Given the diversity in our world today, take a moment and ask yourself: Are you a culturally competent nurse or nursing student? Do you demonstrate cultural humility?
You may have explored the concepts of cultural competence and humility in nursing school, but let’s take it a step further and consider how to apply these concepts in everyday interactions with members of diverse groups and communities.
Whether working in a hospital, walking into a local store, or interacting with neighbors, cultural competence and humility are cornerstones of building strong relationships. Practically speaking, this isn’t a skill you check off your to-do list once. Instead, developing cultural competence and humility is a lifelong process and journey involving continuous reflection, learning, and unlearning. It makes the individuals and groups we interact with feel seen, heard, and valued.
What is Cultural Competence vs Cultural Humility?
Cultural competence is about equipping yourself with knowledge of diverse cultural practices and beliefs, which enables you to provide respectful and appropriate care to patients from varied backgrounds. According to the American Academy of Nursing, cultural competence includes integrating knowledge, attitudes, and skills to facilitate intercultural communication and interactions between people from different racial, ethnic, socio-economic, and religious backgrounds. It’s understanding different cultural customs, traditions, beliefs, and behaviors and utilizing this knowledge to communicate effectively with others.
Here’s what cultural competency as a nurse might look like:
Using appropriate words and phrases that are familiar to the individual
Respecting an individual’s choices and preferences (e.g., diet, treatment)
Refraining from labeling an individual who comes from a particular group
Advocating for an interpreter to translate to facilitate informed decision-making
Acknowledging what is acceptable and not acceptable to say or do with an individual from another culture/background
Cultural humility, a new concept introduced more than thirty years ago, embraces the idea that we must all critically explore and critique ourselves as the first step to learning from and about others. It’s more than being knowledgeable about other cultures and practices. Cultural humility is being ‘others-oriented’ instead of “me-oriented” and recognizing that our understanding of different cultures constantly evolves. It’s a lifelong process of critical self-reflection and an openness to learning from the experiences of others. Humility acknowledges the power imbalances, emphasizing the importance of being receptive to learning from those who may not look, act, or believe in the same things we do.
Demonstrating cultural humility can include:
Participating in cultural competency training
Actively listening to an individual’s beliefs and practices without judgment
Respecting individual autonomy and cultural values when making decisions
Asking open-ended questions to understand an individual’s cultural preferences
Customizing healthcare delivery to align with the individual’s cultural, religious, or linguistic needs
These examples above, rooted in an attitude of openness and self-reflection, can lead to strengthening and maintaining effective relationships built on trust, respect, and collaboration.
How Do I Become More Culturally Competent and Demonstrate Cultural Humility?
Being culturally competent and demonstrating cultural humility takes time to happen. It is also not about choosing cultural humility over cultural competence or vice versa. Instead, it’s about cultivating and enabling both to work in unison.
Here’s how you can begin your journey towards cultural competence and humility.
1. Examine your ‘Blind Spots’
Start by examining and reflecting on your biases, assumptions, attitudes, and values and how they may influence your interactions with others. Identify any implicit bias that might be at play. Implicit biases are those unconscious stereotypes and attitudes you’ve learned and carried toward specific groups of people. These biases are like “blind spots”—you aren’t aware they exist unless you intentionally look!
Identifying your blind spots may involve asking yourself:
Am I tolerant enough to learn from others?
Are there privileges that I have that others don’t?
What do I think about other cultures that are different from my own?
Do I actively seek out perspectives or experiences that differ from my own?
Do I recognize and challenge my assumptions about people different from me?
Do I refrain from having deep conversations about social issues? If I do engage in dialogue, am I listening with intent or just talking?
Once we can identify our blind spots, the work can begin to address those stereotypes and attitudes. We can start unraveling, challenging, and correcting our learned biases.
2. Consider Others’ Point of View
Putting ourselves in another person’s shoes, or “shoe-shifting,” helps us begin to consider the experiences and perspectives of others. Cultural humility and competence require us to avoid being distracted by what we think we know. It’s asking ourselves whether there is anything we ought to know and framing our interactions with others as a partnership. So next time you’re interacting with someone who may appear different than you or may hold different beliefs and values, ask yourself, “What else should I know?” instead of “What do I know?” Be intentional about incorporating humility into your interactions – listening more than speaking, feeling comfortable with not knowing or understanding everything, and demonstrating genuine curiosity. Although we know empathy and compassion are the right things to do, it can be challenging to put these into practice when faced with our stereotypes and implicit biases. Why, though? Perhaps because to truly put ourselves in another person’s shoes, we must be willing and able to remove our shoes first!
3. Get to Know People Different From You
It’s easy to get along with people who are similar to us. Seriously, think about those people who are closest to you, and more than likely, many of them will resemble….well, you! But if you want to develop cultural competence and humility, you’ve got to stretch a little and step outside your backyard. This involves active and intentional efforts to experience others.
Reading books (e.g., autobiographies) to gain new perspective/appreciation
Volunteering or participating in organizations that serve diverse communities
Attending community/multicultural events to promote direct dialogue and interaction
Listening to podcasts with hosts/guests who have different lived experiences or beliefs
When we stretch ourselves this way, we can challenge our stereotypes and attitudes toward others and begin to value their unique experiences. We can create meaningful connections built on respect, appreciation, and a deeper understanding beyond superficial interactions. These proactive strategies allow you to enhance cultural competence and humility and contribute to more inclusive and united communities.
Conclusion
As you strengthen your cultural competency and humility skills, consider yourself and the individuals you live, learn, and work with. Every interaction with an individual is an opportunity to practice, demonstrate, and enhance these skills.
Gradellini, C., Gómez-Cantarino, S., Dominguez-Isabel, P., Mecugni, D., & Ugarte-Gurrutxaga, M. I. (2021). Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. A Scoping Review. Front Psychol, 12(1).
Hughes, V., Delva, S., Nkimbeng, M., Spaulding, E., Turkson-Ocran, R.-A., Rushton, C., . . . Han, H.-R. (2020). Not missing the opportunity: Strategies to promote cultural humility among future nursing faculty. Journal of Professional Nursing, 36(1), 28-33.
McDaniel, V. P. (2021). Cultural Humility in Nursing Building the Bridge to. Virginia Nurses Today, 29(2), 12-14.
Stubbe, D. E. (2020). Practicing Cultural Competence and Cultural Humility in the Care of Diverse Patients. Focus (Am Psychiatr Publ), 18(1), 49–51.
At a point in my career, a devastating event deeply affected me. One of my former nursing students, a vibrant young Black woman, tragically lost her life and the life of her newborn during childbirth. Despite access to healthcare, she fell victim to maternal complications that ended in her untimely death. This loss was not an isolated incident but rather indicative of a more significant crisis facing Black mothers in the United States – one that is not just a healthcare issue but rather a matter of social justice and equity.
In recognition of National Nurses Week, it’s crucial to reflect on nurses’ profound impact on healthcare, particularly in addressing health disparities. This year’s theme, “Nurses Make the Difference,” resonates deeply with me, as I have dedicated my career to advocating for improved maternal health outcomes for Black women and preparing nurses for careers in healthcare aimed at advancing health equity.
Every maternal death is a devastating tragedy that leaves a hole in families – representing a forever-altered dynamic. Perhaps even worse, statistics from the Centers for Disease Control and Prevention show that most maternal deaths are preventable.
This staggering data also demonstrates that Black women are nearly three times more likely to die from pregnancy-related complications than white women. Morbid racial disparities such as these do not have a place in the 21st century. Still, they are exacerbated by socioeconomic factors, a shortage of providers, and a lack of access to quality healthcare.
Central to this work is the recognition of the lived experiences of Black women. Factors such as poverty, barriers to healthcare access, and lifestyle choices are frequently used to explain the disparity in Black maternal health; however, these factors alone are inadequate to explain the problem. Healthcare providers often fail to see their patients as individuals with unique needs and concerns. Implicit bias and cultural incompetence compound these disparities, leading to substandard care and poor outcomes.
To effect meaningful change, we must address these root causes head-on. This includes increasing access to quality healthcare, fostering diversity and inclusivity in healthcare practices, and educating healthcare workers to be culturally competent and understand the social determinants of health.
Increasing access to quality healthcare is essential, and addressing the nursing shortage is a top priority when it comes to Black maternal health. By creating new programs and expanding existing ones that reach future healthcare workers, we can help prepare the next generation of diverse nurses who can reduce the burden on the current population of healthcare workers and meet the evolving needs of society – especially Black women.
As a nurse educator with over 18 years of experience in higher education, I believe education is integral to creating positive, sustainable change. At Walden University, where I serve as the associate dean for the BSN program, our online curriculum emphasizes the social determinants of health and the role of nurses in addressing health disparities. I am particularly excited about a new course we launched this spring, “Advocating for Diversity, Equity, and Inclusion in Healthcare.” This course, among others at institutions like Columbia and Frontier Universities, challenges students to confront their biases and privilege while equipping them with the tools to advocate for inclusive and equitable care. Our focus areas include implicit bias, systemic racism, microaggressions, health disparities, the healthcare ecosystem, and advocacy strategies to improve healthcare outcomes. These programs, which establish a better understanding of the unique experiences of our diverse population, are just a part of the solution. Patient outcomes can also be significantly improved by changing the face of those who deliver it. With minority populations experiencing disproportionate rates of disease and death, it is clear we need to create pathways to the nursing profession for all, regardless of ethnic, religious, or financial factors.
One way to do this is by providing educational access to those who may not yet have had the opportunity, which can mean emphasizing online education programs. This approach enables students to earn their degrees from where they live and encourages the development of nurses who practice within their communities, reflecting the communities they serve. This is a proven way to improve the healthcare outcomes of minorities, and it has the additional benefit of combatting the nursing shortage, particularly in rural areas.
Nurses, educators, policymakers, and advocates must join forces to dismantle the systemic barriers perpetuating healthcare inequality. Our industry has a unique opportunity to drive change and promote health equity by elevating the voices of marginalized communities, challenging implicit biases, and advocating for policies that prioritize equity and justice.
As we celebrate National Nurses Week, let us recommit ourselves to compassion, advocacy, and equity principles. Together, we can make a difference in the lives of Black mothers and ensure that every woman receives the quality care she deserves with the understanding she needs.
Springer Publishing launched a new monthly health care podcast series, Conversations About Health Care Delivery in the United States, featuring discussions with prominent experts, innovators, and leaders in the health sector available on Spotify, Apple Podcasts, and Amazon Music starting on March 7.
The podcast series is hosted by Jim Knickman, the former Robert Derzon Chair at the NYU Wagner Graduate School of Public Service, and Brian Elbel, MPH, Professor of Population Health and Health Policy at NYU Wagner and the NYU Grossman School of Medicine. The series dives into complex and challenging issues affecting the U.S. health care system, its workforce, and the populations interacting with it, covering topics like health management, public health, health behavior, population health, healthcare quality, and health economics.
Knickman and Elbel engage with guests who are leaders in the health sector, from aging services to health policy, to learn more about the key drivers shaping the health care system, challenges and complexities related to health inequities, and the exciting career opportunities available to future health care professionals and leaders.
The podcast series is a companion to the 13th edition of Jonas and Kovner’s Health Care Delivery in the United States, as each episode has ties to essential concepts, challenges, complexities, and themes in the textbook.
Podcast Episode
How the U.S. Health Care Systems is Preparing for the Demographic Cliff features Ramsey Alwin, President and CEO of the National Council on Aging, and Kathleen Cameron, Senior Director of the National Council on Aging’s Center for Healthy Aging.
The episode offers an in-depth discussion about the demographic shift, how the roles of families and social systems have evolved, federal and state-level programs for seniors, social isolation and inequities in the aging population, healthy aging, and exciting career opportunities in aging services.
The podcast series also features a supplemental instructor guide for anyone using the textbook that provides learning activities, discussion questions, and other guidance to engage with each episode, delivering practical and engaging content to learners and professionals in the health care space.
Health disparities have historically impacted multiple populations throughout the U.S. When it comes to health and access to healthcare, consider the plight of Native Americans, undocumented immigrants, people experiencing homelessness and the chronically mentally ill, and rural communities in places like Appalachia, and we see a picture of what’s broken. The undeniable disservice that continues to millions of the most vulnerable is inexcusable, yet this legacy is slow to overcome.
In terms of Black communities and people of color, the disservice is centuries-old. To this day, the legacies of structural racism live on in health disparities that would have no place in 21st-century America if we had already learned our lessons and lived up to the potential outlined in our country’s founding documents.
Nonetheless, disproportionately negative statistics don’t lie. We know beyond the shadow of a doubt that Black Americans have received short shrift in the realms of health and healthcare since the first days of the American colonies, and the work to undo these wrongs is daunting and ongoing.
Distrust, Disparities, and Deceit
The Kaiser Family Foundation website states, “While Black people have made great contributions and achievements in the United States, they continue to face many health and health care disparities that adversely impact their overall health and well-being. These disparities have been exacerbated by the uneven impacts of the COVID pandemic, ongoing racism and discrimination, and police violence against and killings of Black people. Moreover, the long history of inequitable health outcomes among Black people reflects the abuses faced during slavery, segregation, mass incarceration, and their persistent legacies.’
Kaiser’s statistics point out that Black people face more significant financial obstacles to receiving appropriate healthcare and have a higher uninsured rate than white people. And with higher rates of poverty and food insecurity, it’s clear that many factors contribute to this calculus.
“The growing gap of health disparities within the American healthcare system is resulting in the unnecessary deaths of people of color and the continued mistrust of the healthcare system,” states Jasmyn Moore, MBA, BSN, RN, co-host of the Distrust and Disparities podcast.
“If you take a deep look into most health disparities that plague communities of color,” Ms. Moore continues, “you will see that the root cause is systemic racism. The medical field was built off experimenting on Black bodies.” In this statement, Ms. Moore is referring to a legacy exemplified by the Tuskegee experiments, where Black men were misled by researchers to believe that their syphilis was being treated, but in actuality, the course of the disease could be observed by scientists from the U.S. Public Health Service.
“We have all heard the negative statistics surrounding the health of Black, Indigenous, and people of color,” Moore states. “Black mothers are three times more likely to die during childbirth. Black infant mortality is twice as high compared to white babies. African Americans are more than twice as likely to die from cancer.”
Disturbing statistics are nothing new in the world of racial minorities in the United States. Moore comments that “the life expectancy gap between marginalized ethnic groups continues to widen despite health advancements. We are constantly bombarded with those negative and disheartening statistics. The blame is often placed on individuals and families versus a health care system that was not designed to promote and protect our health and livelihood.”
Moore concludes with the following food for thought: “Behind each of those statistics, racism plays a big factor that is often ignored. A report released by the National Academy of Medicine in 2003 pointed out how, in America, race is a determinant of health quality. Their study detailed how Black people and other ethnic minorities receive lower quality of health care than white people even when age, income, insurance status, and severity of conditions are comparable.”
Heightening the Focus
“The COVID-19 pandemic and nationwide racial justice movement over the past several years have heightened the focus on health disparities and their underlying causes and contributed to the increased prioritization of health equity,” states the Kaiser Family Foundation. “These disparities are not new and reflect longstanding structural and systemic inequities rooted in racism and discrimination.”
Aggressively addressing disparities at their root — including police violence against Black citizens, maternal-infant mortality, discriminatory housing policies, income inequality, the impact of climate change on vulnerable populations, and access to care — can lead to us cooperatively working together to find multifaceted and forward-looking solutions.
As the Kaiser Foundation pointed out, these disparities are nothing new; thus, dismantling the structural and societal issues that cause them is an uphill battle. That said, many individuals and organizations have set their sights on these issues, and the 21st-century racial justice movement is an intrinsic part of that process.
Those of us in the healthcare industry must maintain awareness, examine our own biases, and demand that our workplaces do their part in decreasing disparities impacting the populations of color that we serve. We carry that responsibility; stepping up and speaking out is our individual and collective moral obligation.
Palliative care can be equally rewarding and challenging. Patients are navigating the emotional and physical turbulence of terminal illness. The right professional can be instrumental in ensuring patients’ needs are met to make their period of care more comfortable.
So much of who people are impacts their experience of the palliative journey. This includes the nuances of their cultural, racial, and socioeconomic identities. It should be no question, then, that minority nurses are an invaluable resource at this time. Yet, the current state of palliative care suggests that the industry doesn’t quite reflect this.
Let’s explore the intersection of minority identity and palliative care nursing. What are the opportunities for minority nurses, and why are they so vital in addressing the challenges related to this sector?
The Opportunities for Minority Nurses
There’s no question that the medical sector, in general, is in greater need of nurses from various backgrounds. However, it’s also essential to look at the disparities within specializations. The needs of patients taking their palliative care journey suggest that minority nurses can find plenty of opportunities in this field.
The changing demographics of the aging population reflect this. It’s worth noting that there is relatively little research into the racial and ethnic disparities in palliative care staff. Nevertheless, there is some evidence that suggests a need for change. A Journal of Palliative Medicine study reported that over the next 20 years, the population of older minorities is expected to grow by 160%. This is far more than their white counterparts. The same study also cited a bereaved families survey that found “African Americans were less satisfied with the quality of end-of-life care.”
This data tells us there are opportunities for minority nurses to contribute to the specific needs that aren’t being met for the growing population of minority patients who will be seeking palliative care in the future.
Alongside the general need for hospice nurses and palliative care nurses, these opportunities may include:
Palliative nurse practitioners (NPs): Given the disparities in minority palliative care, there must be greater diversity in care leadership roles. Minority NPs can influence strategic decisions that ensure care plans are more relevant and positive for a broader range of patients.
Palliative educators: Palliative care is an emotionally and technically challenging field. Therefore, it requires skilled educators to guide professionals in developing appropriate medical, cultural, and empathic abilities. Nurses from minority backgrounds have invaluable perspectives to provide here.
Certainly, minority nurses themselves can seek the opportunities and talk to one another about them. However, it’s also important to encourage administrators and industry leaders to engage a diverse range of professionals more actively. This should involve pitching palliative care to minority students and nurses looking to shift careers. There must also be more significant financial and psychological support that makes palliative care a practical and attractive option.
Addressing the Challenges
There are clear opportunities for minority nurses in palliative care. But on a practical level, it’s important to establish what specific challenges these professionals are well-equipped to address. Firstly, this helps nurses better serve patients. But it’s also valuable information that care providers and administrators can use to pitch palliative care to minority nurses who may not have considered specializing in it.
Culturally Relevant Care
Palliative care deals with the end of life. Naturally, various cultural nuances influence this experience. One recent report outlined a significant variety of cultural differences related to the just treatment of pain during palliative care. People’s ethnicities, religious beliefs, and even generational demographics can influence how pain at the end of life is both perceived and managed.
This means that minority nurses can be better equipped to offer culturally relevant care to patients with similar backgrounds. In effect, these culturally competent nurses are likely to impact patient experiences and outcomes positively.
Actionable Community Knowledge
Palliative care doesn’t always occur within hospice facilities. Nurses can also treat patients in their own homes. Patients from different cultural and socioeconomic backgrounds can face challenges related to the areas in which they live. Minority nurses can use community knowledge to identify issues and integrate solutions into care processes.
For instance, patients living in heavily industrialized communities may be subjected to poorer air quality. One study found that Black and Hispanic citizens bear 56% and 63% more air pollution, respectively, than they produce. Nurses with greater familiarity with these communities may better understand the signs of air pollution in the home. These may be environmental changes, like unpleasant odors, or additional medical symptoms, such as coughing and congestion. As a result, minority nurses can respond swiftly with preventions and treatments that improve palliative patients’ comfort.
Knowledge of the Practical Barriers
Let’s face it: Nobody better understands the barriers presented by cultural disparities than those subjected to them. Therefore, minority nurses can be powerful allies in improving the palliative care protocols that give hurdles to both patients and professionals.
A continuous commitment to process improvement is vital in any industry. Regularly assessing protocols reveals inefficiencies, issues with regulatory compliance, and tasks ripe for streamlining. It’s important to involve a greater diversity of nurses in mapping out and analyzing care processes. A team with a broader range of perspectives is more conducive to spotting barriers to good care that a more culturally limited one would miss. This enables a positive collaboration for redesigning processes to meet all patients’ needs.
Conclusion
Palliative care is one of the most challenging medical specializations. It deals with a particularly turbulent time for patients and their families and all the more reason, then, to ensure that culturally, racially, and socioeconomically diverse professionals are leading the way.
Nevertheless, addressing the growing disparities in care for those of minority identity needs immediate action. This is likely to require meaningful collaboration. Minority nurses can actively pursue palliative care and advocate for the systemic changes that make a genuine difference. However, administrators and industry leaders have a role in ensuring sufficient respect, support, and resources to make this a viable and enriching option for nurses.
Black women are almost twice as likely to experience infertility as their white counterparts, but only 8% of Black women seek fertility treatment, compared to 15% of white women. Statistics like these, compounded by the fact that Black women are three times as likely to die from pregnancy-related causes, highlight inequalities in reproductive healthcare that the medical community must address.
The higher incidence of infertility among Black women is due in part to a higher prevalence of uterine fibroids, ovulatory dysfunction, and tubal disease. Studies show that Black women also have higher rates of pregnancy loss, including miscarriages and stillbirths when compared to white women. This is likely because Black women have higher rates of risk factors that are associated with pregnancy loss, such as obesity, diabetes, and low socioeconomic status.
For Black women, the isolation of infertility is compounded by various factors (for example, cultural stigma, socioeconomic barriers, and racial bias) that prevent them from getting the care they need. Those who do end up seeking care often find themselves feeling deeply uncomfortable in the medical space, which is still predominantly white.
Diversity in Healthcare Providers
People of color need to have access to BIPOC (Black, Indigenous, and People of Color) healthcare providers because it provides a sense of comfort and familiarity. This can encourage patients to access available fertility care and can even improve treatment outcomes. BIPOC healthcare providers possess culturally specific knowledge, skills, and experiences that help with communication and health management processes involving people of color.
Diversity in providers also helps reduce barriers to the patient-physician relationship for racial/ethnic and linguistic minority patients. In many situations, seeing someone who looks like you and understands your cultural background offers reassurance.
Many studies have demonstrated better health outcomes when BIPOC providers see patients of color. A result of this is increased trust and communication developed between the patient and provider. The patient may feel more comfortable sharing sensitive information with someone who has an unspoken understanding of what the patient might be going through. Research has shown that Black women who have a provider with a similar cultural history may feel more comfortable speaking up and advocating for themselves.
Many people of color have a (warranted) sense of mistrust when it comes to our healthcare system due to historical practices based on racist ideals. As healthcare providers, we must remain dedicated to bridging the gap to improve outcomes for patients of color.
What Factors Most Impact Black Patients?
Long-held beliefs, stereotypes, cultural stigma, and other issues continue to uphold these racial disparities around fertility and family-building. Here are some examples of the various factors that contribute to widening the gap in care for Black women:
Structural racism: This heavily contributes to racial disparities in fertility and maternal healthcare in various ways, as structural racism goes beyond the individual. It refers to inherently racist laws, rules, economic practices, and cultural and societal norms that are embedded in the system itself.
Implicit or unconscious bias: This occurs automatically and unintentionally, affecting our judgments, decisions, and behaviors. For example, a white doctor might downplay complaints of pain after surgery from a patient of color due to engrained, inaccurate stereotypes about the strength or pain tolerance of BIPOC people, only to discover the patient is genuinely experiencing discomfort.
Accessibility: Many people of color encounter barriers to accessing the healthcare they need due to a lack of insurance or insurance coverage that excludes fertility treatment. Financial roadblocks and accessibility to quality reproductive care are often limited by location (rural or underserved areas may not have fertility clinics nearby) and employment (not everyone can take time off of work to go in for morning monitoring appointments, which are often required during fertility treatment).
The myth of hyperfertility: The long-held myth that Black women (and men) are “hyper-fertile” causes considerable harm, leading to a resulting cascade of issues.
Religious beliefs: Many people in the Black community are taught to “pray your way” through difficult situations. And while it’s wonderful to have faith, sometimes it’s necessary to seek professional help. Trusting that a higher power will correct infertility leads some people to delay or avoid treatment altogether.
Harmful stereotypes: Black women are thought of as being incredibly strong ― and we are ― but when we are elevated to “Superwoman” status and need to take off our proverbial capes to ask for help, we are often judged harshly or perceived as weak.
Mental health: Shame, guilt, or anxiety about how people in our community may react prevents or delays many women of color from seeking infertility treatment. The stigma of mental illness is also a concern when addressing infertility. Many people coping with infertility experience depression, anxiety, and grief, and cultural norms can discourage people from sharing that they are struggling with their mental health.
Isolation: Many people hesitate to talk about their personal experiences with infertility, which often leaves Black women with the impression that they are alone in their struggles or that infertility is a reflection of their character or a personal failing. That’s why sharing fertility stories is so important, especially in communities of color.
Black Maternal Mortality Rates
Many women of color might lack insurance coverage for maternal health or be afraid to advocate for themselves with their doctor. But the starkest evidence of the healthcare system failing people of color is Black maternal mortality rates in the United States, which are alarmingly high.
Studies have shown that Black women are three times more likely to die from pregnancy-related causes than white women. Worse yet, even though multiple factors contribute to this disparity, most are preventable. These factors include access to quality healthcare, underlying chronic illnesses, and two of the most easily preventable: implicit bias and structural racism. As a healthcare system, we need to focus on listening to the concerns of patients of color without allowing unconscious bias to play a role in our treatment decisions.
Responsibility to Patients
In vitro fertilization (IVF) and other fertility treatment options can be very expensive, which makes it exponentially more challenging for individuals with lower median household incomes to afford this path to parenthood. With lower incomes in comparison to white and Asian couples, Black and Hispanic couples may have a hard time affording fertility care if they have to pay out-of-pocket.
Knocking down the roadblock of affordability often goes beyond the scope of the medical community’s responsibility. However, bridging the gap of distrust with people of color and providing culturally competent care does not. One important step hospitals and health systems can take is to increase the diversity of providers within reproductive health specialties. Collectively, we must work to dismantle structural racism, educate ourselves, and listen to people of color. Only then will we start to make progress toward lessening racial disparities in fertility and maternal healthcare.
