How structural racism and implicit bias affect America’s children even before birth
by Eli Stang
Becoming a new mom in America is more dangerous for some moms than it should be. every year, 700 women die in childbirth or from causes related to pregnancy in the United States, highest number of any developed nation
Health disparities in the US mean that black women and their babies are most affected by: Black mothers are 243% more likely die from pregnancy than white people. These discrepancies are widespread: American Indian and Alaska Native women are also 2x more likely to experience an unfavorable outcome compared to their white counterparts. Many of our mothers are dying of preventable causes. CDC estimates that 70% of maternal deaths can be avoided – which helps to underscore the urgent need to bring about tangible change.
recent force has helped shine a long-pending spotlight on the black maternal death crisis in America. In April, the Biden administration issued a Declaration During Black Maternal Health Week, and implement planned legislative changes to address implicit bias in health care and funding where it is really needed. Congress is fielding “Momnibus” Bill, which will fund grassroots organizations at the community level, actively establish bias training programs, and fill in the gaps created by the Social Determinants of Health (SDOH). At the end of last year, HHS released action plan To reduce maternal mortality and adverse outcomes by 50% over five years.
Glad to see that action is finally being taken: Our mothers deserve more. At the same time, while we all advocate for standardized and equal access to care for all our mothers, we can’t ignore the latest cry in the room: that of the baby. Even before she takes her first breath, a child’s future will be irreversibly shaped by structural racism and socioeconomic factors beyond her control.
Therefore, to address health inequalities, we must start with our children. Despite major advances in NICU technology and managed health care, infant mortality rates are rising – and it disproportionately affects black children. Today, Black babies twice as likely to die than white babies.
While we need to set new standards at the government level to help equalize access to care, expand coverage, and provide funding for much-needed programs, it takes all of us to make a difference. . Here are three steps that individuals and care teams can start working on today:
Diagnose and treat your implicit bias
Implicit bias is very common and can be difficult to detect. two out of three doctors Having an unconscious implicit bias towards Black and Latino patients. Doctors were also more likely to recommend more advanced and effective medical treatments for their white patients compared to their black people. Barriers to care long after the date of delivery affect both the mother and the baby.
It is no longer enough for clinicians to focus on documenting symptoms, case notes and diagnoses – they must also have training in recognizing and overcoming bias. Building an inclusive language vocabulary is a good first step. Words such as “minority,” “underserved,” “failed,” “lapsed,” and “non-compliance” are loaded with bias and limited in their ability to paint the full picture. By opening our ears, hearts, and minds, we can help eliminate prejudices that can have a long-term impact on the health of our mothers and their new babies.
Make room for more sounds in the delivery room
Often, a pregnant woman visits her attending physician for the first time. After breaking the water, in the delivery room. Luckily, midwives and doulas helping to fill the gap. They act as teachers, friends and advocates by providing support, resources, information and education to new moms-to-be. Experienced in delivery and medical jargon, they can help navigate the healthcare system and access benefits that expand coverage.
recent study showed that stateSignificantly lower rates of premature birth and low birth weight infants were observed with higher midwife integration scores. Many doula and advocacy services are provided free of charge through non-profit groups.. The true expansion of mass care calls for state Medicaid agencies to improve reimbursement rates for out-of-hospital birth options, and for midwives and doulas to receive living wage compensation for their much-important work. In a hospital setting, care providers can help reduce the odds by hugging new care team members and listening to all the voices in the room.
Becoming a True Care Team, From Preconception to Postpartum
There should be a care team at every step, from family planning to antenatal visits, through delivery, and postpartum follow-up. Experts recommend at least 13 antenatal visits. Babies whose mothers did not receive prenatal care are 3 times more likely to have low birth weight, and 5 times more likely to die in infancy.
Unfortunately, repeated doctor visits, especially for prenatal care, are all too often skipped. In 2016, 24% of pregnant women received less than the recommended number of antenatal visits. 10% Black women, 12% American Indian or Alaska Native, and 8% Hispanic women received late or no antenatal care, compared to 5% of white women. State-based expansion for Medicaid can help ensure more equitable access to critical care. Lack of workday flexibility, food insecurity, limited access to transportation and others can interfere with a mother’s ability to keep SDOH appointments. On the provider side, small changes can help address and address these care gaps, including: stigma-free screening programs for nutritional or financial needs, community outreach, local partnerships, and telemedicine during evenings and weekends. offer appointments.
Every child has the right to equal access to essential health care services in the first year of life and beyond. By taking small steps today to improve the quality of care for all our mothers, we can work to ease the burden on our children. We can all play a part in addressing the pervasive framework of underlying prejudice and structural racism that lead to the health inequalities and care gaps caused by SDOH. Ultimately, we are all working towards a reality where we break the cycle of inherited systemic prejudices, so that every child can start their life off with a healthy start.
Ellie Stang, MD is the founder and CEO of ProgenyHealth.
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