*originally published by SQUAT Birth Journal, Issue 19 (2015)
Having access to a healthcare provider who is familiar with your culture, language and appearance is an understated necessity. I’ve held this sentiment for as long as I can remember. I was an interpreter for my mother many times in my life and helped her by translating from English to Spanish and the other way around. Because of this experience, I understand how much is lost in translation. My time studying midwifery on the border of El Paso, TX and Ciudad Juarez, Mexico, providing prenatal care solely in Spanish to the women of Juarez, has made me understand the urgent need to act and create awareness about the importance of culturally relevant care and support. Especially in reproductive and maternal health, there is no longer room for half-hearted treatment and sub-par care based on institutionalized racism and unchecked privilege.
It’s been both a rewarding and infuriating experience being a student midwife here. My level of fluency in Spanish has grown over the last 9 months because I speak it nearly every day. I quickly learned how to explain pregnancy and childbirth to women who aren’t usually cared for as closely as they are at Maternidad La Luz. It is wonderful to be able to go in depth in ways some of my fellow midwives cannot because they lack fluency in the language and do not always understand the nuances of the Latino culture (though I am AfroDominicana and my clients are Mexicanas). I can see and hear the sigh of relief when I open my mouth and a steady flow of their native tongue comes out. It is a true joy to be able to share and communicate beyond a beginner’s level of language.
I know that a lot of times they do not get everything care givers try to explain to them because of the language barrier. I become outraged when I realize a procedure or important information was not covered thoroughly. I notice that English-speaking clients and Spanish-speaking clients are treated differently. It holds true that someone who speaks English here can advocate for themselves in ways that a native Spanish-speaker cannot. Language is a huge deal. It is the primary means by which one communicates ideas, desires and, in this case, concerns and needs. A very deep feeling of powerlessness occurs when you cannot be understood because no one speaks your language. And, if you cannot communicate, others can control you and do what they want with your body and life.
Privilege is one hell of a drug. It blinds well-intentioned individuals from seeing the things in their lives that they never have to think twice about. It makes it so that those of us who have to think about the nuances of language, culture and race are very easily dismissed and looked over. The racism in healthcare is real. The institutionalized racism of this particular country is rampant; and in the medical system, it is expressed by the way we treat African American and Latino bodies as expendable, sites of experimentation and genocide.
In an article entitled, “Confronting Race in Health Care”, Pamela F. Ciprano reports that the Centers for Disease Control and Prevention (CDC) Office of Minority Health and Health Equity found that racial and ethnic populations suffer lower life expectancy, higher infant mortality, and higher rates of disability and preventable diseases than non-minorities. Based on my experience, I suspect one of the reasons why this is occurring is because these populations do not feel cared for by the healthcare providers available to them. They may not feel comfortable or feel they can trust the White doctors who sometimes look and talk down to them. The effects of racism do in fact shorten and complicate the lives of those who experience it. It has been found that even affluent racial and ethnic populations suffer from similar statistic, proving that not even social mobility makes you immune to racism.
While blatant discrimination may not always be the problem, subtle micro-aggressions are incredibly persistent. From my experience living in the Bronx, I have noticed a clear socioeconomic segregation at play when Lincoln Hospital in the South Bronx, for example, is juxtaposed against Beth Israel in downtown Manhattan. Low income communities often have sub-standard hospitals and medical professionals available to them while well-to-do neighborhoods fare better in quality and care. Furthermore, this segregation and difference in the quality of care is expounded by the difference in treatment that people receive.
When it comes to reproductive health, women bear the brunt of the lack access to resources and to adequate healthcare providers. This country does not protect women and their health; and marginalized women, such as African American and Latina women, have it much worse than their white counterparts. According to the Black Women’s Health Imperative, more than 34 percent of 45 million Americans who lack health insurance are women of color. The reality is that they live in underserved and under-resourced communities, where they lack appropriate access to primary health care, and endure more chronic illnesses. Very often their diseases go undiagnosed and/or are not treated adequately, resulting in shortened life expectancy and unnecessary deaths. Furthermore, Latino/as also have the highest uninsured rates of any group in the United States according to Latino Healthcare Forum. Lack of health insurance prevents many women from getting medical attention; and sometimes women will not or are unable to seek healthcare because of their immigration status.
The disparities in childbirth alone are staggering: African American women die in pregnancy or childbirth at a rate of three to four times the rate of white women. Latina women are less likely to receive prenatal care earlier in pregnancy, if at all. The Center for Reproductive Rights’ article “Addressing Disparities in Reproductive and Sexual Health Care in the U.S.” supports the notion that racial disparities are particularly pronounced in reproductive and sexual health. Women of color fare worse than white women in every aspect of reproductive health. The Centers for Disease Control and Prevention have recognized that access to prenatal care can reduce maternal mortality and other negative pregnancy outcomes. Most pregnancy-related deaths occur after a live birth, and women who do not receive prenatal care are three to four times more likely to die after a live birth than women who attend even one prenatal appointment.
My sentiment is that women who look like me do not receive the care they deserve and need because the medical system in the United States is white supremacist and capitalist. Historically, white men have used our bodies as sites of experimentation, best exemplified by Dr. J Marion Sims’ years of torture on enslaved African women, the eradication of the Black granny midwives in the South to eliminate competition and have poor African American women to practice on and forced and covert sterilization practices (La Operacion comes to mind here, the reproductive tragedy that many Puerto Rican women have dealt with).
My decision to become a midwife was directly influenced by my study of these facts and my realization that one of the solutions to these issues is to have culturally sensitive and competent healthcare providers. Meaning, racial and ethnic populations would benefit greatly from medical professionals that can connect with them on a cultural and linguistic level. Recently, I had the experience of having a pregnant woman reach out to me and she cited that one main reason she felt comfortable with me was because my skin tone and Afro look like hers. She asked me if I spoke Spanish. Our conversation became a rhythm of prenatal recommendations and we connected on a sister to sister level in Spanglish. I felt so happy after that conversation, knowing that she felt comfortable speaking to me with such ease because we connected on a cultural and ethnic level.
This solution seems impossible but is in fact achievable. First and foremost, there needs to be more emphasis on supporting existing clinics and hospitals who serve communities of color well and opening up others which are culturally sensitive, well-supported and have trained medical professionals who can address the needs of the community. In regards to medical professionals, there is a need for them to reflect the community they are serving but also to have a strong sense of social justice, understand the socioeconomic dynamics of their community and have the ability to be compassionate and genuine.
Furthermore, reproductive health education needs to be more readily available. Creating more programs for women of all ages is imperative in empowering them to seek and decide how to foster healthy lifestyle choices. I would like to see the widespread implementation of sexual education for middle school and high school girls. Along with this, I want more women of color educators addressing and facilitating this education while serving as real-life role models for these young ladies. This education should include attention to specific cultural traits and to the myths that influence the student’s lives, such as Catholic overtones in Black and Latino communities and internalized oppression and its manifestation. Some examples of myths would be the idea that menstruation is something disgusting and negative in a woman’s life, that Black and Latina women are inherently seductive and promiscuous and , and other fabricated misconceptions of a woman’s life cycle.
In the article, “Closing The Black-White Gap in Birth Outcomes: A Life-Course Approach”, the author(s) also recommend increased access to interconception care, preconception care, quality prenatal care and health care throughout the life course in the form of a 12-point plan. The article also calls to address family and community systems that influence the health of pregnant women, as well as the social and economic inequities that underlie much of the health disparities. The life course perspective conceptualizes birth outcomes as the end product of not only the nine months of pregnancy but the entire life course of the mother before the pregnancy. I would like to propose the implementation of Dr. Michael C. Lu, Vijaya Hogan, Loretta Jones and Kynna Wright’s plan to dramatically change birth and life outcomes for vulnerable populations. The goals of the 12 -Point Plan to Close the Black-White Gap in Birth Outcomes are to: 1) improve healthcare services for at-risk populations, including communities of color and low-income families, 2) strengthen families and communities, and 3) address social and economic inequities over the life course. The 12-Point Plan is different from other approaches addressing racial disparities in birth outcomes because it goes beyond prenatal care and the traditional medical model and offers to address family and community systems, and social and economic inequities.
At the political level, there must be committees or working groups created to tackle the inequities in regards to healthcare insurance. With the dawn of the Affordable Care Act and the various grievances that have come with it, including the fact that it is not in fact affordable at all, advocating for the fair implementation of this act in disenfranchised communities can provide insurance to the most vulnerable part of the population.
Black and Latina women deserve to be understood, cared for, and given all the resources and opportunities to lead healthy lives for themselves and their progeny. Understanding and addressing the inequities in healthcare is imperative. With the proper education, access to resources and health care professionals that can relate on a deeper level with racially and ethnically diverse women, more changes can come about to brighten the future for all of us.