Health of Birthing People in Marginalized Communities
Olympic Medalist Tori Bowie, who passed away at age 32 due to complications from childbirth
The health of birthing people in the US is inadequate, especially when compared to other well-resourced countries. Unfortunately, communities that have been marginalized throughout our country’s history are still experiencing disproportionately negative health outcomes to this day, including within maternal health. There are a number of reasons why we see these disturbing trends, none of which are related to inherent biological differences. Although this is not a comprehensive review of the systemic issues affecting maternal health in the US, we hope to draw attention to this critical topic and highlight companies that are actively working towards necessary solutions.
*We use the term “maternal health” to discuss the health of all birthing people. We recognize that not all people who give birth identify as mothers, and we are passionate about staying informed on inclusive language and practices.
Understanding the Problems in Maternal Health: What this means for people of color
Among the high rates of maternal morbidity and mortality in the US, it is an unfortunate reality that communities of color are hit harder than their white counterparts. Maternal mortality rates are over twice as high for Black and American Indian and Alaska Native pregnant people compared to their white counterparts. One study notes that this holds true after accounting for level of education; Black and American Indian and Alaska Native people with some level of college education are more likely to have a pregnancy-related death than someone in any other racial or ethnic group that has received less than a high school diploma. As striking as this is, a patient’s race and educational opportunities should not impact the care that they receive.
In addition to higher rates of maternal mortality, people of color have higher rates of severe maternal morbidity, defined by the CDC as “unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health.” Black people in particular have a higher risk of developing preeclampsia during pregnancy and are admitted to intensive care units more frequently when giving birth compared to White people.
Unfortunately, these trends do not stop at the health of the birthing person. Infant mortality rates are twice as high for Black, American Indian and Alaska Native, and Native Hawaiian or Other Pacific Islander communities compared to White populations. Black people also have the highest rates of preterm birth (see graphic below) and low birth weight, which are two of the leading causes of infant mortality. This may be partly attributed to the fact that 19% of Native Hawaiian or Other Pacific Islander and 9% of Black pregnant people do not receive prenatal care, or receive it late in the pregnancy, compared to 5% of White pregnant people. Prenatal care is a critical part of both maternal and infant health and everyone deserves equitable access to it.
Source: Centers for Disease Control and Prevention
Understanding the Problems in Maternal Health: What this means for the LBGTQIA+ community
In addition to communities marginalized based on race and ethnicity, people who identify as LGBTQIA+ have more pregnancy related issues compared to their cisgender or heterosexual counterparts. Out of the LGBTQ+ community, lesbian and bisexual people have been studied the most in terms of pregnancy outcomes. For example, lesbian and bisexual pregnant people are more likely to experience pregnancy loss and preterm birth compared to heterosexual pregnant people. Lesbians are also more likely to have infants with low birth weights and to experience postpartum depression, one of the leading causes of maternal mortality.
There is an overwhelming scarcity of data for pregnancy and birth outcomes of transgender and non-binary people, and there is no research that focuses on people of other gender identities. What we do know is that people in these populations have an increased number of barriers towards having a successful pregnancy which include, but are not limited to, disruptions in hormone therapies and not having providers that are trained to help navigate their prenatal and postpartum needs. In addition, transgender and non-binary people may experience additional psychological hardships throughout pregnancy, such as dysphoria and visibility, which can lead to negative pregnancy outcomes.
Some factors influencing maternal health outcomes in marginalized communities
Access to quality healthcare before, during, and after pregnancy is imperative to ensure the health of the pregnant person and the infant. Limited access to these resources have existed for many people, but the overturn of Roe v Wade has, and will continue to have, a larger impact on people of color when accessing pregnancy resources based on the demographics of the areas experiencing restrictive policy changes. In addition, members of the LGBTQ+ community may experience a higher cost for reproductive care, for services such as fertility counseling or gender-affirming care, making a healthy pregnancy less accessible to some. Access to quality healthcare, in general, also impacts maternal health. For example, the disproportionate increase in maternal mortality for Black and Hispanic communities in the US during 2020 and 2021 can be partially attributed to COVID-19 related deaths (see graphic below).
Source: National Center for Health Statistics, Centers for Disease Control and Prevention
Even if an individual has access to maternal healthcare, it is not guaranteed that the care will be of high quality or without discrimination. People of color report a higher rate of mistreatment during maternal care than white people, and more than 50% of LGBTQ+ birthing people report that discrimination or bias impacted the quality of their experience with pregnancy, birth, and postpartum care. Racism and sexism also play a role in how seriously a patient’s complaints are taken by their provider. Chronic stress that results from discrimination has been linked to negative pregnancy outcomes such as preterm birth and plays a large role in maternal mental health. It is important to also acknowledge that for individuals belonging to multiple marginalized groups, the effects of discrimination can often be compounded.
Part of the problem is the lack of diversity within the medical community. One study shows that having a high diversity of nurses reduces severe adverse maternal outcomes for Black, Hispanic, Asian and Pacific Islander, and white birthing people. There is also a lack of diversity in the scientists performing research to better understand maternal mortality. This allows the biases of the scientists to skew the focus of the research, intentionally or unintentionally. For example, there is an abundance of research focusing on the sexual behaviors of LGBTQ+ people, but a deficient amount of information on pregnancy outcomes of members within this community. Another barrier to understanding pregnancy outcomes within the LGBTQ+ community is the inconsistent or incorrect vocabulary used by the medical community and research groups. This leads to the inability to properly aggregate data for analyses in addition to creating negative experiences for the individuals affected.
Strengthening maternal health outcomes with culturally competent care
One approach to addressing the maternal health crisis in marginalized communities involves the use of culturally competent care. Culturally competent maternal care focuses on viewing the pregnant person’s preferences and unique perspectives through a cultural lens. This might consist of increasing diversity in the workforce (including doulas), including culturally relevant birthing practices in a birth plan, or introducing instruction during clinical training that focuses on structural determinants of health inequities. Thankfully, there are a number of companies fighting against the maternal health crisis by providing culturally competent maternal care to pregnant people.
Market Map: Digital players tackling maternal healthcare in marginalized communities
Marginalized communities are disproportionately affected by the maternal health crisis in the US due to issues such as access to care, discrimination, and underrepresentation in the medical field and beyond. Viewing maternal health through a cultural lens is one way to address the needs of these groups and increase positive birth outcomes. Prioritizing maternal health for marginalized groups helps bring us one step closer to achieving reproductive justice for all.
Market map company descriptions
Baby Live Advice connects families to a nationwide network of maternal-infant care professionals to provide support and health education. Their website uses gender neutral terms, such as “expecting parents”, and services are provided in Spanish as well as English.
BabyScripts is a platform that provides support to patients throughout pregnancy and postpartum, including at-home monitoring, educational resources, and continuous access to healthcare professionals, including the pregnant person’s healthcare provider. Their app allows providers to customize risk assessment based on social determinants of health and to send educational resources in both Spanish and English.
Candlelit Care strives to improve perinatal mental healthcare for pregnant and postpartum Black women. They provide mental health screening, personalized care plans, virtual group counseling sessions, and 1:1 coaching. Using AI, Candlelit pairs parents with coaching and digital therapy to improve birth outcomes.
Cayaba Care provides local (in-home or virtual), interdisciplinary care and “Maternal Navigators” for pregnant people to supplement care provided by the patient’s OB. Their mission is to create a new standard of healthcare for Black and Brown communities, starting with pregnancy and postpartum, where health inequities are especially significant.
Culture Care leverages telemedicine capabilities to connect Black women with Black doctors, OBGYNs, pediatricians, therapists, lactation experts, and other relevant specialists through the fertility, pregnancy, and postpartum journey.
Irth is a Yelp-like app where people of Black and brown women can search for and leave reviews of doctors and hospitals about their prenatal, birthing, postpartum, and pediatric experiences, with the goal of protecting women from and raising awareness of racial biases in the pregnancy and motherhood journey.
Health in her Hue is a digital-based content and community forum connecting Black women and women of color with each other and with culturally sensitive healthcare providers. Educational resources, virtual care squads, and community discussion groups are formed around a variety of topics including maternal health, parenting, mental health, and more.
Mae is a pregnancy tracker that is designed specifically for black women to provide culturally-specific information and support from licensed professionals.
SheMatters is a digital platform that provides Black mothers who experience postpartum comorbidities an online community to address mental and physical challenges, culturally relevant resources, and healthcare providers who are vetted or have completed SheMatter’s own Cultural Competence Certification Program.
Wolomi is a membership-based pregnancy companion app for women of color. Women can join pregnancy and motherhood “tribes” to share experiences, receive advice and assessments from providers of color, and participate in virtual group coaching led by registered nurses.