Hospitals need a change in culture to save Black women and their babies.
At a time when our country is reexamining its racist history, we must realize that structural racism pervades our health care system as well. The same system that allows police brutality to steal Black lives is failing Black mothers. And the price of failure is death.
In the United States, Black women are three to four times more likely to die in childbirth than white women, regardless of socioeconomic status, according to the CDC. The rate of infant mortality among Black mothers is also significantly higher than white women. But pregnancy outcomes are not limited to survival. Prematurity has far-reaching implications for the baby and puts the mother at higher risk for postnatal health problems—and again, the preterm birth rate is higher for Black women.
The science behind this inequity is under debate. Medical risk factors for premature birth include family history, high blood pressure, and diabetes. Environmental risk factors, such as low socioeconomic status, increased levels of stress, and exposure to air pollution, lead, and chemicals, also come into play. Black people are much more likely to live in conditions that contribute to these risk factors. Importantly, some researchers believe the accumulation of oxidative stress from constant racist encounters may contribute to higher rates of preterm labor in Black women.
As people protest police brutality and fight for their unalienable right to life as stated in the Declaration of Independence, I would argue that the right to fair health care, given at the same standard to people regardless of their race, is a critical element of the right to life. But to make equitable health care the standard of care for everyone, we need structural, system-wide changes.
Under the mentorship of pediatrician Sivan Hines ’84 MD’87, I sought to not only investigate the reasons for poor pregnancy outcomes for Black women, but to speak with changemakers in the community about their visions of equitable health care.
‘IT HAPPENS ALL THE TIME’
Carroll Medeiros ’89 MD’93 is a clinical assistant professor of obstetrics and gynecology who practices at Women & Infants Hospital and identifies as Black Hispanic. Even after 22 years in practice, with training from one of the best programs in America, “as a physician of color, being, most of the time, the most educated person in the room, still people will treat me like I’m less than they are,” Dr. Medeiros says. “It happens all the time.” She’s lost count of the medical students, usually white men, who introduced themselves to everyone in the room except for her—the attending physician.
The unconscious bias and microaggressions against providers of color highlight a key problem in patient care: if Black attending physicians are seen as “less than,” how are Black patients perceived? When Black patients are seen as less than, the quality of care they receive is directly related to poor outcomes like prematurity and maternal death. Culture change must extend into the realm of medical education, where students can see people of all races in the different roles of providers—an important step in reducing unconscious bias and microaggressions.
Most babies born in Rhode Island are delivered at Women & Infants. The demographic that the hospital serves is much more diverse than its majority-white staff. Because many people of color, especially Black people, distrust the health care system, some may seem a little abrasive—and some providers react by asking, “What is wrong with her?” rather than wondering, “What is it about me or any prior experiences that may make this person a little harder to reach, based on what I’m doing right now?”
Dr. Medeiros believes providers must develop more culturally sensitive approaches to patient care to improve maternal health outcomes. This means adapting to the myriad ways individuals from different cultures deal with health, disease, and the natural process of childbirth. She says team trainings, in which providers act out a script based on how they would experience a scenario like childbirth, facilitate this process of understanding. This is an important step in fighting stereotypes that underlie poor maternal and fetal outcomes. The limiting factor, however, is the lack of providers of color to participate and offer their perspectives. One possible solution—hiring people of color from the local community to be model patients and providers—can help gauge whether the experience of care is improving in response to these trainings.
As we fight for Black lives, the realm of health care must not be left untouched. By working for change at every level—federal and state legislation, individual provider care, and hospital systems—we fight for the lives of all members of society, including Black women and their unborn babies.