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Maternal Health 2020

COVID-19 has disproportionately affected black mothers in America

iStock / Getty Images Plus / digitalskillet

Franka Cadée

President, International Confederation of Midwives

Pandora Hardtman

Board Member, North America and the Caribbean, International Confederation of Midwives

Today, black American women are three to four times more likely to experience a pregnancy-related death than white women, regardless of education, income, or other socioeconomic factors. This dismal truth is a brutal indicator of the pervasive inequalities in our systems.

During the Black Lives Matter movement, inside the confines of the global COVID-19 pandemic, we’ve been painfully reminded of the distressing maternal health outcomes for black American women highlighted in media reports, political speeches, and within the communities impacted by their real-life consequences.

As midwives, one black, and one white, and both with extensive experience working within high, middle and low-resource countries, we’ve come together to highlight the realities facing birthing and pregnant women navigating maternal and newborn care in the United States. It’s through this lens we provide our thoughts on a pathway forward amidst unprecedented social and economic upheaval.

How has this global pandemic aggravated the issue?

As midwife leaders, we’re frequently contacted by members of our global midwife community with alarming anecdotes regarding this pandemic’s impact on the health outcomes of pregnant and birthing women.

Emerging research indicates low and middle-income countries could see an additional 28,000 maternal deaths and 168,000 newborn deaths resulting from the impacts of COVID-19. The United States, despite its high-income country status, is already documenting compromised sexual and reproductive health services, disproportionately impacting low-income and minority communities.

Now, pair this new reality with the knowledge that, prior to “Rona”, black Americans were experiencing substantially higher rates of maternal and neonatal mortality, preterm birth, low birth weight and a culture of disrespect compared to their white counterparts. Comments like the one shared below by a practicing midwife indicate COVID-19 could worsen this disparity:

As black midwives, we’re worried that if we get sick, no one will be left to care for our black patients.

What is the role of white women within this issue?

As women, we understand the emotional, social, and economic impacts of sexism, and can transfer this knowledge to our understanding of racism. True allyship is grounded in action: calling out friends’ behaviours and searching for authentic opportunities to connect with women of colour.

Perhaps most importantly, as white women, we need to sit with our discomfort and acknowledge that comfort is complicity – this is especially true in our hyper-connected digital era where entire movements are accessible on our devices.

A comment made to us by one black midwife on the frontlines of this pandemic, does a good job underscoring this topic: Women of colour are tired of doing the emotional labour that comes with calling out offensive behaviours on the part of white people – start calling each other out!”

So, where do we go from here?

Maternal morbidity and mortality among black American women are complex issues made more complex by the reality that every system, and every individual plays a role in combatting racism. For this reason, confronting the institutions preventing true health equality requires concerted effort from governments, civil society, academia, media, and the private sector.

At a policy level, we know women of colour must have proportional representation in decision-making roles, and appointments such as a Chief Midwife Officer and a Minister of Gender Equality go a long way toward improving health outcomes for marginalised communities.

Investing in midwives and the sexual and reproductive health services we provide will lead to improved health outcomes for black American women. Within this knowledge is the need to grow and diversifying the United States’ largely white maternity care workforce. It’s midwives, practicing within a supportive team providing the continuity of midwifery care based on skill and trust, who are uniquely equipped to respond to the culturally specific needs of minority women. This is not new – we know what works, now let’s make it happen!

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