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New United Nations Report Finds that Systemic Racism and Sexism in Health Systems Governs Pregnancy and Birth Related Outcomes 

Bintou Diarra, A.B | Medical Anthropology, Brown University | August 1, 2023

On July 12th, 2023, the United Nations’ (UN) sexual and reproductive health agency UNFPA released the first cross-continental analysis of Black maternal health. The report, which draws on an evaluation of the maternal health of Black birthing people in North America and South America, concludes that structural racism and sexism contribute to poor maternal health outcomes and disparities that persist regardless of income. This is a significant moment for birthing people and the advocates, birth workers, and caregivers propping them up, as the national forum for naming and initiating dialogue on world issues is legitimizing their concerns, and with them, their fight for a better reality.

This is one among many crucial findings. Their analysis found that the conditions governing the pregnancy and birthing experiences of Afrodescendant people remain the same before and after pregnancy. In other words, disparities in maternal health outcomes reflect disparities in living conditions, and other health conditions plaguing Black birthing people across the Americas. The maternal health crisis is a health issue in and of itself, and it stands as a manifestation of broader societal phenomena. The UN attributes this finding to the dearth of quality health data that accounts for race and gender, which renders women and girls of African descent invisible.

Additionally, the report illuminates the full scope of the issue of Black maternal mortality in the Americas. Whereas many investigations on the issue of maternal mortality center on racial gaps, the findings reveal that Afrodescendent maternal deaths are alarmingly high in absolute terms as well. 

The literature on pregnancy-related deaths showed that across the Americas, cardiovascular maternal health conditions—like preeclampsia, eclampsia, and cardiomyopathy, were the leading preventable causes of maternal death for birthing people. Birthing people of African descent experienced these outcomes at rates of up to five times those of their white counterparts. Thus, centering racial disparities does not make the issue of Black maternal mortality “appear”—rather, it unveils the extent of a problem that already exists to highlight disproportionate impact. According to the UN, this is a result of the failure to consider the unique health-related vulnerabilities people of African descent face when crafting national and local policies, and plans and programs.

The tendency to largely ignore the embodied experiences of Black birthing people starts with medicine’s anti-Black history, which has had implications for medical training. The report highlights racism’s entanglement with the field of obstetrics and gynecology, and the contribution of the institution of slavery to the advancement of the field. J. Marion Sims, known as the father of gynecology, refined his surgical techniques through experimentation on enslaved women, who, because of notions of obstetrical hardiness, were not believed to experience the same pain as their white counterparts.

Unfortunately, the simultaneous involvement and erasure of Black bodies within the medical establishment continues. The report cites a finding that many medical textbooks only describe childbirth as it presents on a specific pelvic morphology—that belonging to white, European women. What this means is that other pelvic presentations are automatically abnormal or at-risk, as many medical professionals find themselves ill-equipped to work with anything that deviates from the “norm”.

The third finding may just be the most groundbreaking within the national conversation, though it is not surprising for those working to spark change. The United Nations named structural racism and sexism as factors contributing to disparities in maternal health outcomes across income levels and national and regional borders. The potent combination of sexism and racism in health service delivery, says the UN, limits the provision of, and in many cases, access to, quality comprehensive maternal and sexual and reproductive health care for women and girls of African descent in the Americas. This shatters the notions of maternal blame that often shape some people’s understanding of the issue of maternal mortality.

For the advocates and policymakers on the ground, the UN’s report is as affirming as it is disquieting. With the findings comes a recommendation—and an expectation—for key stakeholders. The UN asserts that national governments, international organizations, and healthcare organizations across the Americas can meet the reproductive health needs of Afrodescendent birthing people by addressing the root causes of structural racism, misogynoir, and the interactions that speak to these phenomena. 

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