Speaking via closed-circuit video, Karen Scott, project director the California Birth Equity Collaborative, cited specific evidence of institutionalized racism, including the lesser personal attention and health counseling that black women receive as patients. “What in the system allows variation in the responsiveness to a black mother who is reporting symptoms that are dismissed and discounted? These women are coming to the hospital, they are educated, they have health insurance. All of these factors that are normally shown to protect are not doing that.”
Women in rural communities are also likely to face less-efficient hospital care than city dwellers. As Susan Mann, a Brookline obstetrician affiliated with Beth Israel Deaconess Medical Center, put it, “If I sneeze here, there are four people to hand me a Kleenex. In a rural community you may have to wait for the truck to deliver it.”
Mann proposed more standardized health care, focusing on the three most preventable causes of maternal death: hypertension, postpartum hemorrhaging, and blood clots. She also suggested that doctors take a tip from pilots by doing emergency simulations to better prepare for the real thing.
Haywood Brown, past president of the American Society of Obstetricians and Gynecologists, agreed that maternity care is fragmented in the U.S., and that “health deserts” exist in many rural areas. Fifty percent of all counties in the U.S. lack a practicing OB-GYN or a midwife, he noted. Access to insurance likewise varies by area, making some women less likely to find timely prenatal care. “The financial barriers are still there in a country as rich as ours.”
The panel agreed that improvements need to happen on two fronts: equalizing access to hospital care in different areas of the country, and equalizing the amount of respect women receive within those facilities.
“Clinical care is obviously essential,” Langer said, “but the way women experience their childbirth is also critical. When women are poorly treated, they will distrust the medical system and they may not come back.”