While some health outcomes improve in the United States, racial and ethnic disparities in pregnancy-related outcomes persist. In the United States, Black women are three times more likely to die from a pregnancy-related complication than white women. In Kansas, Black women are more than three times as likely to die of pregnancy-related complications compared to White women. Additionally, Black women are more likely to receive inadequate prenatal care (20%) compared to white women (8.3%).
Racial disparities in adequate prenatal care exist because of social determinants of health and lack of patient inclusion in decision making. The lack of equitable terminology that shifts the blame from individuals to system-level accountability worsens these conditions. We have spent years creating interventions and improving care to address social determinants of health. Yet, we have failed to create equitable terminology to improve patient decision making, remove stigma, and create equity. The recognition that some words or phrases can harm communities has spurred a renewed call to recognize that words matter, particularly in the struggle for birth equity.
Systemic Factors Guide Individual Behavior
There are numerous social determinants of health that affect Black maternal health disparities. Factors such as income, access to housing, type of housing, and access to education all matter. The effects of these factors cannot be easily separated into neat categories.
For example, a low income has profound impacts on the neighborhoods where an individual can afford to live. Often, low-income neighborhoods have poor housing quality. In addition, low-income neighborhoods tend to have less access to full-service grocery stores and pharmacies. Lower-income neighborhoods are often less walkable.
As organizations, healthcare systems, and academic institutions aim to address these disparities, they must ensure that the terminology used to address communities impacted by systemic racism does not place blame on individuals. Unfortunately, this is often the case. Words such as non-compliant, uneducated, and vulnerable are associated with social determinants of health. However, they do not adequately acknowledge a person’s lived experiences and lack of access to resources without defining them by the same.
Terms such as non-compliant do not recognize the systemic conditions that deny access to needed resources. Use of the term is less likely to result in the receipt of needed social services and inclusion in decision-making that creates the conditions necessary to adhere to the medical advice. The term vulnerable or marginalized does not highlight the cause of limited access to rights, resources, and opportunities. Thus, the context of social exclusion, lack of societal support, and devaluing is lost. Just like the labels we attach to people, such words reduce communities to their challenges. Simultaneously, stigmatizing language obscures the systemic forces that caused those challenges and the need for systemic solutions to combat them.
Birth Equity Terminology
If maternal health disparities are to be eliminated, we must recognize the power of words to influence the lives of people. We must recognize that words matter in order to eliminate harmful terminology, and create terminology that acknowledges harm.
The Kansas Birth Equity Network is an initiative that brings together stakeholders such as parents, community members, physicians, and researchers. We have worked with network members on transformative birth equity terminology, such as:
- Non-Compliant → Low Patient Activation
- Vulnerable → Low Societal Support
- Uneducated → Learning Communities
- Low Income → Underprivileged
- Single Parents → Parenting Partners or Birthing Person
Creating equitable terminology that acknowledges the role of systemic forces in creating birth inequities allows us to develop the systemic solutions needed to combat birth inequity. This is only the first step. However, we acknowledge that it is a long overdue signal of respect for the shared identities, history, and experiences of Black birthing persons.
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Thank you so much for this Blog Post.
The continued awareness to this ongoing issue must always be at the forefront of our vision that is needed to resolve the complex problem. Language is so critical, as well as cultural awareness and sensitivity to these ongoing challenges that Black and Brown and others women face. I have 2 very close friends, one of Black and Brown, who have had miscarriages that should never have happened if their providers had not had implicit bias and made assumptions in their care.
I applaud you and yours for your courage to speak out about this ongoing complex subject matter.
I look forward to hearing more from your Team in Kansas.
All the Best in Health and Wellness,
Lisa
Lisa C Flaherty, PharmD, MPH, CPHc
Medical Care Section Member
Past Medical Care Blog Contributor