Bias, Before First Breath – The Health Blog


How structural racism and implicit prejudice affect children in America, even before birth


Becoming a new mom in America is more dangerous for some moms than it should be. Every year, 700 women die in childbirth or from causes related to pregnancy in the United States, u higher number of any developed nation.

Health inequities in America mean that to a large extent, black women and their children are the ones affected: Black mothers are 243% more likely to die from pregnancy than white ones. These discrepancies are wide: American Indian and Alaska Native women are as well 2x more likely to experience an adverse result compared with its white counterparts. Too many of our mothers die from preventable causes. The CDC estimates that 70% of maternal deaths are preventable – which helps emphasize the urgency of creating tangible changes.

And recent forces they helped shed a late spotlight on the black maternal mortality crisis in America. In April, the Biden administration released a proclamation during Black Maternal Health Week, and planned legislative changes to address the implicit bias in health care and apply funding where it is really needed. Congress is on the ball the “Momnibus” bill, which would fund grassroots organizations at the community level, actively establish harm training programs, and fill gaps created by social determinants of health (SDOH). At the end of last year, the HHS has released an action plan to reduce maternal mortality and adverse outcomes by 50% in five years.

It is courageous to finally see action taken: our mothers deserve more. At the same time, while advocating for standardized and equal access to care for all of our mothers, we can’t ignore the newest cry in the room: that of the child. Even before she takes her first breath, a girl’s future will be irrevocably shaped by structural racism and socioeconomic factors far out of her control.

That is why, to address health inequities we have to start with our children. Despite major advances in NICU technology and managed health care, infant mortality is on the rise – and disproportionately affects Black children. Today, black creatures are twice as likely to die as their white counterparts.

While we need new standards set at the governmental level to help equalize access to care, expand coverage, and provide funding for much-needed programs, it is up to all of us to create change. Here are three steps people and care teams can take to begin implementing it today:

Diagnose and treat your implicit injury

Implicit bias is too common and can be difficult to recognize. Two out of three clinics holds an unconscious implicit bias against black and Latino patients. Doctors were even more likely to recommend it more advanced and effective medical treatments for their white patients than for his Blacks. Obstacles to care impact both the mother and the child, long after the delivery date.


It is no longer enough for clinicians to focus on documenting symptoms, case notes, and diagnoses – they must also have training to recognize and overcome the injury. A first step is to build inclusive language words. Words such as “minority”, “undervalued”, “failed”, “fall” and “non-compliant” are loaded with prejudices and limited in their ability to paint a complete picture. By opening our ears, hearts and minds, we can help eliminate prejudices that can have a long-term impact on the health of our mothers and their new children.

Make room for more voice in the delivery room

Too often, the first time a pregnant woman meets her attending physician is after its water breaks, in the delivery room. Fortunately, midwives and doulas helping to fill the gap. They act as teachers, friends and advocates giving support, resources, information and education to the mothers they need to be. Experience in delivery and medical jargon can help you navigate the healthcare system and access benefits that extend coverage.

A recent study showed that states with higher obstetric integration scores have seen significantly lower rates of premature birth and low birth weight infants. Many doula and defense services are provided pro bono via non-profit groups. The real expansion of scale care calls on state Medicaid agencies to improve reimbursement rates for out-of-hospital birth options, and for midwives and doulas to receive salary compensation for their very important work. In the hospital environment, caregivers can help reduce barriers by embracing new members of the care team and listening to all voices in the room.

Become a true care team, from conception to postpartum

From family planning to prenatal visits, going through delivery, and postpartum follow-ups, a care team needs to be in place every step of the way. Experts recommend a minimum of 13 prenatal visits. Children whose mothers have not received prenatal care are 3x more likely to have a low birth weight, and 5x more likely to die in childhood.

Unfortunately, recurrent doctor visits, especially for prenatal care, are too often skipped. In 2016, 24% of pregnant women received less than the recommended number of prenatal visits. 10% black women, 12% Native American or Alaska Native women, and 8% Hispanic women received late or no prenatal care, compared to 5% of white women. State expansion to Medicaid can help ensure more equitable access to vital care. Lack of flexibility in the workday, food insecurity, limited access to transportation, and other SDOHs can interfere with a mother’s ability to keep appointments. On the provider side, small changes can help explain and overcome these care gaps, including: de-stigmatized screening programs for nutritional or financial needs, community outreach, local partnerships, and offering evening and telemedicine appointments. weekend.

Every child deserves equal access to the health services necessary to have a healthy first year of life and beyond. By taking small steps today to improve the quality of care for all of our mothers, we can work to alleviate the burden for our children. We can all play a part in tackling the widespread picture of implicit prejudice and structural racism that gives rise to health inequities and care gaps caused by SDOH. Ultimately, we are all working towards a reality where we break the cycle of inherited systemic prejudice so that every child can begin their life with a healthy beginning.

Ellie Stang, MD is the Founder and CEO of ProgenyHealth.

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