Maternity care initiatives tend to address more easily measured factors like prenatal visits and vitamins — which Major-Kincade acknowledged are important — but generally fail to tackle these kinds of “elephant in the room” issues that are deeply related to race.
Nontraditional care delivery models may be one tool to assist clinicians and health centers in leveling birth outcomes across racial and ethnic groups. For example, the CenteringPregnancy model, which delivers group-centered social supports to pregnant women, appears to be one means of improving the disproportionate occurrence of preterm birth among black women.
But what happens in individual patient rooms is only one piece of the puzzle — health systems, public policies, and communities may be stacked against specific groups over the course of their lives, with health risk compounding over time. “Health services and public health workers need to look beyond the traditional paradigm, which is focused on individual-level only interventions,” said Scott. “We need to think of approaches that will address system-level issues, and think across a person’s life span.”
Such approaches would take an encompassing look at health-related factors, according to Scott, and “boldly uncover and dismantle racist ideologies and paradigms structuring quality of and access to affordable, available and acceptable health, health care, housing, schools, grocery stores, employment, transportation, and viable, sustainable and reliable social networks in our communities.”
It’s a daunting task, but given the stakes — the lives of women and their infants — surely one that deserves our unwavering commitment.
Esther Choo, M.D. M.P.H is an emergency medicine physician who is Associate Professor in the Center for Policy and Research in the Department of Emergency Medicine at Oregon Health & Science University. Her research focuses on women's health, substance use disorders, and health disparities.