Standing against racial bias in obstetric care

In recent weeks, thousands of people have taken to the streets in Dallas-Fort Worth and nationwide to protest racial injustice and systemic bias. The timing, amidst the COVID-19 pandemic, has also shined a light on racial disparities in health care, which really hits home in the world of maternal care.

Approximately 700 women die in the U.S. each year of pregnancy complications, according to the Centers for Disease Control and Prevention (CDC). Women of color are three to five times more likely to die from pregnancy-related causes than white women. And a large volume of data shows that people of color are more likely to experience adverse outcomes with COVID-19 infection.

Texas has been criticized consistently in the past decade for poor maternal outcomes. Between 2010 and 2014, maternal deaths in Texas sharply increased. In 2018, data from the Maternal Mortality and Morbidity Task Force and Department of State Health Services Joint Biennial Report revealed that black women in Texas were more than twice as likely to die from pregnancy-related causes than non-Hispanic white women.

As a maternal-fetal medicine doctor at an academic medical center, my team and I care for patients from all walks of life. The protests and the pandemic have made me think more deeply about racial bias – inherent and explicit – and its potential effect on maternal care and outcomes.

Many national organizations are doing the same. The American College of Obstetricians and Gynecologists (ACOG) released a message condemning racism and discrimination in maternal care. ACOG noted, as “the nation’s leading organization of physicians dedicated to women’s health, we know that words are not enough.”

The Society of Maternal-Fetal Medicine (SMFM) released compelling survey results that showed more than 80% of providers think health disparities significantly impact their practice, but fewer than 30% feel their own biases affect patient care. Too many health care providers think fixing racism-based care inequities is someone else's problem.

Ob/Gyns can help guide positive change. We must work toward empowering women of color as the experts in their own bodies and needs and serve as their health care guide – like the care white patients are used to receiving.

To do this, we must honestly examine our own practices and consciously recognize our individual opportunities to prevent disparate outcomes for women of color.

Recognizing causes of racial and ethnic health care disparities

Within the health care system, disparities range from lack of access to inadequate insurance coverage. While the Affordable Care Act reduced longstanding gaps in health coverage, inequity continues to persist. Black people remain 1.5 times more likely to be uninsured than white people.

Some black patients do not receive needed interventions at all or soon enough, leading to a higher risk of chronic health conditions. This means women of color potentially enter pregnancy less healthy than other women, increasing the risk of complications. Even if we control for those sorts of things, they still have worse outcomes than white patients, which is likely due to disparities in their care.

Variation in how providers share information with patients also contributes to inequity in care. More than 20% of black women have reported discrimination at their doctor's office. And women of color repeatedly report they do not feel heard and are often dismissed when they raise concerns about their health.

Tennis star Serena Williams' childbirth story was a high-profile example of this continuing problem. Despite her fame – and known history of blood clots – Williams struggled to get someone to listen and help quickly when she developed a blood clot the day after she gave birth.

Putting an end to disparities in health care

Reducing racial biases requires the participation of multiple systems across our society. Health care organizations and providers can begin to do our part by:

• Advocating for policy and legislative change. These behind-the-scenes actions have the potential to increase access to quality health care and health coverage.
• Providing implicit bias and cultural competency training for health care workers. Recognizing and catching inherent bias before acting can improve patient-provider communication and health outcomes.
• Recruiting and retaining a diverse health workforce. Countless studies have shown that workplace diversity is good for business. In health care, having a diverse staff provides well-rounded perspectives and improves patient care. Research shows that patients treated by an ethnically similar provider tend to report higher levels of satisfaction with their quality of care. But health care has a ways to go. Today, black and Latino people comprise nearly 31% of the U.S. population, but only 9% of registered nurses and 8.5% of doctors.
• Increasing research related to racial and ethnic health disparities. We need these data to better identify and address specific problems. Research shows that pregnant women are already more likely to be excluded from general research studies that focus more on conditions than experiences.
• Recognizing our patients’ diversity. Pew Research Center estimates that by 2050, nearly 20% of people in the U.S. will have moved here from other countries and non-Hispanic whites will become a minority population. We must meet our increasingly diverse patient population's cultural, informational, and linguistic needs to provide better, more inclusive health education.

Racism has no place in our communities, and definitely not in our health care system. We see you. We hear you. And we are committed to giving all patients and their babies the healthiest start in life.