Racism in the United States is bad for your health. This is especially true for Black people, who for centuries have endured the harmful effects of racist systems.
Acknowledgment: In the wake of a centuries-long struggle to thrive and following an especially poignant 2020, many Black people want to be heard. Not through the raw emotion of their most appalling experiences but from their voices of wisdom. The fact that the Black community is still being defined by racial inequities and health disparities is a testament to the work that lies ahead. Yet there is a light that shows the way forward – the healing power Black women, mothers, and birthing people bring to their communities.
The phrase “Black women, mothers, and birthing people” is used throughout this 3-part series to recognize people who identify as non-binary, honor surrogates, and pay respect to those who have lost a child.
Racism in the United States is bad for your health. This is especially true for Black people, who for centuries have endured the harmful effects of racist systems.
College degrees and higher earnings are usually associated with lower incidences of preventable disease. But that’s often not true in communities of color, especially for those who are Black. They continue to experience the most disproportionately negative health outcomes across the board.
Five hospitals across Los Angeles County, along with guidance from Black women community leaders and the support of several health care partners, are working to change that.
Compared to their white counterparts, Black babies across the country are twice as likely to die in their first year – in Los Angeles, they are three times more likely. Black moms, women, and birthing people are three times more likely than white people to die from pregnancy-related causes. Most pregnancy-related deaths are preventable, according to the Centers for Disease Control and Prevention.
Even affluent and successful Black mothers like Beyoncé and Serena Williams can’t escape this reality. A growing body of research shows exposure to the indignities and perils of racism, implicit bias, and stereotyping are at the root of racial disparities. In an article published in the Center for Health Journalism, Monica McLemore, Ph.D., MPH, RN, writes, “There is nothing inherent about black skin that increases risks during pregnancy — except over-exposure to the real culprit, racism, which can harm a mother’s body in real, measurable ways.”
While California is doing better than the rest of the nation in reducing maternal mortality, the dedicated work to improve continues.
Cherished Futures for Black Moms and Babies, a collaboration between hospitals, community-based organizations, public health agencies, and health care workers, aims to upend these health disparities. Its mission to reduce Black infant mortality and improve Black maternal patient experiences and safety lays bare the inequities and biases that have been there for generations.
In Their Own Words: “If you want to see racism in health care, look at a map. Not maps from the 1940s, but today’s maps – they show how our communities are segregated in this present day and age. If racism doesn’t exist, then why is real estate better around university hospitals but not around the county hospitals? Both are hospitals, but why the disparity? You can see it in medicine right there. Zip codes don’t protect you from racism. They can protect you from disease or lifestyles, but racism finds you no matter where you live.”—Dr. Deepjot Singh, obstetrician-gynecologist, Providence Little Company of Mary Medical Center |
Roots of inequity
Choices we make every day are guided by implicit bias – the unconscious assumptions that skew our impression of people outside of our social group. That can be deadly in a health care setting. It’s also the basis for the long history of racial injustices the Black community has endured.
In California, like the rest of the United States, centuries of racist policies and practices have created barriers to stability and health. From slavery, to Jim Crow laws, to redlining, Black people and other people of color were pushed into under-resourced, segregated neighborhoods, and locked out of wealth-building opportunities that were afforded to many white Americans. The effects of these policies are still felt today, and stain every aspect of life from housing patterns and the availability of safe outdoor spaces, to employment opportunities and access to fresh food. The lifelong accumulation of this toxic stress in Black women, moms, and birthing people is known as “weathering”.
Frances Davies, perinatal patient safety specialist for California Hospital Medical Center and a Cherished Futures ally, knows everyone expresses bias. The Registered Nurse and Nurse Practitioner acknowledges she’s guilty of it herself.
“We want to be with people who look like us,” she said. “If they are somehow different, your bias clicks in without you realizing it.”
Davies recalls early in her career, when a couple would come to her practice with a birth plan, she couldn’t help but think the mom-to-be would probably have a C-section – the best laid plans often don’t turn out well.
“But that’s not fair of me to have that view from the very start; you only get one chance to make a first impression,” she said. “Everyone has a right to be respected. You have to treat her like the most important thing in the world right now is this pregnancy and this baby. You have to make people feel like they are not just a number on a page.”
Dana Sherrod, Cherished Futures lead knows firsthand what it’s like to feel like a number. The birth equity and racial justice manager experienced being disrespected and not being listened to during both of her traumatic hospital births.
“It doesn’t matter the degrees you hold, the money you make: racism and implicit bias impacts all of us,” she said. “I often tell folks this work for me is both professional and deeply personal because I, and my colleagues, are part of the very communities that we are trying to improve outcomes for. I also have a Black husband and two Black daughters. That means I am working for the benefit of Black folks and the benefit of my own family.”
Sherrod recalls the pain of watching her mother – a nurse with a doctoral degree who spent more than three decades as a health care executive – be blatantly ignored and deeply disrespected during a medical emergency because she was “too loud” and “needed to calm down” when she advocated for her own care.
“For me, there is a sense of urgency in this work. We [Black people] are facing multiple crises at once on many fronts,” she said. “So many people have been fighting the good fight for decades and this work builds on their labor. It is time for these inequities to be addressed, 400 years is long enough.”
Community effort begins
In 2017, HASC launched a community health improvement program called Communities Lifting Communities (CLC) aimed at reducing health disparities in Los Angeles, Orange, Riverside, San Bernardino, Santa Barbara, and Ventura counties. Two years later, CLC, HASC, and Public Health Alliance of Southern California partnered to identify the hospitals in Los Angeles County with the greatest number of preterm births. Soon, 5 hospitals became the first to join Cherished Futures.
Cherished Futures 2020 Hospitals
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By the end of 2019, SB-464, the California Dignity in Pregnancy and Childbirth Act, became law. Sen. Holly Mitchell’s pioneering legislation mandates implicit bias training for all staff involved in perinatal care of patients within birthing centers in an effort to reduce the high birth mortality rate in the Black community. It was fortunate timing that strengthened Cherished Futures’ work.
Susan Harrington, president of CLC, has worked as a Registered Dietician and nutritionist for more than 34 years. She found a passion for addressing bias at her first job in health care when she was a prenatal nutritionist working with at-risk women in Riverside County. She believes SB-464 will be an important tool in dismantling biased health care.
“Since its inception in 2019, Cherished Futures has charted new territory by bringing together traditionally siloed leaders to think boldly about systems change, develop new ideas, and build solidarity,” Harrington said. “Our leadership with hospital teams shows we can collaboratively bring together providers and community.”
Cherished Futures has started building critical relationships between hospitals, health care systems, clinicians, and other stakeholders. The idea is to bring hospitals and Black community leaders together to create systems-level change in three domains, clinical, institutional, and community.
We share a commitment to understand and tear down the systemic barriers that communities of color face in California. Your support helps us ensure that access to quality health care and personal safety is a right for everyone, not a privilege for some.
Read on for ways you can begin to see and change the implicit biases inside you. Then confront your assumptions to bring about social change.
- Acknowledge, then challenge your implicit bias
- Take an implicit bias test
- Commit to managing your bias
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