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6/24/2022

Physician Guide to Promoting Equitable and Socially Just Obstetric Care

Significant inequities in obstetric clinical outcomes persist despite advancements in technology and social protections such as higher education and income. The disproportionate burden of premature death and morbidity impacts historically marginalized communities, including Black and Indigenous birthing people, those with disabilities, as well as immigrant and LGBTQIA+ parents. The World Health Organization, Healthy People 2030, and the Centers for Disease Control assert that structural and social factors shape these inequities, not individual behavioral or biological factors. To equitably serve birthing communities, we as physicians and healthcare leaders must take accountability for the inadequacies of our healthcare systems and adopt evidence-based obstetrical practices that directly address structural complexities and align with social justice. The following recommendations provide a call to action for every obstetrician toward this aim:

Confront the legacy of reproductive injustice in obstetrics and gynecology in the United States. As a clinical discipline, obstetrics and gynecology emerged to codify and sustain professional practices of oppression, experimentation, exploitation and injustice against women, girls, and people with capacity for pregnancy.  Scholars and activists, including sociologists, midwives, anthropologists, historians, doulas, community members, public health experts, and reproductive justice advocates, recorded much of this critical history in peer-reviewed journals, books, OpEds, documentaries and other archival sources. We must continually learn (and unlearn) from and alongside these experts to prevent continued harm and build meaningful, trusting relationships with communities seeking services.

Elicit and center the needs and values of birthing people and their families. Use active listening, shared-decision making, and other patient-centered communication tools to restore therapeutic interactions and build more authentic relationships with birthing people and their families. Prepare to responsibly participate in collaborative care models with other providers who may be better equipped to meet specific patient needs. This is critical to high quality care.

Support collaborative models of care with midwives, doulas, and other obstetric care team members. Advocate for the development, funding, implementation, and replication of collaborative models of care with patients, their families, midwives, doulas, lactation educators, and other perinatal professionals. To successfully participate in interdisciplinary collaborations, divest from healthcare hierarchy and abandon the false assumption that the physician is the de-facto leader. This belief perpetuates inequity and invalidates the value and expertise other perinatal professionals bring to patient care.

Promote equitable policy initiatives at the health system, local, regional, and national levels.  Assess organizational policies and practices using rigorous metrics that require community transparency. Include community members with decision-making authority on maternal mortality review committees and perinatal quality collaboratives. Support implementation and expansion of home visiting or telehealth programs. Advocate for equitable federal policies, including parental leave for birthing people and co-parents for a minimum of 3 months, and extend Medicaid coverage to 12 months postpartum (more than 40 states approved extension). Learn from and alongside content and community experts in these arenas.

Physicians who respond to this call to action take essential steps towards the health systems change required to realize reproductive justice and obstetrical health equity.

Further Reading:

Julian Z, Robles D, Whetstone S, et al. Community-informed models of perinatal and reproductive health services provision: A justice-centered paradigm toward equity among Black birthing communities. Seminars in Perinatology 2020. https://www.sciencedirect.com/science/article/pii/S0146000520300483

Scott KA, Britton L, McLemore MR. The Ethics of Perinatal Care for Black Women: Dismantling the Structural Racism in "Mother Blame" Narratives. J Perinat Neonatal Nurs. 2019 Apr/Jun;33(2):108-115. doi: 10.1097/JPN.0000000000000394. PMID: 31021935.

American Medical Association and Association of American Medical Colleges. (2021) Advancing Health Equity: Guide on Language, Narrative and Concepts. Available at ama-assn.org/equity-guide

Scott KA, Britton L, McLemore MR. The Ethics of Perinatal Care for Black Women: Dismantling the Structural Racism in "Mother Blame" Narratives. J Perinat Neonatal Nurs. 2019 Apr/Jun;33(2):108-115. doi: 10.1097/JPN.0000000000000394. PMID: 31021935. Free access provided at: https://journals.lww.com/jpnnjournal/Fulltext/2019/04000/The_Ethics_of_Perinatal_Care_for_Black_Women_.5.aspx

Initial Publication June 2022; Revised May 2024.

 

********** Notice Regarding Use ************

The Society for Academic Specialists in General Obstetrics and Gynecology, Inc. (“SASGOG”) is committed to accuracy and will review and validate all Pearls on an ongoing basis to reflect current practice.

This document is designed to aid practitioners in providing appropriate obstetric and gynecologic care. Recommendations are derived from major society guidelines and high-quality evidence when available, supplemented by the opinion of the author and editorial board when necessary. It should not be construed as dictating an exclusive course of treatment or procedure to be followed.

Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. SASGOG reviews the articles regularly; however, its publications may not reflect the most recent evidence. While we make every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. SASGOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither SASGOG nor its respective officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.

Copyright 2024 The Society for Academic Specialists in General Obstetrics and Gynecology, Inc. All rights reserved.  No re-print, duplication or posting allowed without prior written consent.

 

 

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