New Study Explores Structural Racism’s Impact on Adolescent Sexual and Reproductive Health Inequities
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While there is an ample and growing body of public health research demonstrating the impacts of structural racism on health - from chronic health problems and shorter lifespan expectancies to unequal treatment in health care systems – there remains an inadequate volume of research on structural racism’s role in contributing to poor adolescent sexual and reproductive health (ASRH) outcomes among youth of color.
In a new study recently published in Health Promotion Practice, lead author and doctoral candidate Saharra Dixon and colleagues set out to explore how structural racism impacts the sexual and reproductive health of historically excluded youth as they navigate unjust socio-political landscapes. Using an arts-based participatory approach, youth participants identified how the experience of bias, profiling, and tokenism impacted their ability to navigate complex social systems.
"We used a Youth Participatory Action Research (YPAR) approach to investigate social issues meaningful to them and identify actions to address these issues," says Dixon. "By providing arts-based methods such as Photovoice and community mapping, we empower youth participants to identify how structural racism impacts their lives and find pathways toward liberation in pursuit of health and well-being."
Dixon and colleagues present findings from a YPAR Photovoice retreat, which was part of a 4-year Community-based Participatory Action Research (CBPR) study begun in early 2020 by senior author and Professor of Health Promotion and Policy Aline Gubrium and co-author and former SPHHS faculty member Elizabeth Salerno Valdez funded by the Massachusetts Department of Public Health (MDPH), Office of Sexual Health and Youth Development in the Bureau of Community Health and Prevention. In a Photovoice study, participants are asked to express their points of view or represent their communities by photographing anything significant to them related to the research themes.
The researchers partnered with youth serving organizations in Springfield and Lynn, Massachusetts to recruit and engage historically marginalized youth (ages 16-24) in the project. Program activities were held at the two organization’s drop-in centers, both of which provide space for low income and housing unstable youth to gather for pro-social activities (e.g., job training, support groups, and youth-building activities).
Researchers facilitated youth participants in a series of activities including identity building, community mapping, and Photovoice ethics and methods. Through their own analysis of photographs and community maps, a sample of 24 youth found that structural racism had negative and extensive implications for ASRH. University researchers coded and analyzed these findings further for analytical organization, finding three major themes elicited by the youth participants: the impact of racial and ethnic bias on youth; tokenism as a microaggression; and structural racism as a fundamental cause of ASRH inequity. Findings were presented as part of a community-based forum, with members of the Massachusetts Department of Public Health and other community stakeholders in attendance.
With youth voices prioritized, participants explored ways to address structural racism in their lives. The importance of co-creating opportunities with and for youth in critical reflection of their lived experience is emphasized. Through an Arts and Cultural in Public Health framework, researchers provided an analysis of the ways structural racism functions as a gendered racial project and fundamental cause of adolescent sexual and reproductive health inequities, while identifying pathways toward liberation in pursuit of health and well-being.
“The use of Photovoice and other arts-based methods in YPAR can be used to radicalize youth toward a social justice orientation,” notes Dixon. “The arts offer an opportunity to make meaning of the world and further understand how social inequity functions to create poor health outcomes. As youth use art to document and explore their struggles and needs, their creativity and power is captivated in a way that begs us to interrogate the mechanisms through which deep-seated oppression and injustice continues to impact future generations. In this way, the arts and arts-based methods are critical in shaping public policy and shifting narratives and norms that perpetuate health inequity.”
The researchers conclude that youth are not “stagnant players” in their lives. “Youth are constantly thinking of ways to push back against structural racism…. As researchers, we must cultivate spaces for youth to envision the change they want to see. Public health practitioners in collaboration with youth can learn to think more critically and civically. In our study, we have fostered this by inviting youth participants to share their findings in critical reflection with each other and other community members. The use of arts in public health is fundamental to anti-racism and in fostering health equity. We should not be afraid to bend the future together as we are charged to make a world that is healthful and safe for all.”
Research reported in this publication was supported by the Family and Youth Services Bureau in the Administration for Children and Families of the U.S. Department of Health and Human Services, grant #1901MASRAE.