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Structures and SelfAdvancing Equity and Justice in Sexual and Reproductive Healthcare

These videos review the history of oppression and how it contributes to current health inequities. As you watch each video, answer the reflection questions provided for each. Go to the “Resources” tab to download these reflection questions.

Video 1
Structures and Self - Own Our Legacy

Learners will explore how the structures of power and oppression manifest within health care systems and impact sexual and reproductive health outcomes.

Video 2
Structures and Self - Recognize Structures of Oppression

Learners will identify implicit bias, privilege, and fragility regarding patient interactions, their relationship to structures of oppression, and practices for self-reflection and self-care.

Video 3
Structures and Self - Check Yourself

This video will review how the history of oppression contributes to current health inequities.

Video 4
Structures and Self - Take Action

After Learners have recognized their privilege, they will identify ways to center a justice framework and structural analysis as a tool to promote optimal health outcomes.

Innovating Education in Reproductive Health—a project of the Bixby Center for Global Reproductive Health at UCSF—offers free learning tools to ensure sexual and reproductive health, including abortion, is better integrated into medical education. Learn more

Article Information:


Led by Zoë Julian, MD, MPH, Structures and Self is also the result of transdisciplinary, community-engaged curriculum development process, employing novel methods of collaboration, transparency, and accountability that center Black lived experiences and scholarship. The core development team consisted of Black health professions educators, clinicians, and learners from family medicine, nursing, midwifery, and public health, as well as obstetrics and gynecology and family planning: Maisha Davis, MD, MPH; Talita Oseguera, CNM, WHNP; Ariel Hart, MPH; Sanithia Williams, MD; and Biftu Mengesha, MD, MAS. This team also worked in paid partnership with Elizabeth Dawes Gaye of Sisu Consulting, as well as reproductive and birth justice advocates of Black Women Birthing Justice, with continuous support from the staff of Innovating Education in Reproductive Health. See the acknowledgments section below for all our critical partners and mentors in this work.


Black Women Birthing Justice (BWBJ)


Elizabeth Dawes Gay – Sisu Social Justice Consulting

Core development team

Maisha Davis, MD, MPH

Ariel Hart, MPH, MD/PhD Candidate

Zoë Julian, MD, MPH

Biftu Mengesha, MD, MAS

Talita Oseguera, RN, MS, CNM/WHNP Candidate

Sanithia Williams, MD


Christine Dehlendorf, MD, MAS

Andrea Jackson, MD, MAS

Monica McLemore, RN, MPH, PhD

Jody Steinauer, MD, MAS

Executive Producers: Innovating Education in Reproductive Health

Aliza Adler

Stefanie Boltz, MPP

Cassandra Carver, MPA

Jessie Chien

Felisa Preskill, MPP

Amanda Teal, MA

Credit Designation Statement:

Physicians: UCSF designates this enduring material for a maximum of 22.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioners and Registered Nurses: For the purpose of recertification, the American Nurses Credentialing Center accepts AMA PRA Category 1 Credit™ issued by organizations accredited by the ACCME.

Physician Assistants: The National Commission on Certification of Physician Assistants (NCCPA) states that the AMA PRA Category 1 Credits™ are acceptable for continuing medical education requirements for recertification.

California Pharmacists: The California Board of Pharmacy accepts as continuing professional education those courses that meet the standard of relevance to pharmacy practice and have been approved for AMA PRA category 1 credit™. If you are a pharmacist in another state, you should check with your state board for approval of this credit.

California Psychologists: The California Board of Psychology accepts as continuing professional education those courses that meet the standard of relevance to psychology practice and have been approved for AMA PRA category 1 credit™. If you are a psychologist in another state, you should check with your state board for approval of this credit.

This CME activity meets the requirements under California Assembly Bill 1195, continuing education and cultural and linguistic competency.

CME Disclosure Statement: All planning committee members or presenters reported NO financial interests relationship with a commercial interest that provides products or services relating to their role(s) in this activity.


Pillar I: Own Our Legacy

Prevalence of HIV and health care experiences among people of transgender experience

• Becasen JS, Denard CL, Mullins MM, Higa DH, Sipe TA. Estimating the prevalence of HIV and sexual behaviors among the US transgender population: a systematic review and meta-analysis, 2006–2017. AmJ Public Health e1-e8.

• James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The report of the 2015 US Transgender Survey. Washington, DC: National Center for Transgender Equality; 2016.

Pillar II: Recognize Structures of Oppression

Racial residential segregation is associated with higher rates of preterm birth for Black women

• Salow AD, Pool LR, Grobman WA, Kershaw KN. Associations of neighborhood-level racial residential segregation with adverse pregnancy outcomes. Am J Obstet Gynecol. 2018 Mar;218(3):351.e1-351.e7. doi: 10

Physicians spend less time with clinically obese patients and fail to refer them for diagnostic tests compared to thinner patients.

• Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015 Apr;16(4):319-26. doi: 10.1111/obr.12266. Epub 2015 Mar 5. PubMed PMID: 25752756; PubMed Central PMCID: PMC4381543.

Pillar III: Check Yourself

Implicit bias among providers

• FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017 Mar 1;18(1):19. doi: 10.1186/s12910-017-0179-8. PubMed PMID: 28249596; PubMed Central PMCID: PMC5333436.

Racial bias in pain assessment and treatment recommendations

• Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press; Washington, DC: 2013.

• Cleeland CS, Gonin R, Baez L, Loehrer P, Pandya KJ. Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Ann Intern Med. 1997;127(9):813–816.

• Goyal MK, Kuppermann N, Cleary SD, Teach SJ, Chamberlain JM. Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. 2015;169(11):996–1002.

• Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016 Apr 19;113(16):4296-301. doi: 10.1073/pnas.1516047113. Epub 2016 Apr 4. PubMed PMID: 27044069; PubMed Central PMCID: PMC4843483.

Pillar IV: Take Action

Bronfenbrenner's Social Ecological Model

• Bronfenbrenner U. “Ecological systems theory”. In Vasta, Ross (ed.). Annals of Child Development: Vol. 6. London, UK: Jessica Kingsley Publishers.1989. pp. 187–249.


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