Introducing the New Chair of the Population Connection Board of Directors: Estelle Raboni, MPH, MCHES

Estelle Raboni is the new Chair of the Population Connection Board of Directors. She grew up in New York City as a Dominican-American child who didn’t speak English until later in elementary school. Despite this, Estelle went on to attend Columbia University for her BA and Hunter College for her master’s degree. She now directs New York City’s largest teen pregnancy prevention program, New York City Teens Connection. Estelle and her husband of 27 years, Saul, have a “smart, self-avowed feminist son,” and a little rescue dog named Harry. I interviewed her recently about her life and work.
– Lee S. Polansky

Where did you grow up and attend school? Do you have any coming of age stories that especially affected your experience of being Latina?

I grew up in Manhattan and the Bronx, daughter to a Dominican mother and an American-born father. My mother had me when she was 20 years old — barely an adult. My parents separated when I was a child, which created a great deal of economic hardship for my mother when I was growing up. Had my mother been able to finish her education when she was a teenager, things might have been different, but she had to leave school when she was 16 when her father died.

My family was poor and worked in clothing factories in lower Manhattan making coats. I attended public elementary, middle, and high school. As a child I suffered from a terrible stutter and spoke no English. My paternal aunt, who was born and raised in NYC, attempted to enroll me in Head Start but found that the program was full. Because she felt that I really needed early education — due to my disadvantages — she made a financial sacrifice and enrolled me in a private nursery school in Westchester, New York — an affluent suburb of New York City. The difference between the environment around my mother’s apartment and my nursery school was dramatic. My mother’s pest-infested apartment was in a dangerous and noisy neighborhood — there was no playing outside there. My nursery school environment was bucolic — clean, bright, quiet — they even had farm animals on the property that were part of their programming.

My first sense of being different and learning that in the larger context being Latina was somehow disadvantageous happened as early as kindergarten. One afternoon during story time, my kindergarten teacher read a book about “brotherhood” that involved an African American child, a white child, and a Latino child. One student in my mostly-white kindergarten class interrupted the reading saying, “The black kid is yucky, the Spanish kid is yucky. Only the white kid is okay.” The children then walked off to play. That was my first experience of racism, but I didn’t understand it at the time. I only noticed the horrified expression on my aunt’s face (she was a class volunteer), and how she intentionally arranged for me to become friends with the two other Latino students who remained to hear the rest of the story.

There was no bilingual education when I was a child. You either learned English or you didn’t. If you didn’t, you were left behind until you mastered the language. As a result, I didn’t become English-dominant until second or third grade. At that time, NYC schools tracked students. There were classrooms for the “slower” kids, average kids, and advanced kids. I was put into the slower-paced class, which I noticed contained mostly kids of color. As I became more fluent in English, I was able to do better in school. I became an avid reader, and by fifth grade was in the advanced class for my grade. The difference in the classroom experience and resources was remarkable. I noticed that the expectations of students in the advanced class were so much higher than in my previous classes. Our teacher allowed us to run the school garden, learn about organic gardening, put on plays, and do other project-based work that other classes did not have access to. I saw how inequity manifests in different ways at a very early age — from the quality and amount of resources available, to the atmosphere of support and encouragement.

I graduated high school in the Bronx, and after a few years of working, completed a BA in Women and Gender Studies at Columbia University. My interest in social justice was encouraged at Columbia, and while I was also completing a concentration in pre-med (with the intent of going on to medical school to focus on women’s health), I ultimately chose to focus on population health. At the time I didn’t have words for what I was interested in, but I recognized that physicians have a very small influence on the health of large populations. I wanted to make an impact on the social determinants of health that impact women not just in New York City, but around the world.

After Columbia, I began working at Planned Parenthood Federation of America as the Manager of Education, working with the then 100 Planned Parenthood affiliates to coordinate professional development, training, and resources. I loved my work and I loved the organization. In many respects, I felt I had come home, and delved further into my interest in social justice and equity. Here I determined that, instead of pursuing medicine, I would pursue studies leading to a master’s degree in public health. I graduated in 2007 from Hunter College at the City University of New York with a focus on community health.

How did your background influence your interest and work in adolescent health, teen pregnancy, and reproductive justice?

While I was at Planned Parenthood, I worked with the group that launched the first Get Yourself Tested campaign in 2009. The idea for the campaign was — and is — to increase awareness about STIs and HIV. It’s a partnership between several high-profile health organizations and MTV. It was an exciting new campaign, but I felt that the campaign materials did not reflect the population that was most affected by STIs and HIV at that time — young men of color. As the Director of Latino Outreach, I worked to develop complementary campaign materials that took into account the stigma of STI and HIV infection in the Latinx1 community. After the campaign, we found that testing among Latinx clients increased by 20 percent as a result of our efforts to speak directly to the needs of this population.

Being Latina has always informed how I see the world — who has resources, who doesn’t, and why. While teen pregnancy rates have been dropping dramatically across New York City, and the country, there is still a large gap between the drops in pregnancy among white teens versus African American and Latina teens. Much of this gap comes down to wealth discrepancies. The literature in the field indicates that a young person growing up in poverty is three times more likely to become pregnant and drop out of school, making that young person less likely to continue to college and subsequently to higher-paid employment. The community that I work in — where 98 percent of the population is African American or Latinx and where 39 percent of youth are growing up in poverty — currently reflects this data sharply. The Bronx has the highest teen pregnancy rate and the lowest levels of high school graduation in all of New York City, and it consistently ranks #62 out of 62 New York State counties — dead last — in health and economic outcomes. Unintended teen pregnancy is a watershed event — if not provided with sufficient support, a teen mother will have negative health, academic, and economic outcomes.

Please talk a bit about your current job and why it’s important, and describe any challenges.

I am the Director of New York City Teens Connection, the New York City Department of Health and Mental Hygiene’s program to decrease teen pregnancy rates in areas of the city where they are higher than the national average. We work to build capacity in schools by training teachers to provide teen pregnancy prevention programs in ninth or tenth grade, before most young people become sexually active, and linking those students to high-quality, teen-friendly healthcare. Because not all youth are engaged in schools, we also work with partners to implement evidence-based teen pregnancy prevention programs in foster care agencies, youth-serving organizations, colleges, and clinics.

Last year we were able to reach nearly 7,000 New York City youth with evidence-based programming, while also linking them to quality healthcare. This year we project that we will reach approximately 15,000 youth in 20 percent of the city’s high schools. We also build capacity among our clinical partners to provide the latest in contraceptive technology — including Nexplanon and IUDs — so that teens have access to the most effective methods of contraception on the market. These methods take out the human error implicit in methods that depend on the person to take a pill or insert a ring. Colorado, for example, has been able to decrease its teen pregnancy rate by 40 percent as a result of increased use of the most effective methods.

One of the challenges in this work is funding. The current administration has shortened the grant cycle for the Teen Pregnancy Prevention Program, which provides federal dollars to organizations and health departments across the country to decrease teen pregnancy. By shortening the grant cycle by two years, we are less able to support the efforts and inroads we have made. This means that fewer young people will receive the information and services they need to navigate adolescence safely and pregnancy-free.

What are you seeing in the field? How are your programs serving different populations?

What we are seeing is an increase in sex trafficking. According to the report “America’s Prostituted Children,” at least 100,000 children are used in prostitution every year in the United States. The most common age of entry into the commercial sex industry in the U.S. is 12-14 years old. As a result, we’ve been working with organizations that help train teachers and clinicians to recognize signs often present when someone is a victim of sex trafficking. We are also providing training to partners on trauma-informed care, as well as inclusivity training to appropriately address the needs of LGBTQ+ youth. We don’t provide direct service; rather, we build on the capacity of existing networks to provide education and services to youth. Ultimately, we want to make this work sustainable within existing institutions. Still, we hear through our partners how youth react to the programming or services they receive — they are often incredulous that they get to have access to high-quality medical care without their parents’ permission, and at low or no cost. I have the good fortune of working in New York City, within New York State — we have progressive laws such as Minors’ Rights to Confidential Reproductive and Sexual Health Care, which allows minors who meet certain criteria to consent to medical treatment without involving a parent, and the Family Planning Benefit Program, which extends family planning coverage to low-income New Yorkers who aren’t covered by Medicaid.

As the new chair, how do you hope to influence the direction of the Population Connection Board of Directors?

I would like to increase and diversify the membership of the board. The mission of Population Connection is critical, particularly given the current administration’s disregard for women and the environment. We need younger generations of leaders to become engaged in this work so we can promote future policies that will protect the environment and women’s health and rights.

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