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Stephanie Hulsman

Kari Carter

English 1201

30 October 2020

Do People of Color Struggle for Equality During Pregnancy and Labor?

The United States of American is deemed to be a developed country. Many may ask why

the US would be the highest of them all. Women of color and children have a higher chance for

child and woman mortality due to complications of labor. “Women and children of color die four

times more than Non-Hispanic Whites'' (Taylor, et.al.). Labor comes with a long list of

complications that can be possibly avoided. A severe complication that can happen through labor

can be premature labor. This is when the child is delivered before the full term. Women may

also deal with the infection, gestational diabetes, and in severe cases death because of pregnancy.

Women that are African American are two times more likely to suffer from complications that

can be life-threatening, and their overall well-being is less than Non-Hispanic Whites. Health

care struggles with Caucasians being the influence of the dominant culture in the United States.

Health care still deals with those that have prejudices and the staff that they serve this

community. This means that in health care African American people often receive poor quality

of care during pregnancy and labor compared to those that are white, due to structural racism.

Women of color deal with more stressors of physical and mental health that become undermined

by health care professionals. When stressors are presented in women in labor complications such

as preeclampsia (pregnancy-related high blood pressure), eclampsia (complications of

preeclampsia seizures), and embolism (blood vessel obstruction).

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The US is progressive in many ways however, there still are economic barriers due to

structural racism. When social welfare funding is cut it is very harmful to families of color due to

the structural racism set up by society. Funding cuts such as Medicaid, temporary assistance for

needy families, and nutrition assistance. Society has just now put into perspective the inequality

happening to women of color in the US. Even though this is a pubic heal crisis, we aren’t certain

the extent and have enough data to know how to address the issue. However, each person, each

family, has a story and the statistics show the true ideas behind these racial issues. Policymakers

must examine the difference between the US and other developing countries and how the care is

for the mortality of women of color.

The United States has been dealing with racism since the beginning of its time.

People that are working in health care can cause life or death based on racism, prejudices, and

stereotyping. Income level, education, and socio-economic status are all included when it comes

to the health and quality of life of an individual. Structural racism is the main cause of

compromised health. Those that are at a higher socioeconomic status and are women of color are

still at a higher risk than Non-Hispanic whites. Proving that there isn’t a way out of these issues

for being at a higher class. The problem is a system that doesn’t value black women (Nina, et.

al.). Hospitals operate in a dominantly white setting. There is an imbalance of power within

hospitals, the imbalance can fall back to the power issues to women of color. Reproductive

justice helps identify the human right that someone can do what they want with their body when

it comes to reproductive health. A woman being able to have a healthy birth is linked to her

community, which would include access to health care, being able to afford living, economic

opportunities, and more. Policies must start to prioritize those that are dealing with those not

getting equal reproductive justice. Most women of color come from environments of poverty that
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create stressors. Racial discrimination in these environments creates stressors. Women of color

develop stressors associated with physical isolation, living in violent neighborhoods, lack of

social support, and racism. (Giurgescu, et. al). These types of stressors in this community can

tend to lead to more complications during birth related to stressors.

When someone is stereotyped based on their race can cause a very negative effect

on patients in health care and the outcome of their health. Social factors such as education level,

sexual orientation, disability, and immigration status can create biases and stereotypes.

Discrimination can result in women of color feeling invisible, or unheard while expressing

concerns to medical professionals. Women of color are known to be monitored less, concerns are

dismissed, and believing them less with unconscious bias. Women of color dealing with racism

are through mental, emotional, and physical health issues throughout their entire lifetime. Higher

rates of mortality are coming from more C-sections that are happening in the United States

compared to developing countries. “In 2017, the C-Section rate for black women was 36%

compared to 30.9% for non-Hispanic white women'' (Taylor, et. al.). A lack of hospitals and

facilities designed to offer quality care to those that are uninsured or seen as the “under deserved

is a factor in the difference of care in the races. Even though we have the Affordable Care Act

many nonelderly people are still uninsured. People of color and the Hispanic population have a

higher rate of being uninsured than white people. Implicit biases are the attitude, and stereotypes

that can affect the understanding, actions, and decisions in an unconscious manner. Studies have

shown that implicit bias, and the quality of care that the health care professionals will influence

the relationship with the patient.

While a doctor is trained to be prejudice-free we all have biases being humans. If a doctor

does not take notice of where their biases lie they become more likely to act upon their implicit
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bias creating barriers in the care provided to a patient. When a doctor becomes aware of these

biases, they can explore the reasons why and look out for it when making decisions. Implicit

biases are not good or bad. This is just our brains performing its function of gaining information

and using it to guide our actions based on the information that we collected. We tend to make

quick decisions without really thinking about it because the information that we have already

collected categorizes how we think. “After routine statistical checks on data throughout large

hospitals in the United States it has shown data that people who self-identified as black were

generally assigned lower risk scores than equally sick white people. As a result, black people are

less likely to be referred to the programs that provide more personalized care” (H. Ledford, et.

al.). A risk score is all applied risk factors someone shares and what they could be. Hospitals

tend to use the risk score to the total health-care cost. While reviewing data from “Algorithm”, a

large hospital in the US, it showed that the average black person was typically much sicker than

the average white person, with common conditions such as diabetes, anemia, kidney failure, and

high blood pressure. Using data like the following will show the inequality that many US

hospitals go through. The data collected, showed that the care-cost provided to a person of color

was much lower than a white non-Hispanic person. This implies that the reduction of access to

care is due to the effects of systemic racism, because of both the health care system and direct

racial discrimination from health care providers. The data that was provided by the “Algorithm”

showed that people of color had to be sicker than a non-Hispanic white person before getting the

referral for adequate care that a non-Hispanic white person would get no matter what. “Only

17% of patients that Algorithm assigned to receive extra care were black. However, the portion

should be 46.5% if this hospital was unbiased” (Ledford). Using the cost of care to provide care,

creates more issues when trying to help those of color. When you are viewing a healthcare
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system as a collector of money, people tend to slip through the cracks and do not get the care that

they deserve. The lack of diversity within hospitals can tend to lead to a more systematic racism

approach.

A child born before 37 weeks of pregnancy which is the leading cause

of infant mortality, is called premature birth. However, infant mortality due to preterm

pregnancy is three times higher in those that are people of color than those born from white

women (Roeder). The main causes of preterm birth are still being explored by the CDC, and

Health Resources and Service Administration. Although we are still unsure about the exact cause

of premature births, however, through the research we do have, we are starting to grasp an

understanding. Some of the risk factors for premature labor are smoking, stress, and health

conditions. Having implicit biases as a health care provider creates these barriers of trust and

judgment-free environments to get accurate information. Having screening for these risk factors

can be very easy through interviewing the patient. While doing these assessments, trust is the

most important part to get a thorough understanding. History has shown the racism in the US has

affected medicine all through time such as there have been issues with informed consent and

treatment plans. This can be things such as previous unethical medical experiments that have

been performed on those of color.

“A maternity care desert is a county in which access to maternity health care

services is limited or absent, either through lack of services or barriers to a woman's ability to

access that care” (Dimes). The type of care that someone receives through pregnancy is

determined by the hospitals that are in your local area, and health care workers accepting certain

types of insurance, and what insurance will cover. Rural areas with more people of color and

urban areas with low-income families are less likely to have access to proper services while
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pregnant. Without this access to trained professionals in this specialized field, there is a more

likely cause to have complications. Women of color are less likely to have high-quality

obstetrician care and are more likely to give birth in a lower-quality facility. The closures to

obstetric care and hospitals in Urban and Rural areas make access to the care that is needed,

increase the risk of health to low-income women, and women of color. Research confirms,

traveling long distances to seek health care can negatively affect the outcome of the lives of

women and children (Nia, et. al.). Getting rid of the hospitals and clinics for women in these

areas makes traveling for care higher. This creates stress, and these stressors lead to health

complications during labor.

To solve these people, need to work directly with policy makers within a community to

create ideas of change. Educating policymakers about the “underserved” population and the

inequality that they face can make an impact. The “undeserved” are those in rural and urban

areas, largely women and infants of color, and low-income. This creates a lack of access to

quality care and affordable care to these communities that need the access the most. Being able

to continue to advocate for women and children of color within the policymakers to make

changes to make sure that every woman can get affordable, accurate, and adequate healthcare,

within the community. A priority for policy makers should be having access to resources for

women that are pregnant, and in labor. The child and women can obtain a higher rate of positive

outcome in labor in the proper care is given, listened to, and have access to the care. Research

has shown that the expansion of affordable health care can save lives. The expansion in states

that had Medicaid showed that infant mortality declined and even greater within the Colored

community. Using the same data, “The American Progress estimated that expanding Medicaid

programs in states that have not expanded yet would save 141 infant deaths per year. Being able
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to help at a micro-level is to support mothers by getting them into contact with maternity care,

family planning, and other reproductive health care can be very important to make sure the

mother has a long health pregnancy and birth” (Taylor. et. al.) Being able to educate and offer

women of color with more resources and choices for birth can greatly increase a positive

outcome to her and the child. Services such as Midwives and Doulas are known to be only for

those with higher socioeconomic status. However, those that are being “forgotten” are the ones

that would benefit the most from these services. These services are harder to access in low

income communities and communities dominantly colored. Being able to have access to these

tools can help promote the best care. These services should be available for all pregnant women,

regardless of income. Having these supports to women of color can help create more feeling of

confident in the health care decisions to make for themselves and their families. Women of color

often receive poor quality of care and are victims of racial bias in a more traditional health care

setting.

Having access to Midwives and Doula can help produce medical based limits designed

specifically for the person and child involved. Midwives and Doulas are there for the mother,

they care for the baby but, their main concern is that mom is getting everything that she is

needing. During labor it tends to be an intimate time that women feel spoken over. A Doula and

Midwives is there to advocate for the mother. Social Workers can be enriched in a community to

provide education to key policy figures to make more equality of care through communities.

Community-based organizations can help ensure women have access to education to help

mothers and families about all health information and choices to reduce health risks. Providing

educational training to health care professionals is important as well. Training health care

workers to understand implicit biases, have ongoing training for cultural humility can help limit
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the use of implicit biases. Women of color are less likely to have access to mental health care

during and after pregnancy, having resources for every income level and mental health can create

a safer outcome for mother and child. The issues that the United States need to help solve for this

community, is affordable care, available care, adequate care, and all of these in areas that women

of color can access.

The people that someone has during their pregnancy and the support given can have a big

impact on your life while pregnant. Classes such as pre and postpartum care are useful tools to

begin the connection between mom and baby. These classes can help the outcome of labor and

birth. Those that have no support system women are more likely not to attend pre and postpartum

care appointments. To improve the well-being of women of color during pregnancy and labor we

must have universally fair financial services that any background can access. Social workers are

key figures into the access to helping those in these situations.

Social workers are held by a standard of ethics to live by while providing care. Providing

care to these clients is very important and the way you apply these ethics. "Social Justice, social

workers pursue social change, with and on behalf of vulnerable and oppressed individuals and

groups of people. Social workers' social change efforts are focused on issues of poverty,

discrimination, and other forms of social injustice" (NASW). Social workers' job is to make sure

that this group of people, African American women, are getting the care that they deserve as a

human. That there should not be discrimination and working with poverty-driven people to

obtain the proper healthcare during before, during, and after pregnancy. Social workers are

supposed to be able to provide individuals with information, resources, and services. "Integrity,

social workers are to be trustworthy and always aware of their value, mission, ethics, and

principles in their position. They work honestly and respond to clients" (NASW). Being a social
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worker for a group of people that already guard those to help them due to biases, it is important

to gain their trust. Making sure as a social worker you are allowing the mother to express all

concerns and able to communicate with you as trustworthy and a supporter to them can help

them through pregnancy. We have many ways that we as a community can help mothers and

children access equal care in the healthcare field, through social work, community education,

policy reforms, and more training for those that are in direct access to these women.

People may argue that we don’t have enough complete data, but we still have stories of

those in these communities and people that have lived through the racial injustice in the health

care system. There are a lot of classes and helpful tools available for women to obtain to have a

successful pregnancy. However, those in certain community’s struggle for adequate care and

resources. Funding cuts to Medicaid, temporary assistance for needy families, and nutritional

assistance is very harmful to families of color due to the economic barriers in the US. Some

might even argue that the social injustice of women of color is not there, not that bad, or an

opinion however, real data does show that women and newborns of color die four times more

than non-Hispanic whites based on avoidable complications. Meaning there is still something the

United States can do to prevent these complications through more access to health care facilities,

the right people to help, policy reforms, more education and training about cultural competency

to health care workers, and more affordable health care.

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