“Health Disparities are Power Disparities”: Engaging Maternal Health Stakeholders for Birth Equity Solutions

In an effort to address these injustices, our teams at Reproductive Health Impact: The Collaborative for Equity and Justice (RH Impact) and the National Committee for Quality Assurance (NCQA) are using quality measurement to make having a baby less dangerous for Black birthing people and families through our organizations’ joint project, Birth Equity Accountability through Measurement (BEAM).  

BEAM aims to create, test, and apply quality measurement strategies that will promote equitable birthing care throughout the healthcare system in the U.S. Quality measures are used to help us evaluate patient outcomes, healthcare processes, and/or the health system’s ability to provide high-quality care. Similar to how public health departments conduct inspections to ensure the safety and quality of restaurants to protect consumers, we also need the same safeguards and quality measures to protect birthing patients. As part of this project, we looked at what the nation’s scholars, thought leaders, and activists in reproductive health and maternity care have written and shared to understand factors that predict differences in birth outcomes based on a birthing person’s skin color, the ways they pay for their healthcare, or where they live. Additionally, we explored existing strategies and measures to directly address these issues.   

Following this scan, we interviewed 44 maternal health stakeholders between April and June 2023. Our interviewees included birthing patients, their partners, community organizations, policy experts, academics, clinicians, and birth workers. We intentionally interviewed stakeholders from historically and currently marginalized communities from across the country. 

Strategies prioritized by our participants included:  

• Providing more doula care (a doula is a non-clinical birth worker who provides emotional, physical, as well as informational support to birthing people in order to enhance their childbirth and postpartum experiences),  
• Increasing the number of people providing care who have similar racial, ethnic, and cultural backgrounds as the communities they serve,  
• Improving access to birthing care insurance coverage (including, but not limited to, doula care, clinical birth workers, and care across the birthing spectrum), and  
• Holding health systems accountable to providing high-quality care.  

For example, one participant stated: “I luckily have gone to hospitals that have pretty high ratings in their labor and delivery wards, and I toured them prior to going. My mother and generations before me had– there was none of that. There was no tour of the hospital. There was no conversations held with the labor and delivery nurses about the standard of care they provide for people. There was none of that. So, I think about how the experience has already transformed, but what would take it to the next level?”   

Participants also prioritized training healthcare providers and birth workers in anti-racism and ensuring the experiences and voices of marginalized groups are centered in decision-making.  

As another participant stated, “Health disparities are power disparities,” so we must do what is in our power to address disparities on each and every level of birthing work. This includes training the birthing workforce to center patients and engage in respectful maternity care, uplifting the experiences of birthing people, increasing systems-level resources, calling out systemic racism, and holding systems accountable. 

Another interview participant stated: 

“The anti-racism training thing for healthcare providers, that’s something that only a handful of medical schools provide, and I think it’s something that should be a part of the medical education curriculum in general. And I think that definitely anti racism training is something that just needs to happen kind of year-round all over the place. Especially as– I’ve told people, racism and anti-blackness isn’t something that’s confined here to the United States. It’s a global thing, right? So, if you’re bringing in doctors from all over the globe, they need some of that– they need some of that training too. Because they have preconceived notions. They have biases, right? so they definitely need a lot of that training as well.”  

While BEAM works towards creating quality measurement strategies, we hope that you, as readers, will not only uplift and support the needs of birthing people in your community but also help us hold these systems accountable by calling out injustices in healthcare when they take place. The time for change is now, but we will only be able to see a difference if we all work together.