Maternal Health Disparities ___________________________________________________________________
or dismissed; this reflects implicit or explicit biases.
ian, or Peruvian [57]. When involved in the care of Latinx/Hispanic individuals, practitioners should strive to employ personalismo (warm, genuine communication) and recognize the importance of familismo (the centrality of the family). More flexible sched- uling strategies may be more successful with this group, if possible, and some patients may benefit from culturally specific treatment and ethnic and gender matching with providers. Aspects of Latino culture can be assets in treatment: strength, perseverance, flexibility, and an ability to survive. NATIVE AMERICAN PATIENTS The Native American population is extremely diverse. According to the U.S. Census, the terms “Native American,” “American Indian,” or “Alaskan Native” refer to individuals who identify themselves with tribal attachment to indigenous groups of North and South America [58]. In the United States, there are 574 federally recognized tribal governments and 324 federally recognized reservations [59]. In 2020, it was reported that there were 7.1 million Native Americans in the United States, which is approximately 2% of the U.S. population. By 2060, this number is projected to increase to 10.1 million, or 2.5% of the total population [59]. Listening is an important aspect of rapport building with Native American patients, and practitioners should use active listening and reflective responses. Assessments and histories may include information regarding patients’ stories, experi- ences, dreams, and rituals and their relevance. Interruptions and excessive questioning should be avoided if possible. Extended periods of silence may occur, and time should be allowed for patients to adjust and process information. Practi- tioners should avoid asking about family or personal matters unrelated to presenting issues without first asking permission to inquire about these areas. Native American patients often respond best when they are given suggestions and options rather than directions. WHITE AMERICAN PATIENTS In 2021, 76.3% of the U.S. population identified as White alone [60]. The U.S. Census Bureau defines White race as a person having origins in any of the original peoples of Europe, the Middle East, or North Africa [46]. While the proportion of the population identifying as White only decreased between 2010 and 2020, the numbers of persons identifying as White and another race/ethnicity increased significantly. The White population in the United States is diverse in its religious, cultural, and social composition. The greatest proportion of this group reports a German ancestry (17%), followed by Irish
ASIAN PATIENTS “Asian” is a single term widely used to describe individuals who have kinship and identity ties to Asia, including the Far East, Southeast Asia, and the Indian subcontinent. This encompasses countries such as China, Japan, Korea, Vietnam, Cambodia, Thailand, India, Pakistan, and the Philippines. Pacific Islander is often combined with Asian American in census data. The Pacific Islands include Hawaii, Guam, Samoa, Fiji, and many others [48]. There are more than 25 Asian/ Pacific Islander groups, each with a different migration his- tory and widely varying sociopolitical environments in their homelands [49]. As of 2019, 22.9 million Americans identified as Asian [50]. Between 2000 and 2019, Asians experienced the greatest growth compared with any other racial group at 81% [51; 52]. The Chinese group represents the largest Asian subgroup in the United States, and it is projected that this population will grow to 35.7 million between 2015 and 2040 [53; 54]. Recommended best practices when caring for Asian American patients include: • Create an advisory committee using representatives from the community. • Incorporate cultural knowledge and maintain flexible attitudes. • Provide services in the patients’ primary language. • Develop culturally specific questionnaires for intake to capture information that may be missed by standard questionnaires. • Emphasize traditional values and
incorporate traditional practices (e.g., acupuncture) into treatment plans, when appropriate and desired. • Explore patient coping mechanisms that draw upon cultural strengths.
While these approaches have been identified as useful for Asian patients, they may be broadly applicable across racial groups. LATINO/A/X OR HISPANIC PATIENTS In 2020, the Hispanic population in the United States num- bered 60.6 million, comprising 18.7% of the U.S. popula- tion [55]. As such, they are the largest ethnic minority group in the United States. The majority of the Hispanic population in the United States (63.3%) identify themselves as being of Mexican descent [56]. Approximately 27% of the U.S. Hispanic population identify as Puerto Rican, Cuban, Salvadoran, Dominican, Guatemalan, Colombian, Honduran, Ecuador-
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