour together. I am so humbled to have been able to talk to you, to have learned from you. I want to say thank you and really love that you are using this leadership and improving the health and nutrition and well-being of women and their children all around the nation. I’m really looking forward to learning from you again in the future.

JAMILA TAYLOR: Great. Thank you so much, Rachel, and the folks at The Dose for having me, but really appreciate you all for having me.

RACHEL BERVELL: This episode of The Dose was produced by Jody Becker, Mickey Capper, and Naomi Leibowitz. Special thanks to Barry Scholl for editing, Jen Wilson and Rose Wong for art and design, and Paul Frame for web support. Our theme music is “Arizona Moon” by Blue Dot Sessions. If you want to check us out online, visit thedose.show. There you’ll be able to learn more about today’s episode and explore other resources. That’s it for The Dose. I’m Dr. Rachel Bervell. My brother, Joel, will be back with a new episode next week. Thank you for listening.