Via HealthCity: Building Capacity for Patients, Hospitals, and Communities to Address Obstetric Racism
Pregnancy-related complications and death in the U.S. occur disproportionately in Black people, even with social protections such as higher education and income,—a health inequity that continued as maternal deaths rose overall in the first year of the COVID pandemic—but questions of exactly how and why tend to focus more on individual factors such as age, weight, pre-existing health conditions, and number of prior cesarean births. A growing body of research and thought suggests that the problem should be seen not as one of race, but of racism. Beyond factors like prenatal care access, insurance status, or chronic health conditions, inequities show up in poor quality of care provided to Black mothers and birthing people, resulting in disparate experiences of care during pregnancy, labor, birth and postpartum care.
Last fall, Boston Medical Center (BMC) launched its Health Equity Accelerator to examine and address drivers of inequities between white and BIPOC patients. An important piece of that initiative is looking at equity in pregnancy outcomes—not only with specific clinical metrics but by learning more about patients’ experience of pregnancy and maternity care. Tejumola Adegoke, MD, MPH FACOG, an obstetrics and gynecology physician and director of equity and inclusion at BMC, is co-leader of the equity and pregnancy initiative.
Karen A. Scott, MD, MPH, FACOG, has written widely on maternal health inequities and obstetric racism. She is the Chief Black Feminist Physician Scientist, founding CEO and owner of Birthing Cultural Rigor, LLC (BCR), a consulting practice focused on assessing and improving perinatal care quality, value, and safety for Black patients in health institutions. Using data from its national SACRED Birth Study, BCR developed the first and only quality improvement (QI) program that partners with hospitals, health plans, state perinatal quality collaborative Black women-led community organizations to recognize and respond to acts of obstetric racism during childbirth hospitalization. BCR’s QI program consists of a collection of novel trainings, techniques, and tools, such as the novel and valid PREM-OB Scale™ Suite (Patient-Reported Experience Measure of Obstetric Racism©), to provide guidance and support to hospitals in
HealthCity spoke with Dr. Adegoke and Dr. Scott about obstetric racism and how BMC is partnering with BCR and the Resilient Sisterhood Project, a local Black-woman led community-based organization, to launch a pilot capacity-building program aimed at transforming hospital culture and improving the experience for Black birthing patients.
HealthCity: Could you start by defining obstetric racism?
Karen Scott, MD, MPH, FACOG: Obstetric racism is an explanatory framework defined in 2018 by Dr. Dana-Ain Davis, a Black feminist anthropologist. This form of racism has to do with the mechanisms of subordination to which Black birthing people are subjected that track along histories of anti-Black racism. It sits at the intersection of obstetric violence, where any hospital personnel exerts reproductive control and dominance over obstetric patients, and medical racism, where institutions determine treatment or diagnostic decisions in response to the patient’s race, leading to mistreatment, neglect, and/or abuse.
Obstetric racism reflects back to colonialism and slavery, where plantation and slave owners controlled the reproducing Black bodies – forcing or coercing enslaved Black people to partner, parent, and work in the best interests of sustaining or expanding slave labor and the economy. Slave masters routinely snatched Black babies out of the hands of their Black mothers and fathers as a reminder to Black people of loss of their agency and autonomy in building and sustaining Black kinship and futures through sex, reproduction, and family planning during chattel slavery.
What we see [today in contemporary obstetrics care] is what Dr. Davis says is a continuous recalibration of slavery through hospital policies, protocols, practices, and procedures that violate the autonomy and dignity of Black mothers and birthing people. For example, there are many episodes in which babies are prematurely snatched out of the arms of a Black mother or father or family because of “standard of care”, a test must be done after birth. We’re not negating the need for newborn assessments. We are interrogating the standard of care that permits inappropriately timed, unnecessary, or non-urgent separation of Black babies from Black mothers, fathers, and families due to standard of care or routine nursing practice. Based on what learned from listening to Black mothers and birthing people about sacred moments immediately after the birth of a Black baby, we are exploring the lack of appropriate communication, explanation, and empathy as defined for, by, and with Black women and people as patient, community, and content experts. The obstetric racism framework allows for us to better understand the feelings, thoughts, and experiences of being “handled” like an animal for breeding, instead of “cared for” like a human being giving birth by healthcare professionals and the healthcare system.