Journal of midwifery & women's health最新文献

Unintentional overdose is a leading driver of maternal death in Colorado. The high volume of maternal deaths from preventable causes lends questions to failures in our clinical and community-based care for pregnant and postpartum people. The Colorado Maternal Mortality Review Committee identified 3 main contributors including stigma in the community and health care system, fragmentation of the health care system, and the need for more clinician training. The Colorado Perinatal Care Quality Collaborative led a 3-pronged intervention to address these challenges and improve perinatal care. The first intervention, the Colorado Alliance for Innovation on Maternal Health Substance Use Disorder quality improvement initiative, partnered with birthing hospitals statewide to institute universal screening and timely referral for individuals at risk of substance use disorder (SUD) and perinatal mood and anxiety disorders. The second intervention, the Improve Perinatal Access, Coordination, and Treatment for Behavioral Health initiative, established a perinatal support network within communities. This program assists individuals with SUD, perinatal mood and anxiety disorders, or social needs to navigate the perinatal period. The third intervention, the Colorado Maternal Overdose Matters Plus program, has enhanced in-hospital access to pharmacotherapy for pregnant and postpartum individuals with SUD through training and technical support. These collaborative initiatives aim to minimize barriers to care by integrating inpatient screening, treatment referrals, pharmacotherapy access, and community care support to mitigate maternal mortality in Colorado.

The language we choose in scholarly writing in describing the populations we serve is of utmost importance. As such, thoughtful attention to these choices depicts our respect, concern, and care. However, language can also reveal implicit and explicit biases, even when unintended. The Journal of Midwifery & Women's Health (JMWH) editors acknowledge past harms due to unintended implicit biases. Through our process of ongoing review, JMWH continues our aim of respectful and inclusive language ^1-3 and to adapting our style as approaches to language evolve.

The JMWH approach to inclusive language is based on 3 principles: (1) respectful language is a necessary condition for inclusivity; (2) identities such as gender, race, and ethnicity are socially constructed; and (3) inclusive language should be specific and accurate. In combination, these principles help guide authors and editors to consistently use inclusive language in their writing.

Authors must be transparent in how gender, race, ethnicity, and other descriptors are defined within their scholarly work and who contributed to the decision-making process. As socially constructed descriptors, there is no absolute way to categorize people, nor should there be.⁴ Allowing research participants to self-identify shifts the decision-making process and helps address the inherent complexity in describing participants.

JMWH adheres to the American Medical Association's Manual of Style (eleventh edition)⁵ unless specific differences are identified in the JMWH Manuscript Preparation and Style Guide.⁶ The American Psychological Association Inclusive Language Guide is another good resource and provides recent advances in language use with careful explanations.⁷ Additional guides are available to authors, including the GLAAD Media Reference Guide⁸ and the Coalition for Diversity & Inclusion in Scholarly Communication Guidelines on Inclusive Language and Images in Scholarly Communication.⁹ Our goal as editors is to support language that allows individuals and groups to choose how they prefer to be identified, while understanding that language use is dynamic and not everyone will always agree.

The evolution of gender identity language is a prime example of the importance of staying abreast of rapidly changing demographic descriptors in research and scholarly writing. Systematic reviews and other types of evidence syntheses often include studies where researchers assumed participants identified as cis-gender women, thus excluding pregnancy-capable individuals whose gender identity is not female. Likewise, research projects have not always sought nonbinary participants outside of the traditional cis-normative boundaries. In response, JMWH authors have begun to include disclosure s

Improving health and achieving health equity includes access to sexual and reproductive health care for all populations, especially those most in need. However, access to life-saving and life-affirming contraception with an individual's chosen perinatal provider can be impeded by restrictive regulations that limit scope and practice authority. This is especially true for the majority of community and direct entry midwives in the United States who have historically been unable to legally provide effective contraceptive methods. Recently, licensed midwives in Washington state were the first in the nation to achieve prescriptive authority, enabling their clients to directly obtain contraception and access to medications for common prenatal and postpartum conditions. Sustained advocacy efforts in the state's capitol enabled the Midwives’ Association of Washington State to build relationships over time with legislators and government agencies to achieve this long-term goal. We present a successful midwifery-led innovation that achieved scope expansion for licensed midwives whose practice authority was limited by restrictive laws. Lessons learned are described and strategies offered to aid midwives and their advocates in other locales who want to improve health equity and access to contraception. Midwives are well positioned to provide this essential care to individuals living in underserved rural and urban areas and those from historically marginalized communities, but their ability to do so is limited by restrictive legislation.