This was originally an assignment in a midwifery course. I've shared my thoughts here in hopes it helps other birth workers serve all birthing people with dignity and thoughtfulness. To read the original format of the assignment and/or references, click here.
The current state of U.S. maternity care is reflective of the more general picture of current American society. At first glance, a system with the purported goals of equitable health and prosperity seems to be working toward meeting the needs of a population. Yet, a little investigation results in the uncovering of a haphazard assembly of people and institutions whose actual impact is dangerous to anyone the least bit vulnerable. Low-income people, those with lower education levels, and people of color are all at risk in the maternity care system, just as they are in society as a whole. Due in large part to the racist foundations and history of American culture, racial and ethnic minorities are severely impacted by disparities in healthcare. In the maternity care system, this means birthers and babies of color experience morbidity, co-existing morbidities, and mortality at higher rates than their white counterparts.
In 2010, Amnesty International published a lengthy report on the global maternal crisis, shining a light on huge inequities creating barriers to quality healthcare among various populations. Among important findings documented was that a significant number of birthers of color lack access to information to make decisions, fair and appropriate treatment from providers, a socioeconomic status that could provide greater access to quality care, and sometimes even care itself (Amnesty, 2011). More recently, researchers identified multiple categories of maternal morbidities that ethnic minorities are at higher risk of experiencing. In the U.S., black and indigenous birthers experience hypertension, asthma, diabetes, kidney disease, HIV, hysterectomy, and blood transfusion at a higher rate than non-Hispanic white women (Admon et al., 2018). Beyond these morbidity risks, the mortality rate either in or related to childbirth is also significantly higher in birthers of color, with black women being three or four times as likely to die (Amnesty, 2011).
And it is not just pregnant and birthing people who suffer due to race-based inequities in America. Infants of color also experience higher rates of morbidity and mortality than white infants. One example of this is the persistently high rates of low birth weight in black infants. Black babies are almost twice as likely to be born at low weights compared to white infants (13.53% and 7.14% respectively). Considering birth weight is a major indicator of likelihood of survival, it is no surprise, then, that black infants have higher mortality rates than white infants (Brewin & Nannini, 2014). A multitude of factors play into these rates and impact the health of a pregnancy and a baby. Though pinpointing exactly why black infants specifically are at such higher risk is challenging, Brewin & Nannini (2014) suggest long term stress, exposure to violence, lack of social support, and lower socioeconomic status among leading causes of disparities in birth health outcomes.
Addressing maternity care inequities must begin with significant healthcare reform that guarantees comprehensive perinatal care to all. Gaps in care coverage are unacceptable because they lead to delays or even loss of routine care and emergent services due to payment concerns. This puts birthers, their babies, and entire families at risk. Beyond access to safe care for all, mandatory education programs for medical professionals, hospital administrators, and more are necessary to reduce the impact of interpersonal racism. Finally, expansion of midwifery services is going to be a key component in closing the disparities gap. Not only are people of color at higher risk in the conventional system due to racism, the lack of personalized care available in these environments means that individual histories are not considered when planning treatment courses. Midwives are better equipped as providers to assess perinatal needs based on cultural, social, medical, and economic histories because the midwifery model is based on individual care and allows for a greater investment of energy in each birther to improve outcomes.
Amanda Cagle is a professional doula, educator, and student midwife located in Orange County, CA who offers comprehensive services to growing families and birth professionals alike. Amanda can be reached via email at firstname.lastname@example.org or through www.yourbirthteam.com.