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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 one of the highest of developed countries for infant mortality if it is such a

developed country. The reason is because of the inequality of appropriate health care provided to

women of color. Women of color and children have a higher chance for mortality due to

complications of labor. “according to the CDC, women, and infants of color are 243 percent

more likely to die from pregnancy- or childbirth-related causes” (Nina, et. al.). Labor comes with

a long list of complications that can be possibly avoided but are not avoided when you are a

woman of color. A severe complication that can happen through labor can be premature labor.

Women may also deal with the infection, diabetes associated with pregnancy, and in severe cases

death due to pregnancy. Women of color suffer from complications that can be life-threatening,

and their overall well-being is less attended to than four times more than Non-Hispanic Whites.

Women in labor complications such as pregnancy-related high blood pressure which is

preeclampsia, complications of preeclampsia seizures are eclampsia, and blood vessel

obstruction which is an embolism. “The national institutes of Health-funded principal

investigators stated Blacks make up 6 percent of doctors” (Nina, et. al.). The health care industry

deals with the inequality of employees from different backgrounds. The inequality of care to the

color women community while pregnant, during labor, and after labor creates more deaths that

could be prevented.
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Throughout American history, there has been natural prejudice for people of color that

African American people are susceptible to illness, and imperfections (Nina, et. al). Health care

still deals with those that have prejudices and the staff that they serve in this community. Due to

structural racism, people of color receive poor quality of care in health care settings. Structural

Racism is normalized in the US that tends to give an advantage to those non-Hispanic whites.

The hierarchy, inequality, preferential treatment, of people of color, is structural racism.

Healthcare professionals are often undermining women of color who deal with more severe

stressors of mental health and physical health. The inequality of care to the colored women

community while pregnant, during labor, and after labor creates more deaths that could have

been prevented.

History has shown the racism in the United States has affected medicine all through time

such as disregarded informed consent and treatment plans for people of color in history. History

has shown the unethical medical experiments performed on those of color. The United States has

been dealing with racism, stereotyping, and prejudice since the beginning of its time. People that

are working in the health care industry can cause life or death decisions based on racism,

prejudices, and stereotyping. Medical professionals are trained to be prejudiced-free however, all

humans have biases. A doctor must take notice of where their biases lie so it prevents health care

professionals from providing inaccurate care due to their implicit bias. Without acknowledging

your implicit bias, you are preventing to provide adequate care. When a doctor becomes aware of

these implicit biases, someone can explore the reasons why and look out for it when making

decisions (Altman. M. et. al. 2020). Implicit bias is the brains functioning of using the

information it has collected to guide our actions. We tend to make quick decisions without

thinking through because the information that the person has already collected categorizes how
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someone thinks. When someone becomes stereotyped based on their race in a health care setting

it can cause a very negative effect on a patient’s outcome of their health. Social factors such as

socioeconomic, sexual orientation, education level, disability, and immigration status can create

biases and stereotypes. Women of color that are discriminated against can result in feelings of

being invisible, and unheard while still communicating their concerns to medical professionals.

Women of color struggle with their concerns being dismissed monitored less and professionals

tend to believe them less due to unconscious bias (Altman. M. et. al.).

Women of color deal with their entire life mentally, emotionally, and physical health

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

hospitals. This imbalance can affect how health care approaches women of color. “Through the

algorithms of the US Health Care industry it proves that people of color are less likely to receive

more quality care, be referred to programs that provide more personalized care, and the proper

care needed. Large hospitals in the United States have shown data that routine statistical checks

are being made throughout people who self-identified as black and are receiving a Risk Score

equal to those that are non-Hispanic whites healthier than those that identify as black.” (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. People of color had to be sicker

than a non-Hispanic white person with common conditions before getting the referral for

adequate care that a non-Hispanic white person would get no matter what. “Through the same

data collection of large hospitals using the Algorithm, only 17% of patients receive extra care

were black. However, having a hospital be unbiased the number should be 46.5%” (Ledford. et.

al.). Using the cost of care to provide care, creates more issues when trying to help those of

color. The common conditions that are overlooked would be diabetes, anemia, high blood
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pressure, and kidney failure. Using this data will show the inequality that many US hospitals go

through. People of color being sicker than white non-Hispanic but labeled the same due to health

care cost and the use of the “risk score” can create systematic racism. Systematic racism is

created in the health care system when direct racial discrimination and stereotyping are

happening directly from health care providers. People tend to slip through the system and are

forgotten, leading to not receiving the care they deserve when a health care system is only used

to collect money.

The US is progressive in many ways. However, there are economic barriers still 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 to government assistance that help for

survival needs such as Medicaid, emergency disaster relief, assistance to families in need, and

(Food STAMPS) nutrition assistance is all funding’s that harm community of color. Society has

just now put into perspective the inequality happening to women of color in the US. Even though

this is a public heal crisis, we aren’t certain the extent and have enough data to know how to

address the issue. Each person, each family, has a story that justifies the inequality in labor and

their voice deserves to be heard. The statistics show the reality behind these racial issues.

Policymakers must explore the difference between the US and other developing countries and

what makes the US the highest in mortality in developing countries.

“It states in Terresa Morris’s article about the inequality of women in labor that county in

which access to maternity health care services is limited or nonexistent is identified as a

maternity care desert. This can happen either through lack of services or barriers access care for

women” (Morris. Et. al.). Hospitals that are in someone’s local area, health care professionals

accepting certain types of insurance, and what insurance will cover can determine the type of
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care someone receives through pregnancy and labor. Rural areas with more people of color and

urban areas with families that come from low income are less likely to have access to proper

services while pregnant. More complications can come in labor when there are not adequate

professionals in the specialized field of pregnancy, women, and infants. Women of color are

more likely to give birth in a lower quality facility and are less likely to have obstetrician care

that is high in quality. Urban and Rural areas have higher numbers of the closure of obstetric care

and hospitals making access to the care that is needed, harder to obtain, and are overlooked in the

colored communities. Someone traveling a long distance to find proper care can create stressors

that can harm pregnancy and labor (Nia, et. al). Removal of the hospitals and clinics for women

in Rural and Urban areas makes traveling for care higher. Travel for this care can create stress

and stress can cause health complications during labor. Preterm labor is the leading cause of

infant mortality, especially for women of color. Preterm pregnancy infant mortality is three times

higher in those that are born from someone of color than those born from non-Hispanic white

women (Roeder, et. al.). Preterm births are still being explored by the CDC, and Health

Resources and Service Administration even though the main cause is unknown. Although we are

still unsure about the exact cause of premature births, 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. Higher rates of mortality are coming from more C-sections. Which

the United States is the highest in developed countries to perform C-Sections. “Black women’s

rate for C-Sections was roughly 7% higher compared to non-Hispanic white women in 2017''

(Taylor, et. al.).

Health and quality of life can rely on an individual’s income level, education, and

socioeconomic status. Structural racism is the main cause of compromised health. Those that are
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at a higher socioeconomic status and are women of color are still at a higher risk than Non-

Hispanic whites at a lower status socioeconomically. 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.). However, even with this disadvantage to this community, there is yet another

disadvantage if you are low income, in communities that lack health care, and the lack of

Reproductive Justice.

Reproductive justice helps identify the human right that someone can do what they want

with their body when it comes to reproductive health. A healthy pregnancy can be affected by

the community someone lives in, which can also include access to Reproductive Justice. This

would include access to health care, being able to have affordable economic opportunities, living

in safety, living affordably, and more. Policymakers must start to prioritize those that are

struggling with those not getting equal reproductive justice in communities of color. Many

women of color come from environments of poverty that create stressors. These environments

have created racial discrimination that can create stressors. Women of color develop stress and

mental strain with stereotyping, neighborhoods that lack safety and filled with violence,

isolation, lack of strong and productive support from those around the mother, and racism.

(Giurgescu, et. al). Stressors to this extent in these communities can lead to complications during

pregnancy and birth-related stress.

To solve these people, need to work directly with policymakers 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 “underserved” are those in rural and urban

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

affordable care and quality of care to these communities that need access the most. Continuous
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advocacy for women and children of color, policymakers to make changes can make sure that

every woman can get affordable, accurate, and adequate healthcare, within the community. A

priority for policymakers should be having access to resources for women that are pregnant and

in labor. The child and women can obtain a higher rate of a positive outcome in labor in proper

care is given, listened to, and have access to the care. Having affordable, care expanded to all

those expanded economically can save lives. States that have Medicaid expanded shows that

infant mortality declined and even greater within the colored community, with the expansion of

affordable care. “Having Medicaid programs expanded to states that have not expanded yet

would save 141 infant deaths per year.” (Taylor, et.al.). Being able to help at a micro-level is to

work directly with the mother. Mothers need support from a community and social workers by

getting them in contact with maternity care, family planning, and other reproductive health care

can be very important to make sure the mother has a full-term pregnancy and birth” (Taylor. et.

al.) Being able to educate and offer women of color more resources and choices for birth can

increase a more positive outcome for mother and 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. Income

should not affect the availability and quality of care a pregnant woman receives. Having

supportive resources for women of color can help create more feeling of confidence in the health

care decisions someone makes for themselves and their families.

Access to Doula’s and Midwives can help advocate all aspects specifically for the

mother. Midwives and Doulas are there for the mother, they care for the baby but, their main

concern is that the mom is getting everything that she is needing. During labor, it tends to be an
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intimate time that women feel spoken over. A Doula and Midwives are there to advocate for the

mother. 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. Women are less likely not

to attend pre-and post-partum care appointments when they lack a support system. To improve

the well-being of women of color during pregnancy and labor we must have financial services

that are universally fair and gives adequate care applying to any background can access. Social

workers are key figures in access to helping those in these situations.

Social Workers can be enriched in a community to provide education to major policy

figures to make more equality of care through communities. Providing care through ethical

standards to help the person, or group of oppression is a priority of a social worker. "Social

worker's purpose is to pursue a social change within a community. They advocate change for the

vulnerable and oppressed individuals and groups of people. Social workers' social change efforts

are focused on any forms of social injustice such as discrimination and poverty " (NASW).

Social workers' job is to make sure that any discriminatory group, in this case, women of color,

are getting the care they deserve as a basic human right. Women of color should not be

discriminated against in the health care center. Social workers and policymakers should be

working with people struggling in poverty people to receive the proper healthcare as human

beings before, during, and after pregnancy. Social workers provide individuals with information,

resources, and services. 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. Education

about anything to create a safe and healthy family dynamic in the next part of their lives while

reducing health issues. Having ongoing training and classes in health care professions presented
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by people that have studied personally about implicit biases such as social workers about the

inequality, implicit bias, and the communities that are hurting can help the reform to who is

treating people. Access to mental health for women of color during and after pregnancy is

extremely rare. The United States needs 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.

In conclusion, 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 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 the certain community’s struggle for adequate

care and resources. Funding cuts to social service assistance for families in need, Medicaid, and

nutritional assistance is severely harmed families of color due to 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. The inequality of care to the colored

women community while pregnant, during labor, and after labor creates more deaths that could

have been prevented.

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Work Cited

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“Listening to Women: Recommendations from Women of Color to Improve Experiences in

Pregnancy and Birth Care”. Journal of Midwifery and Women’s Health Vol. 65 issue 4.

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com.sinclair.ohionet.org/eds/detail/detail?vid=2&sid=4fae5731-6d37-4237-bbd1-

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Flanders-Stepans, Mary Beth,PhD, RN. Alarming Racial Differences in Maternal Mortality. The

Journal of Perinatal Education. 2000, www.ncbi.nlm.nih.gov/pmc/articles/PMC1595019/.

Ledford, Heidi. “Millions of Black People Affected by Racial Bias in Health-Care Algorithms.”

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Matijasevich, Alicia. Cesar, Victora. Mariangela, Silveria. Fernando, Wehrmeister. Bernardo, Hort.

and Barrod, Ferando. “Maternal Reproductive History: Trends and Inequalities in Four

Population-Based Birth Cohorts in Pelotas, Brazil, 1982-2015.” International Journal of

Epidemiology Supplement 1, Vol 48. (2020). https://eds-a-ebscohost-

com.sinclair.ohionet.org/eds/detail/detail?vid=4&sid=4fae5731-6d37-4237-bbd1-

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Martin, Nina. ProPublica. Montagne, Renee. “Nothing Protects Black Women from Dying in

Pregnancy and Childbirth”. Lost Mothers. (Dec. 7. 2017).

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and-childbirth
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Morris, Theresa, and Schulman, Mia. “Race Inequality in Epidural Use and Regional Anesthesia

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Pregnancy and Childbirth Sexual and Reproductive Healthcare. Elsevier B.V. (2014),

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