Structural Racism and Maternal and Child Health

Objectives
● How has multi-level racism impacted women in the
U.S. (currently and generationally)?

● Racist justifications, racist effects: Punitive welfare

reform and health.

● Racism as a social determinant and compounding

health disparities provided with a case example
Child/Maternal Health and
Welfare Regimes
Brief History of Welfare: AFDC, FSA, PRWORA
● AFDC: a New Deal program
Core American Values and Feasibility
● Reagan’s landslide victory over Walter Mondale in 1984 saw the rise of the New Democrats
(especially the DLC) and Bill Clinton
○ This group fought against the “tax and spend liberal” line of attack trotted out by Reaganite republicans
● Welfare Reform was always racially coded
● The New Democrats sought to court a less egalitarian voting base by vowing not to cave to special
interests--read, people of color, immigrants, labor unions.
● An ideal of American work ethic justified punitive welfare policies
All Sticks No Carrots
● Reforms focused first on imposing punitive
documentation, sanctions mechanisms, and time limits
● Job supports, training, education, help with childcare
provision, was mostly an afterthought for lawmakers.
● Structural racism defines civic worth
○ Therefore it is unsurprising that the supports for
single black women were not implemented
● State-to-state variation indicates the
disparate effects of reactionary state
politics on maternal health.
Health Effects
● Increased stress from intensive work requirements
○ Weathering effect
○ Marked decrease in children’s cognitive scores resulting from lack of time spent with mother
● Increased depression on the part of the mother
The untold story of the anti-austerity struggle
Gender inequality in the workplace
Parental Leave

When it comes to paternal leave, this is not

different.
Racial disparity in the workforce
Gender&Racial Disparity and the Intersectionality

● Multifaceted problem
○ Economical, cultural, political
● Pervades every aspect of our
lives
○ Career, family, hobbies, etc.
● Puts women of color in a
vulnerable socioeconomic
position.
A paradox in maternal and child health
outcomes
Image from:Howell Clin Obstet Gynecol. 2018;61(2):387-399
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915910/
Racism as a Determinant of Maternal & Child Health

● Maternal mortality rate indicates the quality of healthcare in a

country.
● Social determinants of health has influenced inequitable health
and economic opportunities for BIPOC mothers, especially
when combined with compounded health disparities.
● Compounded health disparities are the intersections of race,
ethnicity, sexual orientation, and income that influences health
outcomes.
● BIPOC mothers have more health risks before, during and after
pregnancy.
Compounded Disparities and Risks:
● Discrimination
○ Structural/Institutional Racism
■ Housing, healthcare, education, income, etc.
○ Interpersonal Racism
■ Racism and class contributing to chronic stress and economic inequities.
● Healthcare access and utilization
○ People from BIPOC and marginalized groups are less likely to be uninsured in comparison to non-BIPOC groups.
○ Healthcare access has many barriers (transportation, ability to take time off from work, inability to afford to take time off
from work, childcare, language, government mistrust, and past harm between healthcare systems and marginalized
communities).
● Occupation
○ BIPOC communities are disproportionately represented in “essential work,” (i.e. healthcare, agricultural work, etc.)
● Educational, income, and wealth gaps
○ In comparison to non-BIPOC groups, those who are from marginalized communities have lower high school completion
rates, and limited opportunities for post-secondary educational opportunities which limits increased income opportunities.
● Housing
○ Crowded, multi-generational living conditions.
○ Housing insecurity.
Realities of Maternal Healthcare: A Case Example
History of Present Illness: Patient is a 27 year old Black woman
presenting to the ED via EMS with symptoms of dyspnea, chest pain
that she described as sharp and tight that radiated to her shoulders
and neck with an onset 30 minutes PTA. The patient rated the chest
pain as 10/10. She experienced diaphoresis, chills, and fatigue. The
patient denies any nausea, vomiting, diarrhea, headaches, fever,
abdominal pain or other complaints. She mentions taking Ibuprofen
at the start of onset with no relief. Patient has no past medical
history of MI, DM, or HTN. No personal family history of CVD or MI,
but mentions having a family history of DM and HTN. She is one
week postpartum, and had brought her 1 week old infant with her to
the ED. Patient denies gestational DM during pregnancy. Her
husband is recently deployed, and the patient denies having any
social supports or emergency contacts present on the island for
herself and for childcare while seeking medical care. Image: Peripartum Cardiomyopathy
Conclusion

● These are just some examples of how structural and multilevel

racism are at the core of physical, social and emotional factors
that impact maternal and child health.

● These examples show how in both policy and healthcare

practices how structural racism is reproduced in public health.