Pregnant in the Time of Coronavirus: Racial Disparities In Pregnancy
The police killing of George Floyd and the events of the last few weeks have turned a strong spotlight on the structural, systemic racism that has existed in this state and country for centuries.
Racism extends far beyond our law enforcement and justice system. This series has focused on pregnancy and COVID-19 - and there are stark racial disparities on both of those fronts. African-American and Native American mothers are at least 3 times as likely to die within a year of giving birth in the United States. And Black Americans are 2.4 times as likely to die from COVID-19.
The main factor affecting these adverse outcomes in pregnancy is racism, according to Dr. Rachel Hardeman, an Associate Professor in the Division of Health Policy and Management at the University of Minnesota's School of Public Health. Her work focuses on reproductive health equity, specifically on the social factors and structures that cause adverse health outcomes for moms and babies of color. In her research, she points to issues such as "residential segregation, access to jobs that pay minimum wage or the safety of the neighborhoods we get to live in.” Hardeman says that these factors, along with historical trauma and the cumulative effect of enduring racism throughout one’s lifetime, means that many Black women are less healthy when they become pregnant.
Once pregnant, she says that Black women also face issues within the healthcare delivery system, specifically “where we're seeing that not everyone is getting the same level of high-quality care". This involves “implicit racial bias in the clinical encounter,” she says.
A recent high-profile example of this involves Serena Williams. Add to that the COVID-19 pandemic and Hardeman says that biases can be even more pronounced. “When a clinician or a physician, or a system, is under stress in some way,” she explains, “we draw on those [biases] a lot more heavily, and that's incredibly harmful for how we deliver health care.”
Multi-media artist and model Marz Lovejoy was thinking about these inequities when she found herself pregnant in the middle of a pandemic. Lovejoy, who has a large social media following and uses her platform to give voice to issues which are important to her, decided to livestream her home birth to raise money for Black/POC/LGBTQ mothers. Her goal was to help provide pregnant women the option to give birth with a doula (labor support person) or outside of the hospital with a midwife - options that are not always affordable or covered by insurance plans. In addition, her fundraiser, which generated more than $38,000, also went to pay for doulas and to midwives of color who are going through training.
“Doulas, they are your advocates, especially for a disenfranchised group of people,” Lovejoy says. According to Dr. Hardeman’s research, having a doula is correlated with positive birth outcomes and fewer interventions. But doulas and midwives of color can be hard to find.
One organization working to change this is Roots Community Birth Center, owned by midwife Rebecca Polston (she was featured in Episode 4 of our series). Roots is one of only seven Black-owned birth centers in the country and it reflects the community it serves. Part of that work also involves access, and Roots accepts every insurance provider in the state of Minnesota so that as many pregnant women as possible can have access to their services. In fact, Polston and Hardeman are currently collaborating on research about how culturally focused care can achieve more equitable birth outcomes.
But the whole system must change in an effort to truly make birth outcomes more equitable, says Hardman. “I think the COVID crisis has sort of laid bare what's not working," she adds. “So thinking about ways to rectify that and to build something new and to collaborate. And to really think about community and have community drive that process. No matter what we do next, equity has to be at the forefront of the discussions and the decisions that are being made."
Editor's Note: The video states Marz Lovejoy's son was born March 12th, he was actually born May 12th.
Photos By: Renell Medrano, Tyrone Lebon.
Resources specific to this story:
Roots Community Birth Center: Roots Community Birth Center is a birth center in the Twin Cities that provides full spectrum pre and post-natal care as well as care during labor and delivery. It was damaged in the fires in North and is currently taking donations.
More info on Marz Lovejoy's work can be found here.
More info on Rachel Hardeman's research can be found on her website.
In you are pregnant and/or looking for resources for pregnant women during this pandemic additional information can be found here:
The World Health Organization (WHO) has a Q&A of Pregnancy, Childbirth and Breastfeeding available here.
Centers for Disease Control and Prevention (CDC) in the United States has a pregnancy/breastfeeding and COVID-19 page here
ACOG Practice Guidelines: The American Congress of Obstetricians and Gynecologists published a practice advisory here.
More from our “Pregnant in the Time of Coronavirus” series here.
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