Advancing maternal justice on both sides of the Atlantic – Harvard Health Blog
Positive pregnancy and childbirth experiences go beyond just having a healthy mother and baby – just like maternal justice, a term that encompasses broad goals.
Affordable, timely, high-quality, fair and dignified care during and after pregnancy is essential for everyone who gives birth. Maternal Justice is a culturally appropriate model of care that aims to dismantle inequalities in maternity care and maximize maternal health and well-being. It is based on human rights and obliges us to eliminate rooted racism in health systems.
How does race and ethnicity affect pregnancy and childbirth?
Globally, Blacks, Indigenous People and People of Color (BIPOC) have significantly worse maternal outcomes during and after pregnancy and childbirth. These unfair differences persist even after taking into account risk factors such as maternal age, medical conditions, and socioeconomic status. In addition, the risk differences extend to the next generation. Babies born to BIPOC mothers are more likely to be stillborn or premature and to be admitted to the neonatal intensive care unit. Consider the following statistics on both sides of the Atlantic.
In the USA:
What are the other effects on childbirth and newborn outcomes?
The healthcare systems in the UK and the US differ primarily in the payment structure, access and model of midwifery care. The UK’s National Health Service (NHS) has been a universal healthcare system provided largely free at point of need since 1948. The US healthcare system is a patchwork of insurance schemes, leaving millions of people without adequate coverage. Midwives provide most of the pregnancy care in the UK, working with obstetricians and other specialists as needed, which differs from the current US system of pregnancy care.
Yet in both countries, those who are BIPOC are more likely to experience discrimination, micro-aggression, abuse, and poor maternal care.
Thus, while access to universal health care is essential, closing the maternal health gap is not enough.
Abandon the blame and move towards maternal justice
By definition, inequalities are differences that are preventable, unfair and unfair. However, the predominant narrative blamed BIPOC mothers for their worst maternal health outcomes, for example linking such unhappiness only to higher rates of high blood pressure, overweight, and diabetes before and during pregnancy. This myopic focus fails to recognize how chronic systemic social injustice due to racism disadvantages people by making it harder to make healthier choices.
The growing socio-economic divide in the UK, the persistent pay gap between black women and white men in the US, austerity measures and redlining continue to contribute to inequalities in health and wealth in 2020. Differences in health and well-being do not happen in a vacuum. They are underpinned by the social, economic and political history of systemic racism rooted in colonialism and other systems of oppression. We cannot abolish health inequalities without recognizing their origins and designing solutions centered on anti-racism.
What is being done to eliminate inequalities in maternal health?
In the professional field, the Society for Maternal Fetal Medicine calls for a greater diversity of health workers and leaders, universal health coverage and community participation in research. The National Birth Equity Collaborative advocates for the decolonization of health education and offers racial equity training on implicit bias, anti-racism, and respectful maternity care. Professional organizations such as the Royal College of Midwives (RCM), the Royal College of Obstetricians & Gynecologists (RCOG), and the American College of Obstetricians & Gynecologists (ACOG) have established multidisciplinary racial equity working groups.
Community advocacy organizations, such as Commonsense Childbirth Inc. (CSC), Black Mamas Matter Alliance, Five X More, and Decolonizing Contraception, are bringing together and amplifying the voices of BIPOC.
Collectively, these efforts use advocacy, policy and research to advance maternal justice. Ultimately, we need transparent systems designed to improve the health of all by measuring, tracking and responding to racial and ethnic inequalities in maternal health.
Where does that leave birth attendants, couples, and families?
If you are going through your own pregnancy and childbirth – or supporting someone who is – it helps to keep in mind a key principle of maternal justice: everyone has the right to respectful, safe and secure care. high quality during and after pregnancy and childbirth.
- Trust your instincts. If anything is wrong, talk to a healthcare professional. If that’s still not okay with you, get a second opinion. The Hear Her campaign offers a list of warning signs to consider during pregnancy and the year after birth.
- Do your research on pregnancy, childbirth, and the postpartum period using trusted sources, including the organizations mentioned in this blog post.
- Find an ally. This could be your partner, a friend or a family member you trust and who can stand up for you on your behalf.
- Share your story and raise the voice of other pregnant people and families.
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