Health Care System and Education Reform
Reforms to the way medicine is practiced and taught are also central to the effort to improve outcomes for Black moms. At the center of this work is a reckoning with systemic racism that is baked into the history of the American health system.
The 1910 Flexner Report—funded by the American Medical Association—laid the foundation for American medical education and led to the closure of all but two historically Black medical schools. This created severe shortages of Black health professionals that persist today, contributing to a lack of cultural humility when caring for Black patients.
At the same time, Black providers such as Granny midwives—who attended half of all births at the beginning of the 20th century—were increasingly undermined and discredited. By 1975, less than 1% of births were attended by midwives as hospital births became the health care standard.
Advocacy for reform in health systems and education seeks to unravel the legacy of these practices by reckoning directly with racism, seeking to diversify the health care workforce, and providing Black moms with culturally sensitive care.
That includes expanding access to midwives and doulas to assist Black mothers. People who receive care from midwives are less likely to have a preterm birth, less likely to have a C-section, and more likely to breastfeed. Doulas—non-clinical health care providers who offer physical, emotional, and informational support during pregnancy, labor, delivery, and postpartum—can play a critical role in reducing racial disparities in maternal health, and their services have been associated with fewer birth complications and a reduced risk of having a low birth weight infant. Some states cover these services under Medicaid, and advocates are pushing for expanded access to these services nationwide.
When it comes to clinical care, addressing biased care practices within clinical care is a top priority for physician advocates—and that includes calling out biased care practices, such as the excessive drug testing of Black women on labor and delivery wards. A recent study of Pennsylvania hospitals found that Black women were less likely to test positive for drugs than white women, despite being tested more.
A commitment to addressing discriminatory hospital policies has led many physicians to refocus their energy on advocacy, says Jamila Perritt, MD, MPH ’10, president and CEO of Physicians for Reproductive Health.
“These are policies that are deeply misinformed, misguided, not grounded in science or medical evidence, and in fact, are directly misaligned with principles of public health," says Perritt. “It’s recognition that [physicians] are not infallible. We will make mistakes and we will cause harm and the question becomes, what did we do after it?”
Meanwhile, a new generation of medical trainees is also putting equity front and center of their education, both by participating in the larger anti-racism movement through groups like White Coats for Black Lives and leading the charge to change their curricula, says Neel Shah, MD, assistant professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School.
“One of the things I've seen the last couple of years is that medical students themselves are driving the change,” Shah says. “They're the ones who are calling for implicit bias curricula or calling for health equity to be part of the curriculum.”
Bolstering Community Organizations
The movement for birth equity is also being led with growing momentum by community-based organizations (CBOs) focused on caring for Black moms and advocating for system change across policy and health systems.
“Health isn't produced in the four walls of the clinic,” says Shah. “It's produced in people's homes and their communities and their workplace. And you have to not only have the right technical expertise to serve someone; you have to have the right lived experience, particularly when it comes to childbirth.”
CBOs are often the vital intermediary between individuals and policymakers, working at both the grassroots level, empowering everyday people, and at the “grass tops” level, mobilizing political support and influence. They are particularly well-suited to address the unique needs of their communities, including the challenges faced by Black birthing people seeking quality care.
These organizations are critical partners in efforts to reduce disparities in maternal health outcomes. They collaborate with health care providers, policymakers, and other stakeholders to advocate for programs that target the issue at hand, and they step up to provide much-needed resources such as access to doulas, home visits, social services referrals, and education.
Supporting for the work already being done in Black communities has been written into policy efforts like the Momnibus and the proposals in the 2022 White House Blueprint for Addressing the Maternal Health Crisis.
As complex and deep-rooted as the Black maternal health crisis is, solutions are at play at all levels of society. There is promise in policy, potential in system change, and renewed energy with the next generation of medical trainees. Communities are using collective efforts to transform experiences. Families affected by the crisis are raising their voices.
But it’s not just policymakers, physicians, and Black birthing people who can help solve this problem by staying informed about the roots of the problem, and supporting the work being done to fight it.
If you’re interested in learning more about the Black maternal health crisis, the history of the issue, and solutions to it, check out the links and book recommendations below.
