Maternal Health Disparities ___________________________________________________________________
munication [68]. In this multicultural landscape, interpreters are a valuable resource to help bridge the communication and cultural gap between clients/patients and practitioners. Interpreters are more than passive agents who translate and transmit informa- tion back and forth from party to party. When they are enlisted and treated as part of the interdisciplinary clinical team, they serve as cultural brokers, who ultimately enhance the clinical encounter. In any case in which information regarding diagnos- tic procedures, treatment options, and medication/treatment measures are being provided, the use of an interpreter should be considered. Whenever possible, professional interpreters are preferred. Family interpreters should be avoided if at all possible. Preferred language and immigration/migration status should be considered. Stressing confidentiality and privacy is par- ticularly important for undocumented workers or recent immigrants, who may be fearful of deportation. RACIAL AND REPRODUCTIVE JUSTICE Racial biases in healthcare access, treatment, and outcomes and institutional racism embedded in healthcare institutions contribute to poorer health outcomes in minority popula- tions. Many healthcare organizations are committing to the improvement of racial inequalities by dedicating resources and infrastructure to negating this problem. Healthcare organiza- tions and practitioners have a vital role in acknowledging and dismantling structural racism [69]. Race Forward defines racial justice as “a vision and transfor- mation of society to eliminate racial hierarchies and advance collective liberation, where Black, Indigenous, Latinx, Asian Americans, Native Hawaiians, and Pacific Islanders, in particu- lar, have the dignity, resources, power, and self-determination to fully thrive” [70]. In the context of health care, this concept is related to eliminating race-related health disparities, ensuring access and quality of care for minority groups, and improv- ing quality of life for all persons, regardless of race, color, or ethnicity. This requires that practitioners take a perspective of cultural humility and proactively move to dismantle harmful stereotypes and practices. It is vital to actively listen and critically evaluate patient rela- tionships. All practitioners should seek to educate themselves regarding the experiences of patients who are members of a community that differs from their own. Resources and opportunities to collaborate may be available from community organizations and leaders. The term “reproductive justice” was coined by a group of Black women in 1994 [90]. This concept, linked to racial jus- tice, is based on the core belief that sexual and reproductive justice exists when all people have the power and resources to make healthy decisions about their bodies, sexuality, and reproduction. Reproductive justice sheds light on the mul- tiple combined forms of oppression that contribute to the
reproductive oppression of women of color. This perspective asserts that intersecting systems of oppression (e.g., race, class, gender) result in the control and exploitation of women, girls, gender-expansive individuals, and others through their bodies, sexuality, labor, and/or reproduction [90]. Persons who experience multiple oppressions experience more severe maternal morbidity. Only addressing all of the systemic issues contributing to poorer maternal health outcomes in persons of color will resolve racial health disparities in the United States. INTERVENTIONS TO REDUCE IMPLICIT BIAS AND RELATED MATERNAL HEALTH DISPARITIES According to the CDC, interventions to address bias on mul- tiple levels can reduce pregnancy-related deaths [2]. Healthcare systems should foster a respectful maternity culture by hiring and retaining a diverse labor force and training all healthcare staff to identify implicit bias and stigma. The CDC also rec- ommends healthcare systems promote quality improvement measures, focusing on increasing the respectful maternity cul- ture for all women, so all patients feel they are equal regardless of race, ethnicity, or socioeconomic status. It is also ideal for healthcare professionals to strive for all maternal patients to feel respected, understood, supported, and valued throughout their care [2]. The American College of Obstetricians and Gynecologists makes the following recommendations for obstetrician/ gynecologists and other healthcare providers to improve patient-centered care and decrease inequities in reproductive health care by [71]: • Inquiring about and documenting social
and structural determinants of health that may influence a patient’s health and use of health care • Maximizing referrals to social services to help improve patients’ abilities to fulfill these needs • Providing access to interpreter services for all patient interactions when patient language is not the clinicians’ language • Recognizing that stereotyping patients using presumed cultural beliefs can negatively affect patient interactions, especially when patients’ behaviors are attributed solely to individual choices without recognizing the role of social and structural factors
The CDC has also launched the Hear Her campaign to pro- vide resources for practitioners and pregnant and postpartum women, with an emphasis on preventing pregnancy-related deaths by sharing potentially life-saving messages about urgent
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