Reproductive Justice: RACE, INDIGENEITY AND SOCIOECONOMICS

**NOTE** Medical advancements have saved the lives of women and babies at risk for injury or death during pregnancy and birth. This site is not about the doctors who properly use interventions to save lives; it is about those who use them unethically for profit or convenience. Improperly used interventions have led to harm and death of women and babies and obstetrics is the only field in which mortality rates are rising and non-medically needed interventions such as c-sections are related to 66% of maternal deaths.

**NOTE** This site is designed to share valid evidence for those working to change the maternal healthcare system who do not have access to databases of peered research.

**NOTE** Chronological order allows users to find new data. It also begs the question of why, when we have known for decades that such practices are harmful, do they not only continue to be used but are increasingly used.

RACE, INDIGENEITY AND SOCIOECONOMICS

WHAT DOES THE LITERATURE SAY?

2024

Anyiam, S., Woo, J., and Spencer, B. (2024). Listening to Black Women’s Perspectives of Birth Centers and Midwifery Care: Advocacy, Protection, and Empowerment. Access https://onlinelibrary.wiley.com/doi/10.1111/jmwh.13635

The Black women interviewed in this study emphasized the prevalence of racism and discrimination in perinatal health care encounters, a reflection consistent with current literature. Black women also expressed a desire to use birth centers and midwifery care but identified the barriers in Texas that impede access. Study findings highlight the need to address barriers to promote equitable perinatal health care access for Black women

Emechebe, O., (2024). Strategies to Improve Black Maternal Health Outcomes and Advance Health Equity. Access https://hsph.harvard.edu/exec-ed/news/strategies-improve-black-maternal-health-outcomes-advance-health-equity/

The statistics around Black maternal health in the United States remain unsettling. In the U.S., Black women are three to four times more likely to die from pregnancy-related causes than white women. Black women are also two times more likely to experience severe maternal morbidity and 1.5 times more likely to have a preterm delivery, compared to their white counterparts. There are various factors that contribute to these disparities, such as systemic racism, implicit bias, lack of access to quality care, social and environmental factors, underlying chronic conditions and more

‘Nayak, A. (2024) The history that explains today’s shortage of black midwives. Accessed https://time.com/6727306/black-midwife-shortage-history/

Amid growing maternal mortality rates, Black and Indigenous women in the U.S. are three times more likely to die from a pregnancy-related cause than white women. Many women of color experience painful and traumatic hospital experiences as a result of structural racism and being historically neglected by the American health care system. And while maternal care experts have noted the improved health outcomes that come with midwifery care—less medical intervention and fewer C-sections—over 90% of midwives are white, highlighting how hard it is for Black women to find Black providers.

Post, W. and Thomas, A. (2024) “Black Women Should Not Die Giving Life”: The lived experiences of Black women diagnosed with severe maternal morbidity in the United States. Accessed https://onlinelibrary.wiley.com/doi/10.1111/birt.12820#Research

Future interventions to reduce racism and improve maternal health outcomes should center on the experiences of Black women and focus on improving patient–provider communication, as well as the quality and effectiveness of responses during emergent situations.

2023

4Kira4Moms (2923). Organization formed to combat the high rates of mortality in the U.S. maternal healthcare system in which black women are more than 3 times likely to die in childbirth. Accessed https://4kira4moms.com/

In 2016, our founder, Charles Johnson, lost his wife Kira, during a routine C-section at Cedar Sinai hospital in Los Angeles, California. He founded 4Kira4Moms in 2017 as a response to his experience, to be a voice for other mothers and families facing unnecessary maternal loss, and putting an end to the maternal mortality health crisis. Black women are disproportionately affected by this epidemic, where they are 3x more likely to die from pregnancy than white women. Implicit bias, access to healthcare, and a number of other factors highlight the need for legislation, support for community-based organizations focused on Black maternal health, and access to care, information, and resources for all underserved and disproportionately affected communities.

Black Mamas Matter Alliance. (2023). Social Media Toolkit. Accessed https://blackmamasmatter.org/wp-content/uploads/2023/03/BMHW23-SM-Toolkit.pdf

The Black Mamas Matter Alliance, Inc. (BMMA) is a national network of Black women-led organizations and multi-disciplinary professionals who work to ensure that all Black Mamas have the rights, respect, and resources to thrive before, during, and after pregnancy. BMMA honors the work and historical contributions of Black women’s leadership within their communities, and values the need to amplify this work on a national scale.

Centers for Disease Control and Prevention (2023). Working together to reduce black maternal mortality. Accessed https://www.cdc.gov/healthequity/features/maternal-mortality/index.html

Each year in the United States, hundreds of people die during pregnancy or in the year after. Thousands more have unexpected outcomes of labor and delivery with serious short- or long-term health consequences. Every pregnancy-related death is tragic, especially because more than 80% of pregnancy-related deaths in the U.S. are preventable. Recognizing urgent maternal warning signs, providing timely treatment, and delivering respectful, quality care can prevent many pregnancy-related deaths.

Fung, L. and Lacy, L. (2023). A look at the past, present and future of Black midwifery in the United States. Accessed https://www.urban.org/urban-wire/look-past-present-and-future-black-midwifery-united-states

Midwifery is an effective model for providing prenatal health care and is proven to result in lower C-section rates and fewer preterm births. Though it has roots in Black, Indigenous, and immigrant communities, Black people face systemic barriers to practicing midwifery. As a result, birthing people in their communities may have less access to birthing care and birthing environments that feel safe and comfortable.

National Institute for Children’s Health Quality. (2023). The impact of institutional racism on maternal and child health. Accessed https://www.nichq.org/insight/impact-institutional-racism-maternal-and-child-health/a>

“It’s easy to say that things are different now… that the civil rights movement happened, and Jim Crow laws are gone, so everyone has access to school, services and health care; but that is only a small piece of the narrative,” says NICHQ Senior Project Director and Engagement Lead Kenn Harris. “We need to look at the full continuum to see how racism has been baked into our systems, and then come together to dismantle existing policies that still support racist practices.”

Welch, L. and Baril, N. (2023) Birthing Black: Community birth centers as portals to gentle futures. Accessed https://nonprofitquarterly.org/birthing-black-community-birth-centers-as-portals-to-gentle-futures/

We, the authors of this article, are Black women birthing community birth centers, and we are founders of a national network of Black people, Indigenous people, and people of color who are also leading community birth centers. Birth Center Equity has as its mission to make birth center care an option in every community by growing and sustaining birth centers led by Black people, Indigenous people, and people of color; the mission of Birth Detroit, founded by Welch, Char’ly Snow, Elon Geffrard, and Nicole Marie White, is to “midwife safe, quality, loving care through pregnancy, birth, and beyond;”² the mission of Neighborhood Birth Center, founded by Baril, is to offer comprehensive midwifery care throughout pregnancy, labor, birth, and the postpartum period by integrating an independent freestanding birth center into Boston’s healthcare and community landscape

2022

Aboriginal Health and Medical Research Council. (2022). Supporting Best Practice in Aboriginal and Torres Strait Island Maternal Health. Accessed https://www.ahmrc.org.au/wp-content/uploads/2022/09/AHM_Maternal-Health-booklet_single.pdf

From Intro: “The quality of antenatal and postnatal care provided to an expecting mother is a key determinant of maternal and child health outcomes. Aboriginal women have been found to underutilize such services due to a number of factors including cost, lack of trust, geographic isolation and culturally unsafe practices. Evaluations of existing models of maternal care for Aboriginal women have identified cultural appropriateness and continuity of care as key elements for ensuring successful outcomes (Sivertsen et al. 2020). “

American College of Nurse Midwives, Black Mamas Matter Alliance and International Confederation of Midwives. (2022). Eliminating the racial disparities contributing to the rise in U.S. maternal mortality. Accessed https://www.midwife.org/acnm/files/cclibraryfiles/filename/000000007743/Eliminating-the-Racial-Disparities-Contributing-to-the-Rise-in-U.S.-Maternal-Mortality-ACNM-BMMA-ICM.pdf

CONCLUDED: (from article) “The United States has the highest rate of maternal mortality in the industrialized world. According to the Centers for Disease Control and Prevention (CDC), approximately 700 American women die every year from pregnancy-related complications. Even more alarming are the significant racial disparities that exist in that black women are 3-4 times more likely to experience a pregnancy related death than white women, regardless of education, income, or other socioeconomic factors”

American Society of Anesthesiologists (2022). Systemic racism plays role in much higher maternal mortality rate among Black women. Accessed https://www.asahq.org/about-asa/newsroom/news-releases/2022/10/systemic-racism-plays-role-in-much-higher-maternal-mortality-rate-among-black-women

Black women have a 53% increased risk of dying in the hospital during childbirth, no matter their income level, type of insurance or other social determinants of health, suggesting systemic racism seriously impacts maternal health, according to an 11-year analysis of more than 9 million deliveries in U.S. hospitals being presented at the ANESTHESIOLOGY^® 2022 annual meeting.

BlueCross BlueShield. (2022). Racial and Ethnic Disparities in Maternal Health. Accessed https://www.bcbs.com/the-health-of-america/reports/racial-and-ethnic-disparities-maternal-health

The trends in maternal health disparities are unacceptable. Reversing the trajectory of those trends, like the rates of SMM highlighted in this report, cannot rest on the shoulders of women and health care providers alone. It will take the collective efforts of the health care system, including providers, insurers, policymakers and the nonprofit and private sectors.

California Healthcare Foundation (2022). Reducing unnecessary c-sections in California. Accessed https://www.chcf.org/project/reducing-unnecessary-c-sections/

From article: Unnecessary c-sections are a health equity issue since c-section rates are higher among people of color. Nearly 36% of Black infants, 32.3% of American Indian and Alaska Native infants, and 31.3% of Asian and Pacific Islander infants were delivered by c-section between 2018 and 2020. Overuse of c-sections matters because, while often lifesaving in limited circumstances, the surgery also brings serious risks for babies (such as higher rates of infection, respiratory complications, and neonatal intensive care unit stays, as well as lower breastfeeding rates) and for mothers (such as higher rates of hemorrhage, transfusions, infections, and blood clots).

CDC (Centers for Disease Control (2022) Pregnancy Mortality Surveillance System. Accessed https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm

CDC conducts national pregnancy-related mortality surveillance to better understand the risk factors for and causes of pregnancy-related deaths in the United States. The Pregnancy Mortality Surveillance System (PMSS) defines a pregnancy-related death as the death of a woman while pregnant or within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy. Medical epidemiologists review and analyze death records, linked birth records and fetal death records if applicable, and additional available data from all 50 states, New York City, and Washington, DC

Chambers, B, Taylor, B., Helson, T., Harrison, J., Bell, A., O’Leary, A., Arega, H., Hashimi, S., McKenzy-Samson, S., Scott, K., Raine-Bennett, T., Jackson, A., Kupperman, M. and McLemore, M., (2022). Clinician’s Perspectives on Racism and Black Women’s Maternal Health. Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9148644/

Most participants were obstetrician/gynecologists (n = 11, 44%) or certified nurse midwives (n = 8, 32%), had worked in their current role for 1 to 5 years (n = 10, 40%), and identified as white (n = 16, 64%). Three themes emerged from the interviews: provision of inequitable care (e.g., I had a woman who had a massive complication during her labor course and felt like she wasn’t being treated seriously); surveillance of Black women and families (e.g., A urine tox screen on the Black baby even though it was not indicated, and they didn’t do it on the white baby when, in fact, it was indicated); and structural care issues (e.g., the history of medical racial experimentation).

Dayo, E., Christy, K. and Habte, R., (2022). Health in colour; black women, racism and maternal health. Accessed https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(22)00225-3/fulltext

Applying a racial justice lens is critical to contextualizing and addressing racial disparities in maternal health in Canada. To this end, the purpose of this article is to highlight the drivers of the black maternal mortality crisis, explore the shortfalls of Canada’s colourblind approach to healthcare for racialized pregnant people, and to advocate for the collection of disaggregated racial data to better support advancements in Black maternal health.

Hill, L., Artiga, S. and Ranji, U. (2022). Racial disparities in maternal and infant health; Current status and efforts to address them. Accessed https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/

Differences in health insurance coverage and access to care play a role in driving worse maternal and infant health outcomes for people of color. However, inequities in broader social and economic factors and structural and systemic racism and discrimination are primary drivers for maternal and infant health. Notably, disparities in maternal and infant health persist even when controlling for certain underlying social and economic factors, such as education and income, pointing to the roles racism and discrimination play in driving disparities.

Hoyert, D. (2022). Maternal Mortality Rates in the United States, 2020. National Center for Health Statistics – CDC. Accessed https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm

This report presents maternal mortality rates for 2020 based on data from the National Vital Statistics System. A maternal death is defined by the World Health Organization as, “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes”

Mahase, E., (2022). Maternal health: “white” medical curriculum needs overhaul to tackle racial inequalities, campaigners say. Access https://www.bmj.com/content/378/bmj.o1699

Speaking at the NHS Race and Health Observatory conference at BMA House on 7 July, Tinuke Awe, co-founder of Five X More—a campaigning group aimed at tackling the inequalities in maternal health faced by black women and birthing people1—said hiring more black midwives and doctors and increasing representation at all levels would not solve the problem, unless their education was also improved. “We have to remember that the medical curriculum is essentially white. It doesn’t account for a lot of conditions and the way things present in black skin. …

National Museum of African American History & Culture (Smithsonian). 2022). The historical significance of doulas and midwives. Accessed https://nmaahc.si.edu/explore/stories/historical-significance-doulas-and-midwives#:~:text=Early%20African%20American%20midwives%20were,to%20expand%20their%20labor%20force

This Black History Month, the National Museum of African American History and Culture recognizes the importance of Black Health and Wellness. In this blog, we celebrate the unsung work of birth workers like midwives and doulas by exploring their historical and cultural legacy. In our follow-up blog, we’ll explore the challenges faced today by contemporary Doulas and Midwives.

Ray, K. (2022). Clinicians’ racial biases as pathways to iatrogenic harms for black people. Accessed https://edhub.ama-assn.org/ama-journal-of-ethics/module/2794955

From article: Health Care workers harm Black people when they rely on their racial biases to develop care recommendations. For example, one study found that White medical students and residents who endorsed false beliefs about Black people’s tolerance to pain rated the Black patient’s pain as lower than the White patient’s and showed bias in their pain treatment recommendations for Black people.

Rubashkin, M. (2022). Why equitable access to vaginal birth requires abolition of race-based medicine. American Medical Association Journal of Ethics. Accessed https://journalofethics.ama-assn.org/article/why-equitable-access-vaginal-birth-requires-abolition-race-based-medicine/2022-03

CONCLUDES (abstract). In 2010, the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network developed a decision aid, the Vaginal Birth After Cesarean (VBAC) calculator, to help clinicians discern how one variable (race) might influence patients’ success in delivering a baby vaginally following a prior birth by cesarean. The higher rate of cesarean deliveries among Black and Hispanic women in the United States has long demonstrated racial inequities in obstetrical care, however. Although the MFMU’s new VBAC calculator no longer includes race or ethnicity, in response to calls for abolition of race-based medicine, this article argues that VBAC calculator use has never been race neutral. In fact, VBAC calculator use in the United States is laced with racism, compromises patients’ autonomy, and undermines informed consent.

Taylor, J., Bernstein, A., Waldrop, T., and Smith-Ramakrishnan, V. (2022). The worsening U.S. maternal health crisis in three graphs. The Century Foundation. Accessed https://tcf.org/content/commentary/worsening-u-s-maternal-health-crisis-three-graphs/

The United States continues to be an outlier among industrialized nations, with a maternal mortality rate several times higher than other high-income countries. The maternal mortality rate in the United States is nearly three times higher than that of France, the country with the next highest rate.

Taylor, J., Novoa, C., Hamm, K. and Phadke, S. (2022). Eliminating racial disparities in maternal and infant mortality: A comprehensive policy blueprint. Center for American Progress. Accessed https://www.americanprogress.org/article/eliminating-racial-disparities-maternal-infant-mortality/

CONCLUDED: “The needless, preventable deaths of African American mothers and infants is a national tragedy and disgrace. Eliminating racial disparities in maternal and infant mortality must be a priority for the United States. As articulated in this report, there is no single policy solution that will solve this public health crisis—the approach must be comprehensive and multipronged.” (material omitted).

Wisner, W. (2022). Maternal death shows that ‘racism does exist among physicians’. Accessed https://www.medscape.com/viewarticle/982865

Black mothers giving birth in hospitals are 53% more likely to die during childbirth than are Hispanic and White women, according to researchers who attributed the gap at least in part to bias among physicians and the healthcare system

2021

Alson, J. G., Robinson, W. R., Pittman, L., & Doll, K. M. (2021). Incorporating Measures of Structural Racism into Population Studies of Reproductive Health in the United States: A Narrative Review. Health Equity, 5(1), 49–58. https://doi.org/10.1089/heq.2020.0081

Conclusion: There are quantitative measures of systemic racism available for incorporation into population studies of reproductive health that investigate hypotheses, including and beyond those related to maternal and infant health. There are also promising areas for future measure development, such as the child welfare system and intersectionality. Incorporating such measures is critical for appropriate assessment of and intervention in racial inequities in reproductive health outcomes.

Campbell. C. (2021). MEDICAL VIOLENCE, OBSTETRIC RACISM, AND THE LIMITS OF INFORMED CONSENT FOR BLACK WOMEN. Michigan Journal of Race & Law, 26, 47–75. Accessed: https://repository.law.umich.edu/mjrl/vol26/iss0/4/

CONCLUDED: “Being legally and bioethically empowered means being able to push back against these edifices that continue to mar Black women’s bodies. For some, this might require nothing short of herculean fortitude—an untenable and cruel expectation considering the demands on the body and will during childbirth. More than anything, the ‘problem’ of Black women’s reproductive health and agency must be understood as that of a defective health care system and a legal apparatus that is ill-equipped to cure such defect—not defective bodies. Indeed, this discourse must be situated within the context of the forces of overmedicalization and obstetric racism, which preclude Black women from accessing not only informed consent, but the full spectrum of reproductive rights.”

Cidro, Doenmez, C., Sinclair, S., Nychuk, A., Wodtke, L., & Hayward, A. (2021). Putting them on a strong spiritual path: Indigenous doulas responding to the needs of Indigenous mothers and communities. International Journal for Equity in Health, 20(1), 1–189. https://doi.org/10.1186/s12939-021-01521-3 Accessed: https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-021-01521-3

CONCLUDED “The interviews reveal that the work of Indigenous doulas is really about a cultural resurgence and a recognition that the current systems in place cause harm and damage to Indigenous women. The systemic racism that Indigenous expectant women face both in medical and social service settings continues to have deleterious outcomes. As one participant states, “every Indigenous family who wants a doula should have one.” Until we have medical systems and social services that no longer perpetuate racism, Indigenous doulas have an integral role to play”.

Campbell, C. (2021). Medical violence, obstetric racism and the limits of informed consent for black women. https://doi.org/10.36643/mjrl.26.sp.medical Accessed https://repository.law.umich.edu/mjrl/vol26/iss0/4/

Abstract: “This Essay critically examines how medicine actively engages in the reproductive subordination of Black women. In obstetrics, particularly, Black women must contend with both gender and race subordination. Early American gynecology treated Black women as expendable clinical material for its institutional needs. This medical violence was animated by biological racism and the legal and economic exigencies of the antebellum era. Medical racism continues to animate Black women’s navigation of and their dehumanization within obstetrics. Today, the racial disparities in cesarean sections illustrate that Black women are simultaneously overmedicalized and medically neglected—an extension of historical medical practices rooted in the logic of biological race. Though the principle of informed consent traditionally protects the rights of autonomy, bodily integrity, and well-being, medicine nevertheless routinely subjects Black women to medically unnecessary procedures. This Essay adopts the framework of obstetric racism to analyze Black women’s overmedicalization as a site of reproductive subordination. It thus offers a critical interdisciplinary and intersectional lens to broader conversations on race in reproduction and maternal health.”

Collins, C. C., Rice, H., Bai, R., Brown, P. L., Bronson, C., & Farmer, C. (2021). “I felt like it would’ve been perfect, if they hadn’t been rushing”: Black women’s childbirth experiences with medical providers when accompanied by perinatal support professionals. Journal of Advanced Nursing, 77(10), 4131–4141. https://doi.org/10.1111/jan.14941

CONCLUDED: “The findings emphasize the need for medical providers to be patient-centred, set aside assumptions, treat their patients as experts, value women’s knowledge and voice, and treat patients and their supports as part of the team.”

Crear-Perry, J. Green, C. and Cruz, K. (2021). Respectful maternity care: Shifting medical education and practice toward an anti-racist framework. Accessed https://www.healthaffairs.org/do/10.1377/forefront.20210413.303812/full/

In this post, we examine the historical shifts from predominantly midwife-attended birth to predominantly physician-attended birth in this country, and how that has centered providers while marginalizing birthing people, especially those who are Black. We, then, explore how clinicians are socialized into the provider-dominant clinical culture, by outlining the process from medical residency to practice. To identify opportunities to improve the field’s capacity for respectful care, we explore how medicine is rooted in biased frameworks that bear biased fruit, how systems accountability works to reify medical racism, and how a new standard of respectful care can be liberatory for both patients and providers.

Goode, & Bernardin, A. (2021). Birthing #blackboyjoy: Black Midwives Caring for Black Mothers of Black Boys During Pregnancy and Childbirth. Maternal and Child Health Journal, 26(4), 719–725. https://doi.org/10.1007/s10995-021-03224-1

CONCLUDED “Thus, structural racism is a public health issue (Alang et al., 2017; Owens & Fett, 2019). Birth workers, in addition to best caring for physical wellbeing, must also attend to psychosocial wellbeing. Caring for Black mothers of Black boys in the U.S. demands specialized attention because Black mothers of Black boys’ experiences—manifesting in and on their bodies—demands specialized care. Caring for Black pregnant and birthing people must be simultaneously theorized and executed within an anti-racist, relationshipcentered, reproductive justice framework (Hardeman et al., 2019; Julian et al., 2020). For Black midwives to meet the ever-growing demand of caring for Black pregnant and birthing people, their rightful place in midwifery and the history of the country must be restored (Goode & Katz Rothman, 2017).” (Material Omitted)

Hayward, A., & Cidro, J. (2021). Indigenous Birth as Ceremony and a Human Right. Health and Human Rights, 23(1), 213–224. Accessed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233033/

CONCLUDED (from abstract) “Birthing can be an empowering experience for women. Within many Indigenous cultures around the world, birth is a ceremony to celebrate new life, acknowledging the passing from the spiritual world into the physical world. While initiatives to “indigenize” health care have been made, this paper argues that the United Nations Declaration on the Rights of Indigenous Peoples and the United Nations Sustainable Development Goals contain frameworks for Indigenous rights that include the right to incorporate Indigenous childbirth ceremonies into clinical practice. Examining the importance of birthplace, this paper details a current movement in Manitoba, Canada, to “bring birth home,” which recognizes that the determinants of health experienced in the early stages of a child’s development can have health implications for an individual’s future.”

Hernandez-Cancio, S and Gray, V. (2021). Moms and baby series: Racism hurts moms and babies. Accessed https://www.nationalpartnership.org/our-work/resources/health-care/racism-hurts-moms-and-babies.pdf

Science is catching up to the truth communities of color have known for generations: that experiencing racism throughout one’s life course damages one’s long-term health. “Race” is not the cause of these inequities. Race is a social construct; there is no gene or cluster of genes that belong to any racial group. It is not “Blackness,” “Indianness,” “Latinaness,” or “Asianness” that makes people sicker and shortens their lives, it is living in a country rife with structural and interpersonal racism. Structural racism heaps environmental, economic, and social risks on communities of color, while keeping white neighborhoods safer. Communities of color are stripped of the resources needed to protect themselves and be healthy, as white neighborhoods as close as just one zip code over enjoy health sustaining assets – from better schools, to clean water and air, to safe streets and parks and playgrounds. The exploding interest in addressing social determinants of health is based on addressing these inequities.

Katon, J. Enquobahrie, D., Jacobsen, K. and Zephyrin, L. (2021). Policies for reducing maternal morbidity and mortality and enhancing equity in maternal health. Commonwealth Fund. Accessed https://www.commonwealthfund.org/publications/fund-reports/2021/nov/policies-reducing-maternal-morbidity-mortality-enhancing-equity

CONCLUDED: “There is a maternal health crisis in the United States. The number of pregnant and birthing people dying more than doubled between 1987 and 2018 rising from 7.2 deaths per 100,000 to 17.4 deaths per 100,000. Moreover, racial disparities are stark…” (Material Omitted).

Kozhimannil KB, Almanza J, Hardeman R, Karbeah J. Racial and Ethnic Diversity in the Nursing Workforce: A Focus on Maternity Care. Policy, Politics, & Nursing Practice. 2021;22(3):170-179. doi:10.1177/15271544211005719 Accesed https://journals.sagepub.com/doi/10.1177/15271544211005719?icid=int.sj-abstract.similar-articles.3

Racial and ethnic inequities in health are a national crisis requiring engagement across a range of factors, including the health care workforce. Racial inequities in maternal and infant health are an increasing focus of attention in the wake of rising rates of maternal morbidity and mortality in the United States. Efforts to achieve racial equity in childbirth should include attention to the nurses who provide care before and during pregnancy, at childbirth, and postpartum

Mujahid, M. S., Kan, P., Leonard, S. A., Hailu, E. M., Wall-Wieler, E., Abrams, B., Main, E., Profit, J., & Carmichael, S. L. (2021). Birth hospital and racial and ethnic differences in severe maternal morbidity in the state of California. American Journal of Obstetrics and Gynecology, 224(2), 219.e1–219.e15. https://doi.org/10.1016/j.ajog.2020.08.017

In California, excess odds of severe maternal morbidity among racially and ethnically minoritized women were not fully explained by birth hospital. Structural causes of racial and ethnic disparities in severe maternal morbidity may vary by region, which warrants further examination to inform effective policies.

NIH National Heart, Lung and Blood Institute. Systemic racism, a key risk factor for maternal death and illness. Accessed https://www.nhlbi.nih.gov/news/2021/systemic-racism-key-risk-factor-maternal-death-and-illness

Racial and ethnic disparities – key drivers of worsening outcomes for women and babies – emerged as a focus of the issue, but researchers sought to move away from a conventional analysis of the problem. Crear-Perry, lead author of a paper on the social and structural determinants of inequities in maternal health, explained why racism, classism, and gender oppression are at the root of unequal health outcomes – not simply the conditions in which people are born, grow, live, work, play, and age. These so-called social determinants of health have long been used as ready explanations for health disparities, Crear-Perry noted. But they tend to distort what’s really going on, she said.

Russell, S. (2021). Eradicating racism from maternity care begins with addressing implicit bias. Accessed https://www.sciencedirect.com/science/article/pii/S175148512100074X

Black women have long experienced racism in various areas of their lives. Pregnancy is one of the times in a woman’s life when she is most vulnerable, and she should not have to worry that her health care will be subpar simply because she is Black. Most health care providers do not intend to harm their patients; however, systemic racism and the unconscious biases we hold may cause harm. Training nurses and other health care providers about implicit bias is one step toward eradicating racism from maternity care

Simpson, K. (2021). Racism in maternity care is a public health crisis in the United States. Accessed https://journals.lww.com/mcnjournal/Citation/2021/09000/Racism_in_Maternity_Care_is_a_Public_Health_Crisis.1.aspx

There is ample evidence that racism is a public health crisis in the United States. In maternity care, racism as a factor in maternal morbidity and mortality is highlighted in the significant disparities in outcomes when comparing women of various racial and ethnic backgrounds. The National Center for Health Statistics reported over 750 women in the United States died of maternal causes in 2019. Deaths are higher among women in minorized groups, identified by the National Vital Statistics System as non-Hispanic Black women. Recent evidence about maternal mortality and reports suggesting ways to improve maternity care in the United States are reviewed.

Taylor, J. (2021). Structural racism as a root cause of America’s Black maternal health crisis. Accessed https://tcf.org/content/commentary/structural-racism-root-cause-americas-black-maternal-health-crisis/

According to the CDC, Black women are dying of pregnancy-related causes more than any other racial or ethnic group. We are also most likely to experience severe maternal morbidity. Poor maternal health outcomes among Black women cannot solely be attributed to social determinants, such as poverty or educational attainment. Rather, structural racism is the main culprit. Racism cannot be understood as simply interpersonal bias and animus. It is a powerful social condition that has its roots in a centuries-long system of oppression and devaluing of Black people, and Black women, in particular. It not only persists today in our health care policies and practices—it has real, significant impacts on people’s health.

Thorngate, S. (2021). Race, information and power in perinatal care and childbirth. Accessed https://www.ala.org/acrl/sites/ala.org.acrl/files/content/conferences/confsandpreconfs/2021/RaceInformationPower.pdf

CONCLUDED “To conclude, my goal in analyzing a specific type of actually existing information interaction in this paper was to render visible the power dynamics surrounding the use of information in our everyday social worlds. I acknowledge that I raise more questions here than I provide answers, but my hope is to prompt both myself and other white female librarians to carefully consider how our understanding of information literacy may be specific to our particular social locations. Because if we keep framing information literacy in terms of white women’s experience, without fully considering how race and class privilege shape those experiences, without addressing the underlying power structures that both necessitate information literacy and enable it to perform the work of reproducing racial inequality, then it will not be “empowering” for anyone but us. It will tend towards upholding rather than challenging structures of oppression. “

U.S. Commission on Civil Rights (2021). Racial Disparities in Maternal Health. Accessed https://www.usccr.gov/files/2021/09-15-Racial-Disparities-in-Maternal-Health.pdf

Over the past two decades, the U.S. maternal mortality rate has not improved while maternal mortality rates have decreased for other regions of the world.3 Furthermore, the rate at which women in the U.S. experience short-term or long-term negative health consequences due to unexpected outcomes of pregnancy or childbirth has also steadily increased over the past few decades, with nearly 50,000 women in the U.S. experiencing these health consequences in 2014.4 Significant racial and ethnic disparities persist in both the rate of women in the U.S. who die due to complications of pregnancy or delivery and the rate that women experience negative health consequences due to unexpected pregnancy or childbirth outcomes.

Wheelock, S., Zezza, M. and Athens, J. (2021). Racial and ethnic disparities in severe maternal morbidity in New York City and State. New York State Health Foundation.. Accessed https://nyhealthfoundation.org/wp-content/uploads/2021/04/NYSHealth-Presentation.pdf Full report available at https://nyhealthfoundation.org/wp-content/uploads/2020/08/severe-maternal-morbidity.pdf

CONCLUDED: (from executive summary) Disparities in severe maternal morbidity by race and ethnicity have been well documented in prior research, nationally and for New York State.13,14,15 Several studies focused on births in New York City, where minority racial and ethnic groups make up more than half of the population, also show these disparities.16,17,18 Importantly, many of these studies controlled for differences in health status using data on comorbidities for each pregnant woman—implying that, regardless of how healthy they were before giving birth, minority women were more likely than their white counterparts to have serious complications. Some studies also controlled for other factors, including sociodemographic characteristics, educational attainment, access to prenatal care, and neighborhood characteristics as a proxy for socioeconomic status. Even after adjusting for these factors, significant disparities in SMM rates across racial and ethnic groups remained.

U.S. House of Representatives Black Maternal Health Caucus (2021). About the Black maternal health Momnibus Act of 2021. Accessed https://blackmaternalhealthcaucus-underwood.house.gov/Momnibus

In the richest nation on earth, moms are dying at the highest rate in the developed world – and the rate is rising. For as dire as the situation is for all women and birthing people, the crisis is most severe for Black moms, who are dying at 3 to 4 times the rate of their white counterparts. Native Americans are more than twice as likely to die from pregnancy-related causes. One study found that in New York City, Hispanic birthing people experienced severe maternal morbidity at 1.8 times the rate of non-Hispanic white birthing people. Other research has shown that Asian Americans and Pacific Islanders (AAPI) have higher rates of maternal mortality during hospitalization for delivery, even after accounting for other factors that affect outcomes.

2020

Center for Reproductive Rights (2020). Maternal Health in Louisiana. Accessed https://reproductiverights.org/wp-content/uploads/2020/12/USPA-MHRI-LA-FS-FINAL-Update.pdf

Maternal mortality in Louisiana is increasing at a rate that exceeds the national average.1 Both nationally and locally, negative maternal health outcomes for Black women are disproportionately high. Louisiana’s own experts believe that nearly half of confirmed pregnancy-related deaths in the state are preventable.2 Public policies that seek to improve maternal health must be informed by evidence, respect human rights, and enable every pregnant person in Louisiana to attain the best health possible.

Chosid, H. (2020). Indigenous midwives. Accessed https://www.wilsoncenter.org/event/indigenous-midwives

CONCLUDED (from page) “Expanding access to education for Indigenous midwifery programs is essential to the continuing resurgence of Indigenous midwifery. Māori midwives bring high school students with them to work to recruit younger Māori women to become midwives, said Pihema. They try to get younger people in their communities involved in these practices, especially by encouraging young people to access scholarships to midwifery programs. Increased access to education is important and midwifery programs at universities should be made more accessible to Indigenous women, and community-led Indigenous midwifery programs should be expanded, said Fletcher.”

Cidro, Bach, R., & Frohlick, S. (2020). Canada’s forced birth travel: towards feminist indigenous reproductive mobilities. Mobilities, 15(2), 173–187. https://doi.org/10.1080/17450101.2020.1730611 Accessed https://www.tandfonline.com/doi/full/10.1080/17450101.2020.1730611

CONCLUDED: “Our analysis of Canada’s forced birth travel and its mobilizing effects on Indigenous women in Canada supports an emergent lens of Indigenous reproductive mobilities. Indigenous women are reclaiming sovereignty over their bodies and birth experiences through the mobilization of culturally-based doulas and in so doing, are challenging the settler colonial project in Canada, which underpins mandatory birth evacuation. ” (material omitted

COURTOT, B., HILL, I., CROSS‐BARNET, C., & MARKELL, J. (2020). Midwifery and Birth Centers Under State Medicaid Programs: Current Limits to Beneficiary Access to a High-Value Model of Care. The Milbank Quarterly, 98(4), 1091–1113. https://doi.org/10.1111/1468-0009.12473 Accessed https://www.milbank.org/quarterly/articles/midwifery-and-birth-centers-under-state-medicaid-programs-current-limits-to-beneficiary-access-to-a-high%E2%80%90value-model-of-care/

Medicaid beneficiaries do not have the same access to maternity care providers and birth settings as their privately insured counterparts. Medicaid policy barriers prevent some birth centers from serving more Medicaid patients, or threaten the financial sustainability of centers. By addressing these barriers, more Medicaid beneficiaries could access care that is associated with positive birth outcomes for mothers and newborns, and the Medicaid program could reap significant savings.

Davis, D.-A. (2020). Reproducing while Black: the crisis of Black maternal health, obstetric racism and assisted reproductive technology. Reproductive Biomedicine & Society Online, 11, 56–64. https://doi.org/10.1016/j.rbms.2020.10.001

From abstract: Black women bear the burden of a number of crises related to reproduction. Historically, their reproduction has been governed in relation to the slave economy, and connected to this, they have been experimented upon and subjected to exploitative medical interventions and policies. Even now, they are more likely to experience premature births and more likely to die from pregnancy-related complications. Their reproductive lives have been beleaguered by racism.

Drew, M and Reis, P. (2020). Black lives matter; a message and resources for midwives. Journal of Midwifery and Women’s Health. Accessed https://onlinelibrary.wiley.com/doi/full/10.1111/jmwh.13155

We worry for the mothers we care for. We look at all that impedes their ability to thrive, but in real time we reconcile how to help them simply survive birthing their babies. What does the future hold as these babies grow? Will they be future nurses, physicians, or skilled tradespersons? Or will they be killed by someone who views them as a threat for just existing? We ask these questions in a nation designed to keep us spiritually terrorized, although we already know the answers.

Ellmann, N. (2020) Community based doulas and midwives: Key to addressing the U.S. maternal health crisis. Center for American Progress. Accessed https://www.americanprogress.org/issues/women/reports/2020/04/14/483114/community-based-doulas-midwives/

CONCLUDED (material omitted) “It is crucial that policymakers recognize the importance of doulas and midwives and seek to incorporate their work in developing solutions to the maternal health crisis. Just as importantly, lawmakers must center the voices and follow the guidance of the individuals doing the work—most critically, those who are embedded in the communities most affected by the maternal health crisis—in any policy decisions that affect their practice and livelihoods.”

Hardeman, R. R., Karbeah, J., & Kozhimannil, K. B. (2020). Applying a critical race lens to relationship‐centered care in pregnancy and childbirth: An antidote to structural racism. Birth (Berkeley, Calif.), 47(1), 3–7. https://doi.org/10.1111/birt.12462 Accessed https://pretermbirthca.ucsf.edu/sites/g/files/tkssra2851/f/wysiwyg/Hardeman%20-%202019%20-%20Applying%20a%20critical%20race%20lens%20to%20relationship%E2%80%90centered%20care%20in%20pregnancy%20and%20childbirth-%20An%20antidote%20to%20structural%20racism.pdf

CONCLUDED “Critical race theory provides a structural lens to explore and understand relationship‐centered care and its power to improve clinical experiences and birth outcomes for pregnant Black people. Although relationship‐centered care itself as put forth by Beach and colleagues offers a transformative approach to care that centers the patient, inclusion of a critical race framework is required to make progress toward birth equity. New and innovative models of care delivery that center the lived experience of Black people and specifically highlight how racism influences health are urgently needed. These models offer a pathway through which we can begin to chip away at the persistent inequities experienced by Black birthing people”

Holmes, O’Neill, L., Elmi, H., Chinacherem, C., Comeaux, C., Pelaez, L., Dabney, K. W., Akinola, O., & Enwere, M. (2020). Implication of Vaginal and Cesarean Section Delivery Method in Black-White Differentials in Infant Mortality in the United States: Linked Birth/Infant Death Records, 2007-2016. International Journal of Environmental Research and Public Health, 17(9), 3146–. https://doi.org/10.3390/ijerph17093146 Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246527/

CONCLUDED: In summary, there are racial disparities in infant mortality, which were explained in part by the labor and delivery method comparing vaginal to cesarean section. However, due to the aggregate nature of these data, caution is required in the application of these findings and in intervention mapping in reducing the Black–White infant mortality risk differences. Further, these findings recommend effective policy formulation, implementation, and evaluation in understanding the cause of causes mainly, social gradient in addressing the perpetually and persistently observed racial gap in infant mortality in the USA

Landry, A. (2020). As an indigenous woman, I was scared to have my baby in a hospital. Today’s Parent. Accessed https://www.todaysparent.com/pregnancy/giving-birth/indigenous-woman-scared-to-give-birth-in-a-hospital/#

CONCLUDED: (from article) “There was so little trust placed on my body. Instead, all the trust went into the medication and the medical processes. I think my body wouldn’t have fought so hard against the medications and labour-inducing hormones if the birth team had followed my lead and what I know my body was designed to do. Ultimately, the colonial healthcare system decided my birth plan, and erased the Indigenous birthing practices that were most important to us.”

Quickening. (2020). Valuing the lives of all mothers. Accessed https://quickening.midwife.org/roundtable/eliminating-racial-disparities-contributing-to-the-rise-in-u-s-maternal-mortality-perspectives-from-acnm-bmma-and-icm/

CONCLUDED (from text) “If you are a black woman in America, your risks of dying of a cause related to pregnancy are 3-4 times greater than white women. Other women of color—notably American Indian and Alaska Native—are at a similar risk, but the racial disparities between black women and white women are the most severe. Black History Month reminds us about the critical work that lies ahead in valuing the lives of all mothers equally, eliminating racial disparities, addressing explicit and implicit biases, and making the U.S. a safer and more equitable place to give birth.”

Simpson, A. (2020). Fearing coronavirus, many rural black women avoid hospitals to give birth at home. Accessed https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2020/04/17/fearing-coronavirus-many-rural-black-women-avoid-hospitals-to-give-birth-at-home

From article: “But even before this pandemic, some black women were reluctant to deliver their babies in hospitals, Grayson said. Experts point to systemic health care inequities and institutional racism. Black women often delay prenatal care to avoid racist experiences with the health care system, and are more likely to experience racial discrimination, according to studies republished by the National Institutes of Health. And when they express their concerns to medical professionals, they’re often not heard. Even tennis star Serena Williams had to demand a CT scan and blood thinner when she experienced shortness of breath following a C-section and feared she may have had a blood clot.”

2019

Centers for Disease Control RACIAL AND ETHNIC DISPARITIES CONTINUE IN PREGNANCY-RELATED DEATHS. (2019). US Fed News Service, Including US State News. Accessed https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html

Black, American Indian, and Alaska Native (AI/AN) women are two to three times more likely to die from pregnancy-related causes than white women – and this disparity increases with age, researchers from the Centers for Disease Control and Prevention (CDC) report today in the Morbidity and Mortality Weekly Report (MMWR). Most pregnancy-related deaths are preventable. Racial and ethnic disparities in pregnancy-related deaths have persisted over time.

Chicago Department of Public Health (2019). Maternal morbidity and mortality in Chicago. Accessed https://www.chicago.gov/dam/city/depts/cdph/statistics_and_reports/CDPH-002_MaternalMortality_Databook_r4c_DIGITAL.pdf

Pregnancy can be one of the most exciting experiences in a family’s life. While most pregnancies result in healthy mothers and babies, many women experience adverse outcomes during or after pregnancy. Each woman’s body responds to pregnancy uniquely, but social and environmental factors—including racism, toxic stress, and access to care—also have great influence over a woman’s health. With the realization that pregnant and postpartum women in the United States, especially women of color, are experiencing adverse outcomes at increasing rates, more attention is being focused on maternal health and the disparities seen

Eastern Virginia Medical School (2019). When childbirth is deadly. EVMS Digital Magazine. Issue 11.2. Accessed https://www.evms.edu/about_evms/administrative_offices/marketing_communications/publications/issue_11_2/feature_when_childbirth_is_deadly/

Nationally, black women are 243 percent more likely to die from pregnancy or childbirth-related causes than white women. In Virginia, it’s worse. Black women are 300 percent more likely to die in childbirth than white women, reports the Virginia Department of Health.

Hardeman, R., Karbeah, J. Kozhimannil,K. (2019) Applying a critical race lens to relationship-centered care in pregnancy and childbirth: An antidote to structural racism. https://doi.org/10.1111/birt.12462 Accessed https://onlinelibrary.wiley.com/doi/full/10.1111/birt.12462

From intro “Achieving racial equity in childbirth care is critical to the health and well-being of our nation. Black infants are more than twice as likely as White infants to die before reaching their first birthday, and Black individuals who experience reproduction are 3-4 times more likely to experience a complication or death related to childbirth.1 These inequities are one clear manifestation of structural racism—a form of racism that lacks an identifiable perpetrator but is instead the codification and legalization of society’s unequal allocation of resources and opportunity based on an established racial hierarchy.2, 3 Clinical care during pregnancy and childbirth is an important determinant of perinatal-infant outcomes; however, for Black birthing people, care in the medical context does not consistently meet their clinical needs.4 In addition, racial discrimination and experiences of interpersonal racism such as implicit racial bias and microaggressions during clinical encounters create disproportionate barriers to high-quality, respectful, patient-centered care experienced by Black people”

McDonald, Amatya, A., Gard, C. C., & Sigala, J. (2019). In States That Border Mexico, Cesarean Rates Were Highest For Hispanic Women Living In Border Counties In 2015. Health Affairs, 38(2), 276–286. https://doi.org/10.1377/hlthaff.2018.05369

Concluded: “Given that high cesarean rates reflect medically inappropriate use of this procedure,i3 attempts should be made to address high rates among Hispanic women, particularly in border counties. To date, however, high-quality evidence of success following interventions to reduce cesarean rates is minimal. A 2011 review of nonclinical interventions to reduce “unnecessary cesarean section” found little evidence that maternal education, guidelines, second opinions, peer review, or policy or legislative reform have had a major impact on the problem.40 Other reviews and intervention evaluations41,42 have also con- eluded that most interventions have had small impacts. One exception is an evaluation of the change in nulliparous cesarean rates after implementation of training and provider guidelines in a North Carolina hospital network, which reported a decline in the cesarean rate from 28 percent to 20 percent.43″

Nash, J. C. (2019). Birthing Black Mothers: Birth Work and the Making of Black Maternal Political Subjects. Women’s Studies Quarterly, 47(3/4), 29–50. https://doi.org/10.1353/wsq.2019.0054 Accessed https://carleton.ca/womensstudies/wp-content/uploads/project_muse_736603.pdf

CONCLUDED: (material omitted) “Indeed, the only bodies mobilized to care for black women’s lives are other women of color, and that care is increasingly described not as work but as a “community service,” as a labor of love, and thus as something that need not be compensated. The ongoing task of contending with the hospital, the doctor, or the insurance system, as the crisis—and not black women’s bodies as the crisis—remains the site where feminist intervention is most urgent.’

Peterson, E., Davis, M., Goodman, D., Cox, S. Syverson, C., Seed, K., Shapiro-Mendoza, C., Callaghan, W., and Barfield, W. (2019). Racial/Ethnic Disparities in pregnancy-related deaths – United States 2007 – 2016. (Center for Disease Control) Accessed https://www.cdc.gov/mmwr/volumes/68/wr/mm6835a3.htm

CONCLUDED: “During 2007–2016, black and American Indian/Alaska Native women had significantly more pregnancy-related deaths per 100,000 births than did white, Hispanic, and Asian/Pacific Islander women. Disparities persisted over time and across age groups and were present even in states with the lowest pregnancy-related mortality ratios and among groups with higher levels of education. The cause-specific proportion of pregnancy-related deaths varied by race/ethnicity.”

Suarez, A. (2019). Black midwifery in the United States: Past, present and future. Accessed https://mamazur.org/wp-content/uploads/2021/03/Suarez-Alicia-2020.-Black-midwifery-in-the-United-States.pdf

Midwifery care typically leads to excellent physical and emotional outcomes for low‐risk mothers and infants, and reduces reliance on medical interventions. As the United States currently has alarming racialized rates of maternal and infant mortality despite vast medicalization, there is much to consider about increasing access to midwifery care in the United States.

Taylor, J., Novoa, C. and Hamm, K. (2019) Eliminating racial disparities in maternal and infant mortality: A compreshensive policy blueprint. Accessed https://www.americanprogress.org/article/eliminating-racial-disparities-maternal-infant-mortality/

Intro: If the fact that the United States has the highest maternal and infant mortality rates among comparable developed countries is not bad enough, the survival rates for African American mothers and their infants are even more dismal.¹ African American women across the income spectrum and from all walks of life are dying from preventable pregnancy-related complications at three to four times the rate of non-Hispanic white women,² while the death rate for black infants is twice that of infants born to non-Hispanic white mothers.

Terreri, C. (2019). Black History Month: The importance of black midwives: Then, now and tomorrow. Accessed https://www.lamaze.org/Connecting-the-Dots/black-history-month-the-importance-of-black-midwives-then-now-and-tomorrow-1

Midwives and specifically Black midwives, for centuries, have played a critical role in improving the care and outcomes for Black families. At the same time, Black midwives have also faced extra, unnecessary, and often extreme and insurmountable challenges to practicing and serving the families in need of their care.

Vilda, D., Wallace, M., Dyer, L., Harville, E., and Theall, K. (2019). Income inequality and racial disparities in pregnancy-related mortality in the US. https://doi.org/10.1016/j.ssmph.2019.100477 Accessed https://www.sciencedirect.com/science/article/pii/S2352827319301673#:~:text=Across%20all%20states%2C%20increasing%20contemporaneous,controlling%20for%20states’%20racial%20compositions

From abstract: “Across all states, increasing contemporaneous income inequality was associated with a 15% and 5-year lagged inequality with 14% increase in pregnancy-related mortality among black women (aRR = 1.15, 95% CI = 1.05; 1.25 and aRR = 1.14, 95% CI = 1.04; 1.24, respectively) after controlling for states’ racial compositions and socio-economic conditions. In addition, both lagged and contemporaneous income inequality were associated with larger absolute and relative racial inequities in pregnancy-related mortality. These findings highlight the role of contextual factors in contributing to pregnancy-related mortality among black women and the persistent racial inequity in maternal death in the US.”

Warren, K. (2019). ‘We can help ourselves’: Native women come together to confront high rates of maternal mortality. Cronkite News. Accessed https://cronkitenews.azpbs.org/2019/12/16/native-american-maternal-mortality/

CONCLUDED: (from text): “But even in communities where accessibility is less of an issue, the approaches of Western medicine often don’t align with the values and practices of Native American culture.”

2018

Adams, C., & Thomas, S. P. (2018). Alternative prenatal care interventions to alleviate Black–White maternal/infant health disparities. Sociology Compass, 12(1), e12549–n/a. https://doi.org/10.1111/soc4.12549

CONCLUDED “In this paper, we proposed three sociological bodies of literature that can improve critical analyses of standard prenatal care and help scholars understand the utility of alternative models of prenatal care for African American women. Intersectionality, in particular, allows us to position African American women in the broader socio‐historical institutional milieu to understand how their marginalization may affect their pregnancy and childbirth experiences. While intersectionality has been used to study a wide variety of topics, few scholars have investigated how the intersections of gender, race, and class contribute to African American women’s maternal health (Roberts, 2014). More research is needed to explore the reasons why minority women fail to use alternative caregivers, investigating barriers such as unfamiliarity with alternatives to obstetricians, financial constraints, a lack of access to alternative caregivers in their geographical area, and a lack of access to minority alternative caregivers, among others. Research should also investigate the professional challenges facing minority doulas and midwives, as these challenges may prevent minority women from utilizing alternative caregivers, which in turn may affect the maternal and infant health benefits discussed in this paper associated with the use of midwives and doulas.”

Gamlin, J., & Holmes, S. (2018). Preventable perinatal deaths in indigenous Wixárika communities: an ethnographic study of pregnancy, childbirth and structural violence. BMC Pregnancy and Childbirth, 18(1), 243–243. https://doi.org/10.1186/s12884-018-1870-6 Accessed https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1870-6

CONCLUDED: (material omitted) “Structural factors determine how and where women decide to give birth, why they choose unassisted births at home over health facility births, and ultimately how likely they are to experience perinatal deaths. While common frameworks for understanding maternal health in medicine and public health indicate that women must be educated to seek prenatal and obstetric care in a timely fashion, our research indicates that many indigenous women in Latin America have good reason for avoiding medical care. Thus, medical and public health interventions to improve childbirth and maternal survival rates must not focus only on the knowledge, beliefs and behaviours of mothers, but perhaps more importantly on the organization of health care, the attitudes and practices of health professionals in relation to indigenous women, and societal gender equity. These are important, achievable targets for a middle-income country.”

Howell E. A. (2018). Reducing Disparities in Severe Maternal Morbidity and Mortality. Clinical obstetrics and gynecology, 61(2), 387–399. https://doi.org/10.1097/GRF.0000000000000349 Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915910/

CONCLUDED “Significant racial and ethnic disparities in maternal outcomes exist in the United States and there is an urgent need to reduce disparities. A growing body of research acknowledges the role that structural racism plays in generating these disparities. The complex nature of racial and ethnic disparities in severe maternal morbidity and mortality rates requires a multipronged approach to reduce their occurrence. A comprehensive approach to quality improvement throughout the care continuum (from preconception to postpartum and inter-pregnancy care) is required to reduce racial and ethnic disparities in severe maternal morbidity and mortality rates.”

Klasing, A. (2018). Valuing Black women’s and infants’ lives in the U.S. Access https://www.hrw.org/news/2018/04/13/valuing-black-womens-and-infants-lives-us

Around the world every single day 800 women and girls die from preventable causes during and after pregnancy. Human Rights Watch has documented some of the root causes of these deaths – lack of accountability of health professionals to poor quality care to considerable cost barriers to care. In many countries, this number is dropping. But in the United States – one of the world’s richest countries – it’s rising. Many people would be shocked to learn that at least two women and girls die from pregnancy-related causes each day here. Shamefully, Black women are more than three times as likely to die than white women.

Marini, J. (2018). Caring for maternal health needs in indigenous communities with local midwives. Accessed https://womendeliver.org/2018/maternal-health-needs-indigenous-communities-local-midwives

CONCLUDED “A common approach is to focus on the medicalization of birth and force indigenous women to travel to health facilities, but this does not consider cultural perceptions of birth. For instance, many groups view delivery as a ceremony with important ritual and celebration. Further, several studies found that mainstream hospital practices are increasingly disrespectful to the needs of Native women. Therefore, a growing number of indigenous women feel more comfortable with midwives from their communities”.

National Birth Equity Collaborative (2018). Black maternal health inequities; New York State task force on maternal mortality and disparate racial outcomes in 2018 https://www.health.ny.gov/community/adults/women/task_force_maternal_mortality/docs/meeting1/2018-06_crear-perry_nys_mm.pdf

Presentation re: systemic racism in maternal healthcare

National Partnership for Women and Families (2018). Black women’s maternal health; a multifaceted approach to addressing persistent and dire health disparities. Accessed https://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html

Black women deserve to have safe and healthy pregnancies and childbirth. To meaningfully improve Black maternal health outcomes, we need systemic change that starts with the health care system, improves access to care and makes the places Black women live and work healthier, more fair and more responsive to their needs. Only when we do that will Black women be able to achieve their optimal health and well-being throughout their lifespan, including if they choose to become parents.

Owens, D. and Fett, S. (2019) Black maternal and infant health: Historical legacies of slavery. Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727302/

The legacies of slavery today are seen in structural racism that has resulted in disproportionate maternal and infant death among African Americans. The deep roots of these patterns of disparity in maternal and infant health lie with the commodification of enslaved Black women’s childbearing and physicians’ investment in serving the interests of slaveowners. Even certain medical specializations, such as obstetrics and gynecology, owe a debt to enslaved women who became experimental subjects in the development of the field. Public health initiatives must acknowledge these historical legacies by addressing institutionalized racism and implicit bias in medicine while promoting programs that remedy socially embedded health disparities.

Vang, Gagnon, R., Lee, T., Jimenez, V., Navickas, A., Pelletier, J., & Shenker, H. (2018). Interactions Between Indigenous Women Awaiting Childbirth Away From Home and Their Southern, Non-Indigenous Health Care Providers. Qualitative Health Research, 28(12), 1858–1870. https://doi.org/10.1177/1049732318792500 Accessed https://journals.sagepub.com/doi/10.1177/1049732318792500

CONCLUDED “In sum, the medical encounter between Indigenous childbirth evacuees and non-Indigenous health care providers can be viewed as a site of intergroup contact that can both promote as well as stymie the patient–provider relationship. On one hand, the medical encounter is an opportunity to break down cultural barriers, challenge stereotypes, and improve health care service delivery. On the other hand, the medical encounter can also reinforce stereotypes, instill medical mistrust, and further marginalize and disempower Indigenous patients. Currently, the determination of whether the medical encounter leads to an opportunity for relationship building or misunderstanding rests in part on the communication styles and interpersonal skills of individual health care providers. However, health care providers’ individual efforts to decolonize the medical encounter must also be supported by parallel institutional commitment to equalize patient–provider power dynamics and improve maternity care services for Indigenous women in Canada”

2017

Adams, C. and Thomas, S. (2017). Alternative prenatal care interventions to alleviate black-white maternal/infant health disparities. Sociology Compass. https://doi.org/10.1111/soc4.12549 Accessed https://compass.onlinelibrary.wiley.com/doi/abs/10.1111/soc4.12549

From abstract: “This paper attempts to forward the maternal health literature that critiques standard prenatal care in the United States by drawing on intersectionality, medicalization, and fundamental causation theories. We argue that these theories deepen our understanding of the maternal health experiences of Black women and can help explain why alternative prenatal care interventions have value for Black pregnant women. Alternative models of prenatal care, which include the use of midwives, doulas, and group prenatal care, are associated with equal or better health outcomes for infants and mothers compared to the standard prenatal model in the United States.

Goode, K., & Katz Rothman, B. (2017). African‐American Midwifery, a History and a Lament. i>The American Journal of Economics and Sociology, 76(1), 65–94. https://doi.org/10.1111/ajes.12173

CONCLUDED (material omitted) “The 1960s was a time of reaction against a century of medicalization of women’s health. The feminist movement encouraged women to become more conscious of their own bodies and to develop skills in healthcare. One effect of this change has been a reconceptualization of childbirth as a process over which women can have greater control. The same is true of abortion. Women have begun to find ways to remove it from the realm of medical control, since there is no reason any procedure that was once carried out by a midwife should be carried out exclusively by doctors. The values of the other-mother, community-based “grand midwife” are coming to be appreciated again—but those very women who are descended from those grand midwives may not have access to that kind of care. As we become aware of the value those traditions, perhaps we can work to reclaim them”

2016

Alhusen, J. L., Bower, K. M., Epstein, E., & Sharps, P. (2016). Racial Discrimination and Adverse Birth Outcomes: An Integrative Review. Journal of Midwifery & Women’s Health, 61(6), 707–720. https://doi.org/10.1111/jmwh.12490 Accessed https://onlinelibrary.wiley.com/doi/10.1111/jmwh.12490

Racial discrimination is a significant risk factor for adverse birth outcomes. To best understand the mechanisms by which racial discrimination impacts birth outcomes, and to inform the development of effective interventions that eliminate its harmful effects on health, longitudinal research that incorporates comprehensive measures of racial discrimination is needed. Health care providers must fully acknowledge and address the psychosocial factors that impact health outcomes in minority racial/ethnic women

Eichelberger, Doll, K., Ekpo, G. E., & Zerden, M. L. (2016). Black Lives Matter: Claiming a Space for Evidence-Based Outrage in Obstetrics and Gynecology. American Journal of Public Health (1971), 106(10), 1771–1772. https://doi.org/10.2105/AJPH.2016.303313 Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024373/

CONCLUDED “Enough is enough. Race is a social construct and the overwhelming statistics we present are attributable to a broken racist system, not a broken group of women. Evidence-based outrage is the objective, logical conclusion. We, as the caretakers of women’s health, must realize that real action requires enough courage to embrace a fundamental shift in our perspective. We challenge obstetricians–gynecologists to consider how accepting that Black women do worse in your research study, worse in your quality improvement project, or are absent from your clinical trial as the status quo directly reinforces the lesser value our society has assigned to Black women’s lives. Instead of sitting back on the reflexive defense that racial disparities are too complex for us to do anything about, what if we decided to try anyway? What if every obstetrics and gynecology department made racial equity in known areas of disparity the priority of all quality improvement projects? For researchers, how would your study designs change if the primary metric was whether they helped Black women? How would your interventions be modified if you could not claim success without racially equitable outcomes? Let’s start with these challenges and learn what works, together. We can prioritize racial equity in women’s health, but we must actively choose to do so. How can we look at the evidence and do anything else?”

New York City Department of Health and Mental Hygiene (2016). Severe Maternal Morbidity in New York City, 2008–2012. New York, NY. New York City, 2008-2012: Severe maternal morbidity. Accessed https://www1.nyc.gov/assets/doh/downloads/pdf/data/maternal-morbidity-report-08-12.pdf

CONCLUDED: from article “There are also persistent disparities by race and ethnicity, particularly between Black and White nonLatina women. Nationally, Black non-Latina women are three times as likely to die during pregnancy or childbirth and twice as likely as White non-Latina women to experience SMM. 5,6 A recent report on New York City pregnancy-associated mortality found that Black non-Latina women were 12 times as likely as White non-Latina women to die from pregnancy-related causes”

Thompson, D. (2016). Midwives and pregnant women of color: Why we need to understand intersectional changes in midwifery to reclaim home birth. Columbia Journal of Race and Law. Accessed https://academiccommons.columbia.edu/doi/10.7916/D8V69JX0

CONCLUDED: “The racist regulatory schemes that eliminated the midwife are perpetuated by and connected to the regulatory schemes historically used and still being used to regulate pregnant women of color. Those structures and schemes still need to be tackled today. Insurance and hospital structures, structures that dictate licensing barriers and family planning distribution, and hygiene and safety discourses—all of which have and currently do perpetuate class, race, and gender biases against midwifery, home birth, and reproductive agency among low-income, pregnant women of color—are the structures in need of an intersectional, black feminist-centered shift in analysis.” (material omitted)

2015

Huesch, & Doctor, J. N. (2015). Factors associated with increased cesarean risk among African American women: evidence from California, 2010. American Journal of Public Health (1971), 105(5), 956–962. https://doi.org/10.2105/AJPH.2014.302381

CONCLUDED: “Results. Cesarean rates were significantly higher overall for African American women than other women (unadjusted rate 36.8% vs 32.7%), as were both elective and emergency primary cesarean rates. Elevated risks persisted after risk adjustment (odds ratio generally >1.27), but the prevalence of particular risk factors varied. Although African American women were clustered in some hospitals, the proportion of African Americans among all women delivering in a hospital was not related to its overall cesarean rate. Conclusions. To address the higher likelihood of elective cesarean delivery, attention needs to be given to currently unmeasured patient-level health factors, to the quality of provider-physician interactions, as well as to patient preferences

2014

Goode, K. (2014). Birthing, Blackness and the Body: Black midwives and experiential continuity of institutional racism. Accessed

. Despite a long history of midwifery in the black community, black women currently represent less than 2% of the nation’s reported 15,000 midwives. Relatedly, black women and infants experience the worst birth outcomes of any racial-ethnic cohort in the United States.

2013

Olson, R., & Couchie, C. (2013). Returning birth: The politics of midwifery implementation on First Nations reserves in Canada. Midwifery, 29(8), 981–987. https://doi.org/10.1016/j.midw.2012.12.005

From article: Place of birth is central to the topic of Aboriginal maternal health care in Canada today. In this paper, we argue that any change or steps forward towards relocating birthing services to rural and remote First Nation communities must include midwifery as a central component in the process. And part of this process must be to remove policy barriers that inhibit the ability of midwives to practice in First Nation communities today.

Shaw. (2013). The Medicalization of Birth and Midwifery as Resistance. Health Care for Women International, 34(6), 522–536. https://doi.org/10.1080/07399332.2012.736569 Accessed https://www.tandfonline.com/doi/full/10.1080/07399332.2012.736569

CONCLUDED: “The medicalization of birth in Canada is a process that took place over much of the late nineteenth and early twentieth centuries, and it continues today. Characterized by a physician-lead, highly interventionist model of care, medicalization has taken the natural ability to labor and give birth away from women. This is problematic because unnecessary medical interventions during labor and birth can compromise the safety and emotional well-being of both the mother and baby. Furthermore, by normalizing technological births, the concept of childbirth has changed to reflect a paternalistic, physician-lead event where women are expected to be submissive. The negative effects of over-medicalization are especially noticeable in northern Aboriginal communities where women are routinely evacuated from their homes in order to give birth” (material omitted)

2011

Mohammed, R., & Panazzolo, M. (2011). Birthing Trends in American Society and Women’s Choices. Race, Gender & Class (Towson, Md.), 18(3/4), 268–283.

Today, the most popular birthing practices in the United States reflect our capitalist society, having the main focus not on the health of women and their offspring, but instead on monetary profit and efficiency. The notorious birthing techniques currently utilized by allocate almost total power to doctors, leaving women in the dark. The false notion that America is filled with high-risk women that are unable to achieve childbirth naturally is used to justify the numerous medical and childbirth interventions that occur in American childbirth

2011

Craven, C. and Glatzel, M. (2010) Downplaying difference: Historical accounts of African American midwives and contemporary struggles for midwifery. Feminist Studies, v.36, no 2 Accessed hhttps://www.jstor.org/stable/27919104

Scholars such as Gertrude Fraser have critiqued the tendency of contemporary proponents of midwifery to equate the history of Afriacn-American midwives – who were largely eliminated by the late twentieth century through racist healthcare initiatives- with the contemporary struggles of primarily white middle-class midwives and mothers seeking home births.

1988

Institute of Medicine (US) Committee to Study Outreach for Prenatal Care; Brown SS, editor. Prenatal Care: Reaching Mothers, Reaching Infants. Washington (DC): National Academies Press (US); 1988. Chapter 1, Who Obtains Insufficient Prenatal Care? Available from: https://www.ncbi.nlm.nih.gov/books/NBK217693/

Several interrelated demographic factors put women at risk for insufficient prenatal care: being in a racial or ethnic minority group (especially American Indian, black, and Hispanic), being under 20 (particularly, under 15), having less than a high school education, higher parity, and being unmarried.