As long as outcomes in infant and maternal health are not disaggregated by race and ethnicity by each provider or facility, we will never capture a true idea of how well certain providers are servicing families of color. Without this data, we are losing an opportunity to address racial inequities in infant and maternal care.
Racism is the primary driver of why Black American women are 3 to 4 times more likely to die from childbirth than their white counterparts. Infants who are born to Black American women are dying at twice the rate as white infants. National birth equity experts are working on reducing racial disparities through increasing access to health insurance, reforming the health care system, advancing quality care, and providing culturally sensitive-patient centered care.
Two bills are expected to be introduced this week in the Colorado Legislature — Protecting Pregnant People in the Perinatal Time Period, and Maternal Health and Health Care Providers. Both are Colorado’s chance to join national birth equity leaders and make Colorado a safe place to give birth for all families. Also part of the birth equity bill package before the Legislature this year is an effort, led by Sen. Rhonda Fields, to continue the state’s Direct Entry Midwifery program. The package is expected to be spearheaded by Sen. Janet Buckner and Rep. Leslie Herod.
Having studied midwifery on the U.S.-Mexico border in 2012, I was acutely aware of the racial inequities in maternity care and how systemic racism impacts pregnancy. I became a midwifery educator in 2013. The same disparities and stats of prematurity, low birth weight, maternal mortality, and morbidity — specifically among Black women — that I shared with my students in 2013 persists today, eight years later. The only places I have seen sufficient, substantial change towards more positive birth outcomes is through community-driven, birth equity work, led by women, doulas, and midwives of color.
Mamatoto Village in Washington, D.C., is a great example. It works to improve the experiences of women, families, and babies. Their stats reflect their commitment – in 2017, 74% of women working with Mamatoto Village gave birth vaginally, and there were zero infant or maternal losses, and 92% of their clients that attended their 6-week postpartum visit.
Or Ancient Song Doula Services in New York, which commits to eliminating the infant mortality and maternal morbidity rate through collective work. In 2014-2015, 85% of its clients birthed vaginally, and they have had zero maternal deaths among their clientele.
An incredible local example is Demetra Seriki and her practice A Mother’s Choice Midwifery in Colorado Springs. Seriki has committed her career to service families by providing comprehensively accessible and equitable midwifery care to the Colorado Springs community. She has eradicated racial inequities in her practice and has been given the certification of Perinatal Safe Spot — coined by the Perinatal Task Force. To meet that criteria, she can quote her practice statistics on preterm birth rate, low birth weight, infant mortality, maternal mortality, and maternal morbidity.
Every birth clinic at which I worked as a midwife collected disaggregated data by race and ethnicity of our clients. Yet, this information is still not dissectible in the hospital system. Further, the model of midwifery care is relationship-based and provides longer appointments, so clients have a chance to really get to know and trust their provider. Midwifery prenatal appointments are on average 45 minutes, for a standard OB/GYN practice that same appointment is cut in half, averaging 20 minutes. I have serviced nearly 300 families as a midwife, and my clients would often discuss their stress (or trauma), associated with the experience of racism or other forms of oppression.
I always wondered how OB/GYN practices attended to those concerns if they arose, provided individualized care, performed all vital checking of mom and baby, and provided prenatal and childbirth education in 20 minutes, while also giving recommendations. There simply is no room to address someone’s concerns, perform their routine prenatal, and provide thorough education to prepare them for childbirth in 20 minutes — or in the model in which the majority of maternity care is delivered.
I used the report by Amnesty International, “Deadly Delivery,” published in 2010, with my midwifery students. The report painted a real picture of what mortality and morbidity looked like for American women and recommended that the targets for improving maternal health in the United States are linked to a fundamental breakdown in provider accountability. The report recommended more accurate and comprehensive data collection and improved attention to disparities. Now, over a decade later we have yet to create accountable systems that can show how well families of color are faring in birth outcomes.
Transparent data on outcomes disaggregated by race and ethnicity should incentivize providers to do better, and provide a blueprint for families to choose which provider may be best equipped to provide quality prenatal and postpartum care to their family. We need to show how individual hospitals are working towards changing the status quo for families of color. The two proposed Colorado bills will do that, in a way that is not punitive to providers.
It is time Colorado caught up to speed with other states, and provided a multipronged approach to inequities that Colorado families face at the very beginning of life, by supporting these two bills — Protecting Pregnant People in the Perinatal Time Period and Maternal Health and Health Care Providers, and continuing the Direct Entry Midwifery program.
Kayla Frawley is working directly with the nonprofit Elephant Circle, which has led birth equity initiatives in Colorado and is working with lawmakers on the birth equity bill package.