Racial Concordance, Part 2: Leveraging Community Resources to Expand Concordance
Last week, we blogged on the importance of racial concordance to infant survival. The study we highlighted showed the importance of matching patients with physicians of the same race, even at the earliest moments of life. This study adds to a growing body of work that shows over and over the importance of racial concordance – and when not available, the vital need to train physicians in respectful care. The maternal health crisis offers us a case study in why it matters – and during the current pandemic, why we cannot wait and must include funding and programmatic investments to steer our health systems toward justice.
Pregnancy and Mortality Before COVID-19
The pandemic serves as both a magnifying glass and a shrill alarm on the inequity of our health system for those who are privileged and able to reside outside of the harm it perpetuates. Pregnancy-related deaths of Black women and birthing people is a longstanding pre-pandemic crisis that has increased in urgency over the last six months. In general, birthing people of color face high rates of pregnancy-related deaths. Specifically, for Black women this means on average, 37 deaths per 100,000 compared to 14 for white women and these numbers correlate with higher rates for Black women of uninsurance, chronic illness and likelihood to hold essential jobs.
Pregnancy and COVID-19
COVID-19 has changed the birthing experience for everyone, but adds a new layer of trauma for Black women and birthing people. While data remains limited to date, research shows that pregnant women with COVID-19 compared to non-pregnant women, are more likely to require Intensive Care Unit care and ventilator support. When layered with a June 2020 CDC report that Latina and Black pregnant women are more likely to be disproportionately affected by COVID-19, the warning signs of a growing mortality rate of pregnant people of color during and postpartum are in full view.
However, doulas and other birthing care providers of color offer hope. Prior to, and during the pandemic, these providers have helped to lead the way in supporting birthing for people of color. Research shows that women who were able to utilize prenatal doula care had 22 percent lower odds of a preterm birth and the odds of cesarean delivery were reduced by nearly 60 percent when women had doula support, in comparison with not having a doula. This is lifesaving care for Black women and birthing people who live at the intersection of multiple systems of oppression, daily.
Like doulas, Community Health Workers (CHWs) also play a crucial role in infant and family health postpartum. As evidence, the Strong Beginnings program in Michigan, which focuses on improving maternal, infant, and child health for high-risk African American and Latinx families has seen a 50 percent reduction in African American infant mortality in 11 years. Having providers that are of the same race and reside in the community are a key piece of advancing equity and improving health outcomes for those historically excluded from the health care system.
We know three things to be true:
- birthing people of color (Black, Indigenous and other people of color) face a heightened risk of COVID-19 complications;
- maternal mortality was a crisis even before the pandemic, which has lifted the veil of ignorance for others to view; and
- when birthing people and their babies are cared for by providers who look like them, their health outcomes improve.
What Are We Waiting For?
Racial concordance matters. The pandemic is taking rates of both infant and maternal death in the wrong direction while we are standing idly by. We can take action now by expanding the birthing workplace to fund and leverage doulas, community health workers and other birthing supports led by people of color. This will not only increase the likelihood of racial concordance for birthing people and create a bridge to culturally competent physician care that may assist with infant care and postpartum support, but also pave the way for a future that is more inclusive and diverse.
Legislative Action is Needed
There are a number of legislative proposals on deck, driven by the Black Maternal Health Caucus to address the growing maternal health crisis across the country. The Black Maternal Health Momnibus which was introduced in March and is led by Rep. Lauren Underwood, Rep. Alma S. Adams, and Sen. Kamala Harris, is one such effort. The legislative package is comprised of nine individual bills which will fill gaps in existing legislation by advancing policies that grow and diversify the perinatal workforce, increase postpartum Medicaid coverage from 60 days to 12 months, invest in rural maternal health, fund tech programs to provide doula support via telehealth and enact implicit bias trainings.
Communities across the country need lifesaving care, and the Momnibus is a first and critical step forward for Black infants, women and birthing people. Congress must act now.