What does “Birth equity” mean to me? If someone had asked me that three years ago I likely would have had a different answer. The answer should be easy – an equal and fair opportunity for all mothers to receive appropriate obstetrical care during pregnancy, delivery and the postpartum period. The task should be easy – Treat everyone the same. Give everyone the best of our abilities and resources to ensure the best care in our control. Everyone.
So why is this a topic? Shouldn’t this be automatic? Instinctive even? Unfortunately it is not. Pregnancy-related maternal death is declining all over the world, but it is increasing at an alarming rate in the United States. More specifically, Black women are three times more likely to suffer a pregnancy-related death than women who are White or non-Black Hispanic and babies born to Black women are dying at twice the rate as those born to the same counterparts. The first time I heard this I thought “This can’t be true. There must be something they are missing”. But statistics don’t lie and this is true even when controlling for different variables such as social and economic factors, education and geographical location. “What?” I thought. “No way?” But statistics don’t lie. It hit me like a truck. What makes this more alarming is that 80% of maternal death is considered to be preventable. Another truck.
How did this happen? How did we get here? This has been a known and evolving statistic for a couple decades but has only been making headlines for the last few years. I wasn’t aware of this disparity until about three years ago. It’s certainly a multifactorial issue with many parts. Likely at the center of it is structural racism and implicit bias. What is implicit bias? It is defined as bias that occurs automatically and unintentionally but nevertheless affects judgements decisions and behaviors. “Not me” I thought. “There is no way I could have any biases that could put a woman at risk”. But that’s the thing about implicit bias, it’s unconscious and statistics don’t lie. That felt like a semi truck.
After diving into this, I think the best definition of “Birth Equality” is defined by the California Maternal Quality Care Collaborative (CMQCC): “The assurance of the conditions of optimal births for all people with a willingness to address racial and social inequities in a sustained effort.” Birth equality doesn’t just mean equal opportunities for all – it means making the extra effort to find out why it’s not equal in the first place. It’s learning about the disparities and finding their origins. It’s recognizing my own lapse in knowledge and recognizing my own implicit bias. It’s studying the population of women who are most at risk and learning what plagues them and learning their early signs of trouble. Birth Equity is not passive. It’s proactive.
My partners and I have dedicated our adult lives to this job. Outside of our families, taking care of patients is what fuels us. As all humans are, we will forever be works-in-progress so we will continue to make the necessary efforts to narrow this gap. We will continue to study the literature and have the discussions. We will continue to complete the workshops and attend the conferences. We will continue to explore our own biases and recognize our own deficiencies. Most importantly we will continue to listen to the patients. We will continue until there is no gap to speak of.
If you would like to read more about Birth Equity we recommend the following resources:
https://www.cmqcc.org/content/
https://www.ama-assn.org/
https://www.cdc.gov/