Native-born African American women are at higher risk for preterm birth in the United States than any other racial-ethnic group. Some people posit that this is genetic, but black African and Caribbean-born women do not have the same risk profile. Preterm birth risk increases, however, for each subsequent generation born in the U.S.
Numerous initiatives try to address preterm birth, often targeting African American women because their risk is so much higher than average. These initiatives are invariably “scientific,” using “proven” methods. Some of these methods are certainly helpful, for instance, use of 17P injections among women who experienced a prior preterm birth. However, the interventions are almost universally reactive rather than proactive. They address an already established risk (e.g. prior preterm birth) or a problem that has already manifested (e.g. disbetes or pre-eclampsia). They do not deal with racial segregation, racism, or poverty. They do not specifically address culturally appropriate and sensitive care or the fact that people tend to respond best to medical care providers who are of the same racial background as themselves. They do not address the woman as a person, but rather as a biological host for the fetus, one that needs to be medically coaxed to become an ideal environment for fetal development.
For all of these reasons, I was thrilled to see Jennie Joseph, a midwife and founding member of the National Association of Birth Centers of Color, featured in an interview on improvingbirth.org. Joseph notes many crucial issues affecting care, including access, cultural competence, respect, care options, and racism, but she also addresses the importance of seeing health beyond a set of scientific numbers. So many times we hear that the only important outcome of birth is a healthy baby. Sometimes people with add a healthy mom. But Joseph notes that the health of the woman is crucial and that health is more than avoiding infection or hemorrhage: “Healthy is when a woman can look at her experience and feel complete, feel whole.”
It is amazing what can be done when a woman is cared for as a human being in her own right.
Read the whole interview with Jennie Joseph here: http://www.improvingbirth.org/2013/07/privilege/
homepage of the National Association of Birth Centers of Color: http://www.birthcentersofcolor.org/
March of Dimes table on preterm birth risk by race: http://www.marchofdimes.com/peristats/level1.aspx?reg=99&top=3&stop=62&lev=1&slev=1&obj=1
CDC fact sheet on health disparities and preterm birth: http://www.cdc.gov/minorityhealth/reports/CHDIR11/FactSheets/PretermBirth.pdf
article on black ethnic groups, racial segregation, and preterm birth in New York City: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139970/
article on quality of care from same-race physicians: http://www.amednews.com/article/20040112/profession/301129960/7/]