THE FIGURES HAVE BECOME ingrained into the minds of black women across America in recent years: For every 100,000 who give birth, about 41 will die within a year – roughly three times the number of white women who will succumb to the nation’s escalating maternal mortality crisis. Thousands of others will suffer severe complications tied to pregnancy or childbirth.
These racial disparities are driven by multiple factors – including a lack of access to quality health care – but researchers say they’re also rooted in the structural racism that women of color face throughout their lives. And as the maternal mortality rate and public attention around the issue have risen in recent years, some women are seeking alternatives to hospital deliveries, wary of a health care system that statistics show has struggled to adequately care for them.
“I didn’t want to have my child at a hospital,” says Jasmine Greene, a 26-year-old youth coordinator at a church in Minneapolis. “I know, being a woman of color, that a lot of black women die giving birth in hospitals (because of) doctors not listening to our concerns, and things like that.”
Greene was five months pregnant when she started receiving prenatal care at Roots Community Birth Center, a freestanding facility in a North Minneapolis neighborhood where 41% of residents are black and the poverty rate is 27.8%. Though state licensing requirements vary, such facilities generally aren’t affiliated with a hospital or a doctor’s office but can deliver babies and provide prenatal and postpartum care for women with low-risk pregnancies.
According to the American Association of Birth Centers, there are 380 freestanding birth centers in the U.S. Roots is one of just a handful that are owned by an African American woman, researchers at the University of Minnesota who recently published a study on the center say. Rebecca Polston, a certified midwife who opened Roots in September 2015, is betting that access to culturally centered and woman-driven care will improve outcomes for mothers and babies alike.
“We treat culture as an asset, instead of a pathology,” Polston says. “Frequently, culture is viewed as something that must be bridged. It’s like this gulf to get across to the other person … to get them to do what you want.”
There is empirical evidence that the quality of interpersonal care patients receive varies dramatically along racial and ethnic lines, with African American people often reporting much lower quality of care than their white counterparts. Improving the interpersonal relationship between clinicians and patients has been identified as one way to improve quality of care. Specifically, research has identified that patients feel more satisfied with the care that they receive from clinicians with whom they share a racial identity. However, little is known about how clinicians provide racially concordant care. The goal of this analysis was to identify the key components of high‐quality care that were most salient for African American birthworkers providing perinatal care to African American patients.
We conducted semistructured interviews (30 to 90 minutes) with clinicians (N = 10; midwives, student midwives, and doulas) who either worked at or worked closely with an African American‐owned birth center in North Minneapolis, Minnesota. We used inductive coding methods to analyze data and to identify key themes.
Providing racially concordant perinatal care to African American birthing individuals required clinicians to acknowledge and center the sociocultural realities and experiences of their patients. Four key themes emerged in our analysis. The first overarching theme identified was the need to acknowledge how cultural identity of patients is fundamental to the clinical encounter. The second theme that emerged was a commitment to racial justice. The third and fourth themes were agency and cultural humility, which highlight the reciprocal nature of the clinician‐patient relationship.
The most salient aspect of the care that birthworkers of color provide is their culturally centered approach. This approach and all subsequent themes suggest that achieving birth equity for pregnant African American people starts by acknowledging and honoring their sociocultural experiences.