Despite the fact that the United States spends more money on health care than nearly any other industrialized nation, we also have the highest rate of deaths related to pregnancy and childbirth in the industrialized world. Our infant and maternal mortality rates (IMR and MMR) are shockingly high: in fact, in lists of international IMRs and MMRs, the United States ranks thirty-ninth in MMR and thirty-fourth in IMR, just below nations such as Cyprus, Croatia, and Cuba. At least half of these deaths are considered "preventable."
Perhaps most distressingly, both the IMR and the MMR in the United States reveal staggering disparities between African Americans and other racial populations. Black individuals are three to four times more likely to die in pregnancy or childbirth than their white counterparts. Black babies are 49 percent more likely to be born preterm and twice as likely to die before their first birthdays. While international rates for maternal mortality have decreased overall since 1990, even among “developing” nations, the U.S. rate has increased 65% and, again, African American people seem to shoulder a disproportionate share of that burden.
Researchers have explored the effects of socioeconomic status, education, health behaviors, and genetics and/or geographic ancestry on birth outcomes, but none of these explain this big gap. Racial disparities persist regardless of socioeconomic status (black individuals in the wealthiest neighborhoods still do worse than white, Asian, and Latina individuals in the poorest neighborhoods) and education levels (black individuals who are college-educated have worse outcomes than people of all other races who never finished high school). Obese individuals of all races do better than black individuals who are of normal weight. And explanations that rely on genetic or “biological” differences between African Americans and other races have also been consistently refuted. Instead, we are beginning to understand that this health disparity is a product of the systemic racism and sexism. The chronic stressors of discrimination and unequal access access to healthy food, safe neighborhoods, good schools, decent jobs, good insurance, and reliable transportation accelerate aging at the cellular level, and maternal age is an important risk factor for many severe pregnancy-related complications. These chronic stressors are exacerbated by biases embedded within the medical system, which often leave black individuals feeling devalued and disrespected by medical providers.
Midwives may be a key in fixing our failing system. Recent studies have shown that, in the United States, the states that have done the most to integrate midwives into their health care systems have some of the best outcomes for mothers and babies across race and class. Worldwide, integrating midwives into health care systems could prevent more than 80 percent of maternal and newborn deaths. The midwifery model of care emphasizes close, trusting relationships where providers listen to their clients and respect them as the ultimate authorities of their bodies; holistic prenatal and postpartum wellness; and the avoidance of unnecessary interventions that can spiral into dangerous complications.
New York occupies a unique place in these discussions, as the center of groundbreaking research and initiatives on these discrepancies, as well as one of the nation's starkest examples of such inequality. We, the homebirth midwives of New York State, are committed to being part of the solution. We provide safe and respectful care regardless of regardless of racial or sexual identity, class, background, family structure, circumstance, or belief system.
For more information and evidence about how midwives improve outcomes and healthcare disparities: The Lancet Series on Midwifery
Perhaps most distressingly, both the IMR and the MMR in the United States reveal staggering disparities between African Americans and other racial populations. Black individuals are three to four times more likely to die in pregnancy or childbirth than their white counterparts. Black babies are 49 percent more likely to be born preterm and twice as likely to die before their first birthdays. While international rates for maternal mortality have decreased overall since 1990, even among “developing” nations, the U.S. rate has increased 65% and, again, African American people seem to shoulder a disproportionate share of that burden.
Researchers have explored the effects of socioeconomic status, education, health behaviors, and genetics and/or geographic ancestry on birth outcomes, but none of these explain this big gap. Racial disparities persist regardless of socioeconomic status (black individuals in the wealthiest neighborhoods still do worse than white, Asian, and Latina individuals in the poorest neighborhoods) and education levels (black individuals who are college-educated have worse outcomes than people of all other races who never finished high school). Obese individuals of all races do better than black individuals who are of normal weight. And explanations that rely on genetic or “biological” differences between African Americans and other races have also been consistently refuted. Instead, we are beginning to understand that this health disparity is a product of the systemic racism and sexism. The chronic stressors of discrimination and unequal access access to healthy food, safe neighborhoods, good schools, decent jobs, good insurance, and reliable transportation accelerate aging at the cellular level, and maternal age is an important risk factor for many severe pregnancy-related complications. These chronic stressors are exacerbated by biases embedded within the medical system, which often leave black individuals feeling devalued and disrespected by medical providers.
Midwives may be a key in fixing our failing system. Recent studies have shown that, in the United States, the states that have done the most to integrate midwives into their health care systems have some of the best outcomes for mothers and babies across race and class. Worldwide, integrating midwives into health care systems could prevent more than 80 percent of maternal and newborn deaths. The midwifery model of care emphasizes close, trusting relationships where providers listen to their clients and respect them as the ultimate authorities of their bodies; holistic prenatal and postpartum wellness; and the avoidance of unnecessary interventions that can spiral into dangerous complications.
New York occupies a unique place in these discussions, as the center of groundbreaking research and initiatives on these discrepancies, as well as one of the nation's starkest examples of such inequality. We, the homebirth midwives of New York State, are committed to being part of the solution. We provide safe and respectful care regardless of regardless of racial or sexual identity, class, background, family structure, circumstance, or belief system.
For more information and evidence about how midwives improve outcomes and healthcare disparities: The Lancet Series on Midwifery
