The New York City Standards for Respectful Care at Birth (NYC Standards)

Implementation Toolkit Practice Guidance

Purpose: This document is intended to support MCH professionals to implement a practice found in the Implementation Toolkits. This resource provides the information needed to replicate the practice and is divided into two sections: the first section provides a high-level overview of the practice while the second section describes how to implement the practice. For additional information on any of the content provided below, please reach out to the practice contact located at the bottom of this document.

Section I: Resource Overview

Practice Description

The New York City Standards for Respectful Care at Birth (NYC Standards) were co-created by the Sexual and Reproductive Justice Community Engagement Group (SRJ-CEG) and the New York City Department of Health and Mental Hygiene (NYC DOHMH) to inform, educate and support pregnant, birthing, and parenting people with regard to their human rights, and encourage them to be active decision-makers in their healthcare experiences. The 29 NYC Standards are organized into 7 overarching categories: Education, Quality of Care, Informed Consent, Decision- Making, Dignity and Nondiscrimination and Support.

In July 2015, the NYC DOHMH convened the SRJ-CEG in order to co-create respectful, equitable, culturally grounded, and community-driven means of promoting sexual and reproductive health and justice in NYC. Drafting, publishing and promoting the NYC Standards was one success of SRJ-CEG’s Birth Justice campaign, which aimed to 1) support community members and providers to advocate for respectful care at birth, 2) increase application of best practices for respectful care at birth within health care institutions, and 3) mobilizing stakeholders and changing institutional policies and practices to support the use of the sexual and reproductive justice framework and community-led initiatives and accountability.

Through collaborative efforts between 2015-2019, the NYC DOHMH and SRJ-CEG developed and promoted educational materials such as the Sexual and Reproductive Justice video and discussion guide [Español]. They hosted numerous community engagement events, and healthcare provider trainings and workshops such as grand rounds presentations on Birth Justice in hospitals throughout NYC. Additionally, they convened the Birth Justice Defenders (BJDs), a team of community members representing all 5 boroughs who engage in community outreach, advocacy, and education around the NYC Standards in order to increase awareness, self- determination, and actualization of the human right to respectful care at birth among community members. As of 2020, the BJDs organize out of two birth justice hubs which serve as a guide and a resource to them for skill-building, networking, and visioning impactful community-centered initiatives to implement in their own communities.

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Purpose In NYC, Black women are 8 times more likely to die from a pregnancy-related causes, and 3 times more likely to suffer severe maternal morbidity than white women. Women who identify as Latinx, Asian, and Pacific Islander are also at higher risk of maternal morbidity and mortality than white women. These inequities are produced and sustained by structural racism, medical racism, and systematic and longstanding underinvestment and disinvestment in communities of Black, Indigenous and other People of Color (BIPOC). The NYC Standards are a community-driven response to racial and ethnic inequities in maternal health outcomes, and aim to improve these outcomes by increase knowledge, power and agency among community members who are disproportionately impacted, and improve the practice, culture, and provision of respectful care within healthcare institutions throughout NYC.

Community members that are centered within SRJ-CEG’s work are those who identify as/are: Black, Latinx, Asian Pacific Islander, Native American, LGBTQIA+, Transgender/Gender non- conforming, low-income, living with HIV, Medicaid recipients, differently-abled, involved in the commercial sex industry, formerly incarcerated, substance users, immigrant/undocumented, non- English speaking/ low English proficiency.

Practice Foundation Intentionally rooted in shared leadership and collaboration between government and community, the NYC Standards took two years to create, the process of which included soliciting feedback from pregnant and parenting community members within 14 community gatherings. The NYC Standards are responsive to the needs, concerns, histories, and experiences of community members throughout NYC regarding birth injustices.

The NYC Standards are rooted in Sexual and Reproductive Justice, Birth Justice, and Community Engagement frameworks. Sexual and Reproductive Justice exists when all people have the power and resources to make healthy decisions about their bodies, sexuality and reproduction. That means every person has the right to:1) Choose to have or not have children. 2) Choose the conditions under which to give birth or create a family. 3) Care for their children with the necessary social support in a safe and healthy environment. 4) Control their own body and self-expression, free from any form of sexual or reproductive oppression. The term "reproductive justice" was coined by a group of black women in 1994. From this group, a framework and SisterSong, a collective led by BIPOC, emerged. Birth Justice exists when everyone has the freedom and support to make decisions about pregnancy, childbirth, and postpartum with dignity. This includes access to high-quality, culturally responsive care, freedom to chose where and with whom to give birth, and the ability to accept or decline medical interventions. Community Engagement is the direct participation of neighborhood residents or other members of cultural, religious, social or political communities in addressing issues directly affecting that population.

The NYC Standards were informed by various human rights documents and publications including the New York State Hospital Patients' Bill of Rights, LGBTQ Health Care Bill of Rights, Black Mamas Matter Toolkit, Respectful Maternity Care Charter: the Universal Rights of Childbearing Women, The Rights of Childbearing Women, Breastfeeding Mother’s Bill of Rights, The prevention and elimination of disrespect and abuse during facility-based childbirth, Long- Acting Reversible Contraception Statement of Principles, and more recently the Black Birthing Bill of Rights.

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Section II: Practice Implementation

Overview On July 20, 2018, First Lady McCray and Deputy Mayor for Health and Human Services Dr. Herminia Palacio announced New York City’s first comprehensive plan to reduce maternal deaths and life-threatening complications of childbirth among women of color. This five-year initiative aims to reduce the severe maternal mortality amongst women of color and as a result of this funding the Maternity Hospital Quality Improvement Network (MHQIN) was formed at the NYC DOHMH. As of July 2020, the MHQIN was still piloting implementation of the NYC Standards within 14 maternity hospitals across NYC. Once completed, NYC DOHMH will release further implementation guidance. In the meantime, it is recommended that clinical sites aiming to implement the NYC Standards take these initial steps:

• Designate multidisciplinary team members in frontline and leadership positions to lead NYC Standards implementation efforts. • Require staff training in anti-racism, sexual and reproductive justice, and the purpose and social/historical context of the NYC Standards. • Create or strengthen real-time/right-time patient experience reporting and response mechanisms that aim to gather in-depth narrative feedback (e.g. patient focus groups, patient interviews) and have timely and patient-engaged response mechanisms. • Establish or strengthen patient/community advisory councils, and/or create sustainable processes in which patients serve on hospital-based quality improvement committees to help improve the quality, accessibility, and appropriateness of maternal health services. • Display NYC Standards posters and brochures in areas that are accessible to staff, patients, and their support teams.

Download NYC Standards posters and brochures:

For more information visit NYC.gov and search “SRJ” or email [email protected]

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