Advancing maternal justice on both sides of the Atlantic – . Health Blog

Positive pregnancy and childbirth experiences go beyond the mere birth of a healthy mother and child – as does mother's justice, a term that encompasses broad goals.

Affordable, timely, high quality, equitable and dignified care during and after pregnancy is essential for all people giving birth. Maternal justice is a model of culturally sensitive care that aims to reduce inequalities in maternity care and maximize maternal health and wellbeing. It is based on human rights and requires us to dismantle the racism that is anchored in health systems.

How do race and ethnicity affect pregnancy and childbirth?

Globally, black, indigenous and colored people (BIPOC) have significantly worse maternal outcomes during and after pregnancy and childbirth. These unfair differences persist even after considering risk factors such as mother's age, health and socio-economic status. In addition, the risk differentials extend to the next generation. Babies born to BIPOC mothers are more likely to be dead or born prematurely and are admitted to the neonatal intensive care unit. Consider the following statistics from two sides of the Atlantic.

In the USA:

In the United Kingdom:

What else affects human and newborn birth outcomes?

The UK and US healthcare systems differ mainly in payment structure, access and midwifery model. The UK's National Health Service (NHS) is a universal health system that has been provided largely free of charge at the time of need since 1948. The US healthcare system is a patchwork of insurance plans that leave millions of people inadequate. Midwives provide most of the prenatal care in the UK and work with obstetricians and other specialists when needed, which is different from the current US system of prenatal care.

In both countries, however, those affected by BIPOC are more likely to be exposed to discrimination, microaggression, abuse and poor maternal care.

While access to universal health care is essential, it is not enough to fill the gap in maternal health.

Away from guilt and towards maternal justice

By definition, inequalities are differences that are avoidable, unfair and unjust. However, the prevailing narrative has blamed BIPOC mothers for their poorer maternal health outcomes, for example only associating such calamity with higher rates of hypertension, obesity, and diabetes before and during pregnancy. This shortsighted focus fails to recognize how chronic systemic social injustice caused by racism disadvantages people by making it harder to make healthier choices.

The widening socioeconomic divide in the UK, the persistent wage gap between black women and white men in the US, austerity and redlining continue to contribute to inequalities in health and wealth in 2020. Differences in health and wellbeing do not occur in a vacuum. They are underpinned by the social, economic, and political history of systemic racism embedded in colonialism and other systems of oppression. We cannot address health inequalities without recognizing their origins and developing solutions that focus on anti-racism.

What is being done to reduce inequalities in maternal health?

In the professional world, the Maternal Fetal Medicine Society calls for greater diversity in health care workers and leaders, universal health coverage, and community participation in research. The National Birth Equity Collaborative advocates the decolonization of health education and provides training on racial justice in relation to implicit bias, anti-racism and respectful maternity care. Professional organizations such as the Royal College of Midwives (RCM), the Royal College of Obstetricians and Gynecologists (RCOG), and the American College of Obstetricians and Gynecologists (ACOG) have established multidisciplinary task forces on racial justice.

Community advocacy organizations such as Commonsense Childbirth Inc. (CSC), the Black Mamas Matter Alliance, Five X More and Decolonising Contraception bring together and reinforce BIPOC voices.

Taken together, these efforts use advocacy, policy, and research to advance maternal justice. Ultimately, we need transparent systems to improve health for all by measuring, tracking and responding to racial and ethnic inequalities in maternal health.

Where are people, couples and families?

When directing your own pregnancy and childbirth, or supporting someone who is, it helps to keep in mind a key principle of maternal justice: Everyone has the right to respectful, safe, and quality care during and after pregnancy and childbirth.

Trust your gut feeling. If something doesn't feel right, speak to a doctor. If it still doesn't feel right, ask for a second opinion. The Hear Her campaign provides a list of warning signs to watch out for during pregnancy and the year after giving birth.
Research pregnancy, childbirth, and the postpartum period using reputable sources, including the organizations mentioned in this blog post.
Find an ally. This could be your partner or a trusted friend or family member who can stand up for you on your behalf.
Share your story and raise the voices of other pregnant people and families.