Nurses can lead in providing ethical pregnancy care to Black women

For far too long, people have focused on policing women’s behavior to manage pregnancy conditions, with little success. Over the last 20 years, research has documented the impacts of social determinants—the conditions in which people are born, live, learn, work, play worship and age that impact their health. Professional organizations recognize the unacceptable disparities in maternal health as a result of structural racism. Researchers have identified economic vulnerability, stress and experiences of discrimination as racism-related risk factors during pregnancy. A new paper from Bixby member Monica McLemore, Karen Scott and Laura Britton provides nurses and public health professionals with tools to dismantle structural racism and ethical principles for providing pregnancy care to Black women.

Blaming Black women for poor reproductive health outcomes ignores circumstances, environments and situations these women face as they seek to stay healthy, become pregnant and give birth. The authors identify several strategies for health equity in birth outcomes that reject that framework:

  • Tool kits for providers. Tools kits from the California Maternal Care Quality Collaborative and Bundles from the Alliance on Innovations in Maternal Health have been instrumental for clinical care.
  • Preconception care. It’s estimated that preconception care for all woman would prevent thousands of birth defects, perinatal deaths and preterm births. Black women are most likely to be uninsured and thus least likely to receive this care.
  • Innovative group and home-based programs. Research has shown that Black women in group prenatal care had significantly lower rates of preterm birth than their peers in traditional prenatal care. These kinds of strategies allow for more interpersonal knowledge and social support.

While these strategies are helpful, they are not sufficient without grounding in ethical principles. “Setting the Standard for Holistic Care of and for Black Women” from the Black Mamas Matter Alliance offers 8 standards that are essential for the healthcare workforce. These include listening to Black women; replacing white supremacy and patriarchy with a new care model; and recognizing that access does not equal quality care. Much of this aligns with the American Nurses Association’s Code of Ethics.

Another essential component is diversification of the healthcare workforce. When Black women are treated by a provider of a different race, it can have profound implications for communication and interpersonal care. People of color in health professions are also more likely to serve minority populations and to work with publicly insured patients.

Nurses and public health professionals can lead the way in better serving patients and families by adopting strategies that respond to structural inequalities. Ethical care of Black women requires a well-educated and diverse workforce with deep knowledge of social determinants of health, health disparities, health inequity and community engagement.