Birthing Bias: What We’ve Learned from Women of Color About Giving Birth in the U.S.
By Jennifer DeYoung, Dr. Venice Haynes & Annie Yu
At United States of Care, we believe that building a better health care system for everyone starts by listening to people first. Guided by our United Solutions for Care, the four goals and 12 solutions built out of years of listening directly to what people want and need from their health care, we apply people’s experiences to our work and advocate for policies designed to make health care more affordable, dependable, personalized, and understandable.
As we built our solutions, we saw that the call for better maternal and newborn care continued to rise to the top of what people needed most. With the Black maternal mortality crisis continuing and health outcomes for women of color throughout the birthing experience still lagging behind those of white women, we leaned in on this issue and listened to the maternal health experiences of women of color across the nation. From our listening research, we uncovered three key consistent themes that may help us support women of color in having a happy, healthy birthing journey — and where we can work to eliminate this disparity.
Differential Treatment, Stereotyping, and Racism in the Black Maternal Health Experience
“As an African American woman, they [health care providers] look at you and feel like your pain is less than [someone] outside of my race.”
- Black woman, Northeast
Often throughout our listening work, we hear from Black women and other people of color that they simply want to be treated like a human being while seeking health care. They want to be heard, respected, and given the same chance to receive quality health care as anyone else. As we listened to Black women’s maternal health experiences, we heard several instances where Black women experienced dismissive and differential treatment based on their race. From providers minimizing their pain to assumptions about the quality and type of insurance Black women have, these experiences highlighted significant obstacles Black women face when seeking maternal health care.
Similarly, the Black women we heard from in our listening research expressed feeling the burden of needing to be strong even during one of the most vulnerable moments of their lives. Together with the keen awareness many Black women have of racism and discrimination in our health care system, the barriers for Black women seeking health care throughout the birthing experience have risen to the top in our listening work — and efforts to produce safe and joyful pregnancy and postpartum journeys for Black mothers should keep these experiences in mind.
Limited Knowledge and Experience with Midwives and Doulas
“I want to say the doula is the woman who helps you through your prenatal period. A midwife is the woman after — when the woman is postpartum.
No, no it is the other way around, I think.”- Black woman, Midwest
Another key insight from our listening research on maternal health is the lack of knowledge and experience with midwives and doulas. We know that midwives and doulas have a positive impact on maternal health outcomes, but throughout our conversations we heard from women of color who expressed confusion about what a doula is and how they differ from a midwife. Similarly, the social stigma associated with using a doula and the financial, social, informational, and cultural barriers to using a doula were expressed in these conversations.
Despite these perceptions of doula care, the women we listened to in our research shared that the idea of a doula was appealing and that they had positive experiences with care that was more personalized. In particular, these women shared that the informational, emotional, and physical support a doula can provide would have been helpful in their birthing journeys.
Lack of Postpartum Support
“Once I gave birth to my daughter, I didn’t have any support. I literally had one appointment after I had her and that was 6 weeks after I gave birth to her… After that, I didn’t really have any sort of support coming from being pregnant where you have an appointment once a month, every two weeks, and they are constantly checking on your blood pressure, how you are feeling, and ultrasounds. It literally just stopped after I had her.”
- Hispanic woman, Southwest
The third trend we observed was the lack of postpartum support for new mothers. Despite the importance of the “fourth trimester,” or the 12 weeks after giving birth, many of these women experienced a significant drop in care and support after giving birth, and many of them understood postpartum care to primarily be help and guidance provided by family and friends rather than professional health care providers.
These women had a lot of regular appointments with their health care providers and support during their pregnancy. Once the baby was born however, the focus shifted to the child, leaving these women feeling alone when they returned home and uneducated about what the postpartum process looked like for themselves.
The Road to Improvement
We know that maternal care continues to top the list of areas people want improvement in our health care system, and as we are seeing in our listening research, the experiences of women of color throughout the birthing journey are fraught with problems and areas for improvement. While there are some encouraging trends, like the growing number of states expanding Medicaid postpartum coverage, there is still a long way to go until we eliminate the racial disparity in maternal health outcomes to ensure safe and supported pregnancy and postpartum experiences for women of color — and we can all start by simply listening.
Jennifer DeYoung is our Senior Director of Policy & Innovation.
Dr. Venice Haynes is our Director of Research & Community Engagement.
Annie Yu is our Policy Innovation Manager.
About United States of Care:
United States of Care is a nonpartisan organization committed to ensuring that everyone has access to quality, affordable health care.
Disclaimer:
This article is part of United States of Care’s Medium publication, representing the individual views of the author(s). It does not necessarily reflect the beliefs or positions held organizationally by United States of Care or its board of directors. As a non-profit organization dedicated to ensuring that everyone has access to quality, affordable health care, United States of Care values and seeks out a diverse range of perspectives. We believe in the power of different voices to enhance understanding, empathy, and dialogue about critical health care issues.
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