Originally published in the April issue of the Notes on Antiracism, Justice, and Equity newsletter.

This week, April 11-17, is Black Maternal Health Week (BMHW). Founded five years ago by the Black Mamas Matter Alliance (BMMA), BMHW is a time to celebrate the resilience, advocacy, and changemaking of Black birthing people and their families.

Racism, not race, is the cause of racial health inequities for Black birthing people and their babies. Structural racism involves interconnected institutions created by the historical and ongoing devaluation of Black lives. Because of structural racism:

• Black and Indigenous birthing people die 2-3x as often as white their counterparts across the U.S.

• Black and Indigenous babies die before reaching their first birthday 2x as often as white babies.

Not all Black communities are equally affected. Rural communities with a higher proportion of Black residents are less likely to have access to maternity care locally, and in the most rural counties in the U.S., Black birthing people are 3x as likely to die as white birthing people living in the same counties.

These health inequities do not occur in a vacuum. To understand and address contemporary Black maternal health inequities, we must first “learn about, understand, and accept the U.S.’s racist roots.” Black enslavement, starting in 1619, comprises 60% of the U.S.’s history, Jim Crow another 20%. To justify slavery and institutional oppression, racist myths like Black people having thick skin or experiencing less pain were created, and these myths still shape U.S. medical education and care today.

The impacts of medical racism on reproductive care are well-documented. Birthing people of color receive less pain relief and experience racist mistreatment. A recent study found that Black babies are more likely to survive when they are cared for by a Black physician.

Structural racism is a public health crisis, but it is also a fixable problem! Action addressing the causes of Black maternal health disparities is urgently needed. We recommend:

• CENTERING CULTURE: Research conducted in partnership with the Minneapolis-based Roots Community Birth Center (Roots) demonstrated that culturally and relationship-centered care improves health outcomes for Black birthing people and their babies. Cultural identity is an asset, not a liability, for Black birthing people, and centering culture in care has been shown to increase feelings of respect and autonomy for Black people.

• DESEGREGATING THE WORKFORCE: Steps towards desegregating the healthcare workforce — including antiracist hiring and retention practices, investing in diversity in education and training, and reforming racist institutional policies — could benefit Black birthing people receiving care.

• PRIORITIZING ANTIRACISM AS A CORE PROFESSIONAL COMPETENCY: Healthcare clinicians, public health professionals, policy makers, and researchers must consider antiracism as a core professional competency. Structural racism impacts intersecting institutions, affecting where Black people live, work, play, and age. Health and policy professionals must focus on antiracism when providing care, leading programs, conducting research, and creating policies.

• REDIRECTING RESOURCES: Allocating resources via antiracist policy directs financial and other support to the people and communities that have suffered the worst burdens and acknowledges centuries of underinvestment, which has led to today’s inequities. For example, this should include expanding Medicaid coverage postpartum, supporting antiracism training for clinicians, and ensuring access to safe care in a range of birth settings, including freestanding birth centers.

Authors

Rachel Hardeman
Associate Professor and Blue Cross Endowed Professor of Health and Racial Equity, UMN School of Public Health
Director, Center for Antiracism Research for Health Equity
View Rachel’s bio

Katy Backes Kozhimannil
Distinguished McKnight Professor, UMN School of Public Health
Director, Rural Health Research Center
View Katy’s bio

Jaime Slaughter-Acey
Assistant Professor, UMN School of Public Health
View Jamie’s bio