Updated: Nov 18, 2022
November is Prematurity Awareness Month. Premature babies can face complicated medical setbacks including infections, asthma, stomach complications, hypothermia, bleeding in the brain – the list goes on. The earlier your baby is born, the higher the risk of complications.
In Minnesota, the preterm birth rate among Indigenous women is 46% higher than the rate of other women and 31% higher for Black women. Why? According to the Mayo Clinic’s website, the reasons are unknown.
Dr. Rachel Hardeman, a professor and researcher at the University of Minnesota’s School of Public Health, disputes that claim. “For as long as we’ve been collecting data, inequities in preterm birth have persisted. Even as the United States has lowered its overall infant mortality rate, the gap between white infants versus Black and Indigenous infants has persisted,” she said.
“My research - and that of many others across the country - has demonstrated that racism - not race - is a fundamental cause of racial inequities in preterm birth.
Health professionals should consider understanding the historic and contemporary impacts of structural racism to be a core professional competency.”
Widlyne Desir is a doula and massage therapist at Desir Holistic Therapy in the Twin Cities. “The things I have witnessed in Minnesota as a doula are horrific,” she said. “I have seen how they treat women of color versus treatment of white women. The darker your skin, the more problems you encounter.”
With both her pregnancies, Widlyne went into labor early and felt unseen and unsafe with the care she received at the hospital. When she was five months pregnant with her first child, Widlyne was taken by helicopter to St. Cloud Hospital in active labor.
Once there, she was given medicine to stop her contractions and then - to her surprise - was discharged and sent back to her doctor, a 90 minute car ride away.
Widlyne was put on total bed rest for two months before bringing a small but healthy baby girl into the world.
Her second pregnancy was with twin boys. “Since I went into labor early with my daughter, I was high risk for another pre-term birth. I had a checkup at 27 weeks and once again, I was in labor.”
This time, her doctor sent her to the Mother Baby Center at Children’s Minnesota.
“A male doctor came in, he didn’t even introduce himself to me, and stated I would be prepped for surgery.” Widlyn asked instead for medicine to stop her contractions. The doctor told her, “There is not such thing,” and Widlyne panicked.
“I started screaming at the top of my lungs, ‘You’re trying to murder my babies!’ over and over again. The doctor left the room while I cried and came once I stopped to tell me they found the medicine — and didn’t speak to me again after that.”
Widlyne’s twins were born six weeks early. Because of how she was treated, she didn’t trust that the doctors and nurses would treat her babies any better.
“I was so scared to leave their side,” she said. “They kept trying to get me to go home, and I refused.”
Racism is bad for the body.
“Black and Indigenous people endure the effects of racism, hostility, disrespect, and bias in all aspects of society,” Dr. Hardeman said. “And it can be deadly when perpetrated by health care providers.”
Still, structural racism and interpersonal racism, better known as implicit bias, remain.
“Implicit biases are often unconscious and automatic,” said Dr. Hardeman. “They negatively influence the healthcare Black and Indigenous people receive and can be held by people who would not consciously agree with racist stereotypes.”
What is the solution?
President Joe Biden’s budget request for Fiscal Year (FY) 2023 includes $470 million to reduce maternal mortality and morbidity rates, expand maternal health initiatives in rural communities and address the highest rates of health disparities in the weeks following a birth. Additionally, Vice President Kamala Harris announced that the Maternal Care Act includes a budget of $30 million to implicit bias training. FY23 funds will be available in March. Dr. Hardeman called the investment important, but not enough.
“We cannot train ourselves out of racial inequities in preterm birth and other reproductive health outcomes. We need policy change that addresses the ways in which structural racism impacts the lives of racialized people.”
Health and Human Services announced the availability of $4.5 million available for hiring, training, certifying, and compensating community-based doulas. Currently, Minnesota is one of 10 states that reimburse mothers on Medicaid for doula services.
“It would be amazing to see this expanded across all states,” said Widlyne. “But for pregnant people without an advocate or a doula, trust your gut. Voice your concerns. If you don't like what they are saying, ask for a second opinion. No question is a dumb question when it comes to the health and safety of you and your babies.”
Read more of Dr. Rachel Hardeman’s research: Structural Racism and Supporting Black Lives — The Role of Health Professionals