Black, Indigenous and People Of Colour & Pregnancy
Claire Mazzia, MSc and Kelsey McLaughlin, PhD
Systemic Racism & Pregnancy Outcomes
Systemic racism is a significant factor impacting pregnancy outcomes of women and their babies that needs to be acknowledged. Meaningful change is essential to improve the health of these marginalized populations.
There are different forms of systemic racism that can impact the health outcomes of patients. These include structural, interpersonal and internalized racism:
Structural or institutionalized racism: unequal access to opportunities, resources and services depending on one’s race. Examples include education, health care, employment, safe and affordable housing.
Interpersonal racism: when people make assumptions about the abilities and intentions of others based on race, resulting in prejudice and/or discrimination against minorities. Examples include deliberately avoiding a person of colour, treating them suspiciously or being rude to them because of their race.
Internalized racism: the diminished perception of one’s own worth and abilities as a person of colour due to personal experiences of discrimination and marginalization.
Visible Minorities in Canada
Approximately 22% of the Canadian population identifies as a visible minority. In the 2016 Canadian census, 6.2% of the population reported Aboriginal ancestry. The black population accounts for 3.5% of Canada’s total population.
Statistics Canada estimates that 30% of Canada’s population could belong to a visible minority group by 2031.
The acronym BIPOC stands for 'black, Indigenous and people of colour'.
BIPOC Pregnancies & Maternal Health
Racial discrimination against pregnant women is associated with poor pregnancy outcomes.
In Canada, Indigenous women are at increased risk of preterm birth, gestational diabetes and high blood pressure.
In the United States, pregnancy outcomes are also worse for BIPOC women. Black, American Indian, Alaska Native, Native Hawaiian and Other Pacific Islanders in the United States are at increased risk of gestational diabetes, gestational hypertension, preeclampsia and caesarian section.
Race also impacts labour, delivery and recovery of pregnant women. Racialized patients are at increased risk of induction of labor, maternal transfusion and admission to ICU.
In Canada, pregnant Indigenous women are 2 times more likely to die than pregnant non-Indigenous women.
In the United States, pregnant black women are 3 times more likely to die (41 deaths per 100,000 births) and pregnant American Indian & Alaska Native women are 2 times more likely to die in childbirth (30 deaths per 100,000 births) compared with pregnant white women (13 deaths per 100,000 live births).
Importantly, the cause of death of pregnant women in the United States differs significantly based on race & ethnicity. For example, the cause of death of black pregnant women is more likely to be due to blood pressure or heart conditions, such as preeclampsia, while Hispanic pregnant women are more likely to die from severe bleeding at delivery.
BIPOC Pregnancies & Fetal Health
In Canada, Indigenous infants have higher rates of poor birth outcomes, including preterm birth, stillbirth, neonatal death and infant death, compared to non-Indigenous infants.
Shockingly, infant mortality rates in Indigenous communities are 2 times higher than non-Indigenous communities. First Nations and Inuit populations are 7 times more likely to suffer the loss of a child due to Sudden Infant Death Syndrome (SIDS) compared to the non-Indigenous population.
In the United States, the infant mortality rate for non-Hispanic black births is double the overall national infant mortality rate (11.11 infant deaths per 1000 live births vs 5.96 infant deaths per 1000 live births). Infants of racialized women in the United States are also at higher risk of preterm delivery, birth defects and chromosomal disorders.
Why are Pregnancy Outcomes Worse for BIPOC Women?
Scientists have identified a number of factors that contribute to worse pregnancy outcomes in BIPOC women, including:
Systemic racism and racial discrimination
Unequal access to high quality health care: black women in the United States are more likely to be treated in hospitals that provide lower quality care
Underinvestment in family support and health care programs
Underrepresentation in scientific and professional jobs in health care
Lack of education for health care professionals regarding issues of race, power and privilege
Lack of discussions regarding reproductive justice: reproductive justice acknowledges that each woman’s ability to control their reproductive health is dependent on access to resources and support in the community, such as high quality health care, employment, safe and affordable shelter
Transgenerational trauma: Indigenous people have experienced significant trauma due to the destruction of their lands and culture as a result of European colonization. High quality health care is inaccessible in many Indigenous communities in Canada. In addition, Indigenous women are less likely to seek medical care during pregnancy, contributing to maternal health disparities in this population. Many women are required to leave their communities to deliver their baby, causing them to feel isolated from their family, stressed and not in control of their birthing experience.
How can Pregnancy Outcomes of BIPOC Women be Improved?
Strategies to improve pregnancy outcomes of BIPOC women include:
Acknowledgment of implicit biases among healthcare professionals that are deeply rooted in our society
Elimination of racial and social injustice in healthcare
Commitment to addressing social determinants of health
Improving quality of healthcare for BIPOC women
Improving access to patient-centered care that is responsive to the needs of BIPOC women
Expanding and maintaining access to pre-conception and post-partum care
Addressing maternal and infant mental health
Improving oversight from hospitals and medical clinics to improve the health and safety of BIPIOC women
Expanding paid medical and family leave, and protection for pregnant workers
Systemic racism increases rates of poor health outcomes for women and their babies. Black, Indigenous and People of Color have worse pregnancy outcomes relative to white women, including a higher risk of pregnancy complications, maternal death and worse fetal health. Acknowledgement, education and additional resources are required to end racial discrimination in BIPOC pregnant women.
Every woman and every pregnancy is unique. Pregnant women should speak to their healthcare provider to ensure maternal and fetal safety. This article is meant to provide readers with current information and opinions. All medical and treatment decisions should be discussed with your healthcare provider.