SUBJECT
Title
CREATE A UNIT DEDICATED TO REPRODUCTIVE HEALTH, JUSTICE AND EQUITY (DISTRICTS: ALL)
Body
OVERVIEW
California and the County of San Diego (County) are leaders on reproductive health care rights. The County Health and Human Services Agency (HHSA), in collaboration with committed community members, local organizations, and State and federal partners, plays an important role in supporting access to critical health care services through a fully optimized health and social service delivery system. This includes supporting access to reproductive health services.
While pregnancy and maternal care are vital aspects of reproductive health, they are not its only components. Reproductive health includes: family planning, fertility services, sexual health services, menstrual health, gynecological care, gender-affirming care, prevention and treatment of gender-based violence, reproductive cancer screening and treatment, and education and counseling. These elements collectively address the diverse needs of individuals across different stages of life and gender identity, ensuring access to essential care and support. Together, these services reflect a holistic approach, promoting equity, health, and well-being for all individuals.
Reproductive justice emphasizes the social, economic, and political conditions necessary for all individuals to have the ability to make decisions about their bodies, families, and communities. It recognizes that reproductive rights alone often do not address the broader systemic inequities that impact people’s reproductive lives.
In 2022, the U.S. Supreme Court directly attacked reproductive justice by overturning Roe v. Wade. The decision resulted in states throughout the nation placing strict restrictions on abortion health care services, with some banning abortion services entirely. The overturning of Roe v. Wade has had severe consequences for individuals seeking lifesaving reproductive health care services.
In addition to the recent restrictions on abortion related health care services, the United States is currently facing a maternal mortality crisis. The United States maternal mortality rate continues to exceed rates of other high-income nations. The World Health Organization defines a maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” Native Hawaiian and Pacific Islander, Black, and American Indian and Alaska Native women have the highest rates of pregnancy-related death. Persistent inequities in health care are a major factor in why Black women in the United States are by far the most likely to die from pregnancy or childbirth.
On May 24, 2022 (24), the San Diego County Board of Supervisors directed staff to conduct a comprehensive assessment (Assessment) of reproductive health care services offered by County and County heath contractors, including: barriers to care; opportunities to optimize these services; expanding partnerships with providers; and identifying opportunities to address and reduce health disparities for marginalized communities by advocating for regulatory, budgetary, and legislative efforts that strengthen access to reproductive rights and health care services, including abortion.
The Assessment focused on prevention, identification, and treatment of pregnancies that are unintended, undesired, non-viable, and/or a threat to the pregnant person’s health. To complete the Assessment, staff held workgroup meetings and in-depth interviews with County department representatives to collect information on the aspects of reproductive health addressed in their programs. Staff also reviewed literature to identify evidence-based practices to support increasing access to services.
The Assessment found that while many programs and social services are available from the County and from community reproductive health service providers, conducting training to support County staff in discussing reproductive care options with patients and updating procedures focused on person-centered referral pathways are recommended to ensure people can connect with these important services.
A unit within the County dedicated to reproductive health, a unit within the County dedicated to reproductive health ensures comprehensive, accessible, and equitable care for our communities and will strengthen connections to person-centered reproductive health care services and related resources in San Diego County. The unit could serve as a centralized hub for coordinating reproductive health care resources and addressing the unique needs of the community through targeted programs and outreach. It could also advocate for policies that improve access to care, support education on reproductive health issues, and facilitate collaboration among local organizations. By focusing on reproductive health, we can reduce disparities in care, promote preventive measures, and provide essential resources for family planning, sexual health, and gender-affirming services. A dedicated unit ensures that reproductive health remains a priority, leading to better health outcomes and a more informed, empowered community.
Today’s action authorizes staff to create a unit within the County of San Diego Health and Human Services Agency dedicated to reproductive health, justice, and equity, and seek grant and other funding opportunities to support the expansion of reproductive health efforts, during the Fiscal Year 2025-26 Operational Planning process.
RECOMMENDATION(S)
CHAIRWOMAN NORA VARGAS
1. Direct the Chief Administrative Officer (CAO), during the Fiscal Year 2025-26 Operational Planning process, to create a unit within the County of San Diego Health and Human Services Agency, dedicated to reproductive health, justice, and equity, to serve as a centralized hub to coordinate reproductive health care resources, address the unique needs of the community through targeted programs and outreach, advocate for policies that improve access to care, support education on reproductive health issues, and facilitate collaboration among local organizations.
2. Authorize the Agency Director, Health and Human Services Agency, or designee, to apply for additional funding opportunities to support reproductive health efforts.
EQUITY IMPACT STATEMENT
Black and Latina women experience higher rates of maternal mortality and severe maternal morbidity compared to white women. Specifically, Black women in San Diego face a maternal mortality rate that is 2.5 times higher than their white counterparts. Approximately 20% of low-income women of childbearing age lack access to necessary reproductive health services, including family planning and prenatal care. Nearly 25% of transgender and non-binary individuals report difficulties in accessing gender-affirming care due to lack of providers and financial barriers. Today’s action represents a transformative step towards advancing equity in reproductive health care. Having an office dedicated to reproductive health, we ca identify, target, and address disparities faced by marginalized communities, including communities of color, low-income individuals, and LGBTQ+ populations.
SUSTAINABILITY IMPACT STATEMENT
Today’s action aligns with the County of San Diego sustainability goals for providing just and equitable access to County services and engaging the community to develop communications and engagement strategies that include language and cultural considerations to ensure equitable access and participation.
FISCAL IMPACT
There is no fiscal impact based on these recommendations at this time, although it may result in future fiscal impacts. Resource needs will be considered in the exploration of creation of a unit within the Health and Human Services Agency, dedicated to reproductive health, justice, and equity to serve as a centralized hub. The costs and funding sources associated with the establishment of a unit will be explored during the Fiscal Year 2025-26 Operational Planning process for budgetary consideration. Depending on the results, there may be additional staff years and a net General Fund cost. Any new General Fund resources required may result in budget reductions in other programs.
BUSINESS IMPACT STATEMENT
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Details
ADVISORY BOARD STATEMENT
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BACKGROUND
The County Health and Human Services Agency (HHSA), in collaboration with committed community members, local organizations, and State and federal partners, plays an important role in supporting access to critical health care services through a fully optimized health and social service delivery system. This includes supporting access to reproductive health services.
While pregnancy and maternal care are vital aspects of reproductive health, they are not its only components. Reproductive health includes: family planning, fertility services, sexual health services, menstrual health, gynecological care, gender-affirming care, prevention and treatment of gender-based violence, reproductive cancer screening and treatment, and education and counseling. These elements collectively address the diverse needs of individuals across different stages of life and gender identity, ensuring access to essential care and support. Together, these services reflect a holistic approach, promoting equity, health, and well-being for all individuals.
Reproductive justice emphasizes the social, economic, and political conditions necessary for all individuals to have the ability to make decisions about their bodies, families, and communities. It recognizes that reproductive rights alone often do not address the broader systemic inequities that impact people's reproductive lives. Reproductive justice includes the right to have children, not to have children, and to parent children in safe and sustainable environments. It acknowledges how factors such as race, class, gender identity, sexual orientation, immigration status, and disability can influence access to reproductive care and autonomy.
The reproductive justice movement was started by 12 black women leaders known as the Women of African Descent for Reproductive Justice. They bought full-page ads in the Washington Post and Roll Call that featured over 800 signatures calling for any health care reform package to include the concerns of black women. Three years later, 16 organizations including black, Asian-American, Latina and indigenous women got together to create SisterSong, a collective devoted to the reproductive and sexual health of women and gender-nonconforming people of color, based in Atlanta. Recognizing the origins of reproductive justice is crucial because it highlights the lived experiences and struggles of marginalized communities, particularly Black women and other women of color. Understanding these origins underscores why reproductive justice is distinct from mainstream reproductive rights movements and why it addresses issues that are often overlooked in traditional frameworks.
On June 24, 2022, the U.S. Supreme Court directly attacked reproductive justice by overturning Roe v. Wade. The decision resulted in states throughout the nation placing strict restrictions on abortion rights, with some banning abortion entirely. The overturning of Roe v. Wade has eliminated bodily autonomy and health care access to all individuals who are able to become pregnant. As of August 2024, 14 states have an abortion ban in effect and eight states with a gestational limit, including our neighboring state of Arizona who has banned abortion at 15 weeks of pregnancy. This means that throughout the United States, approximately 1 in 3 women have lost access to abortion.
The overturning of Roe v. Wade has had severe consequences for individuals seeking lifesaving medical care. By restricting access to abortion, individuals are forced to continue their pregnancies to leaving them to face many health risks associated with pregnancy and childbirth. In states, such as Texas, that have banned abortion in its entirety, healthcare providers are denying or delaying lifesaving care out of fear. In cases such as ectopic pregnancy, where the fertilized egg implants in a location other than the inside of the uterus, immediate treatment is crucial for the survival of the patient. Although Texas law does allow for abortion in cases of ectopic pregnancy, doctors and hospitals are still hesitant to provide such care, even when a patient's life or health is at risk, due to the severe penalties under state law. These penalties include up to 99 years in prison, loss of medical license, and fines of at least $100,000 for providing abortion care.
In November 2022, California voters took pivotal steps to protecting reproductive health care by enshrining the right to reproductive freedom, including abortion care and contraception. Proposition 1, introduced as SCA 10, amended the state constitution and cemented our state as a national leader and beacon of hope for people across the country. Furthermore, following the overturning of Roe v. Wade, Governor Newsom signed legislation that helped protect patients and providers in California from civil liability for providing, aiding, or receiving abortion care in the state. This was especially critical as neighboring states began implementing abortion bans and restrictions.
In addition to the recent restrictions on abortion related health care services, the United States is currently facing a maternal mortality crisis and the maternal mortality rate continues to exceed rates of other high-income nations. The World Health Organization defines a maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes”. Native Hawaiian and Pacific Islander, Black, and American Indian and Alaska Native women have the highest rates of pregnancy-related death. Persistent inequities in health care are a major factor in why Black women in the United States are by far the most likely to die from pregnancy or childbirth.
In 2022, per the Centers of Disease Control (CDC), 817 women died of maternal causes in the United Staes, compared with 1,205 in 2021, 861 in 2020, 754 in 2019, and 658 in 2018. In 2021, individuals who identified as Non-Hispanic Black, per the CDC category, experienced a maternal mortality rate of 69.9 deaths per 100,000 live births, which is 2.6 times the rate for non-Hispanic White women. Hispanic individuals experienced a maternal mortality rate of 28.0 per 100,000 live births. A survey conducted by the CDC found that 30% of Black, 29% of Hispanic, and 27% of multiracial women reported mistreatment during maternity care. They commonly reported receiving no response to requests for help, being shouted at or scolded, not having their physical privacy protected, and threatened with withhold treatment or made to accept unwanted treatment. Given the rising maternal death rates in the United States, it is vital for individuals who are pregnant to have the care they need as soon as possible.
On May 24, 2022 (24), the San Diego County Board of Supervisors directed staff to conduct a comprehensive assessment (Assessment) of reproductive health care services offered by County and County heath contractors, including: barriers to care; opportunities to optimize these services; expanding partnerships with providers; and identifying opportunities to address and reduce health disparities for marginalized communities by advocating for regulatory, budgetary, and legislative efforts that strengthen access to reproductive rights and health care services, including abortion. The Assessment focused on prevention, identification, and treatment of pregnancies that are unintended, undesired, non-viable, and/or a threat to the pregnant person’s health. To complete the Assessment, staff held workgroup meetings and in-depth interviews with County department representatives to collect information on the aspects of reproductive health addressed in their programs. Staff also reviewed literature on evidence-based practices to support increasing access to services.
The Assessment found that while many programs and social services are available from the County and from community reproductive health service providers, conducting training to support County staff in discussing reproductive care options with patients and updating procedures focused on person-centered referral pathways are recommended to ensure people can connect with these important services. Additionally, the Assessment found that the key challenges for reproductive health care services included federal funding restrictions, limited information available to identify if providers offer the full range of reproductive health options, insufficient data related to lack of reporting for services provided to be able to determine extent of need, misinformation about abortion risks and options, lack of direct treatment, and training gaps for pregnancy-related issues.
To focus on improving access to reproductive health care and abortion-related services, the County has since worked to increase staff training, improve referral pathways, and to prioritize reproductive health care in the County legislative agenda and advocate for State and Federal budget proposals. In 2022, the County Office of Economic Development and Governmental Affairs (EDGA) added Reproductive Health Care as a priority issue in the County Legislative Program. Since then, the County has officially supported AB 2085, AB 2319, AB 352, SB 487, S. 701, H.R. 12, and H.R. 3420.
A unit within the County dedicated to reproductive health, a unit within the County dedicated to reproductive health ensures comprehensive, accessible, and equitable care for our communities and will strengthen connections to person-centered reproductive health care services and related resources in San Diego County. The unit can serve as a centralized hub for coordinating reproductive health care resources and addressing the unique needs of the community through targeted programs and outreach. It can also advocate for policies that improve access to care, support education on reproductive health issues, and facilitate collaboration among local organizations. By focusing on reproductive health, we can reduce disparities in care, promote preventive measures, and provide essential resources for family planning, sexual health, and gender-affirming services. A dedicated unit ensures that reproductive health remains a priority, leading to better health outcomes and a more informed, empowered community.
Today’s action authorizes staff to create a unit within the County of San Diego Health and Human Services Agency dedicated to reproductive health, justice, and equity, and seek grant and other funding opportunities to support the expansion of reproductive health efforts, during the Fiscal Year 2025-26 Operational Planning process.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s action aligns with the County of San Diego 2024-2029 Strategic Plan and initiatives of Health and Quality of Life to (i) reduce disparities and disproportionality and ensure access for all through a fully optimized health and social service delivery system and upstream strategies and (ii) focus on policy, system, and environmental approaches that ensure equal opportunity for health and well-being through partnerships and innovation.
Respectfully submitted,
NORA VARGAS
Supervisor, First District
ATTACHMENT(S)
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