This opinion article was written by Dr. Brittany D. Chambers, Assistant Professor at the University of California, San Francisco. It is also included in our field guide on structural racism in health.
“Structural racism is a silent opportunity killer that regulates access to resources, better education and safe neighborhoods for a particular race.”
-Postpartum Focus Group in Oakland, California
Despite advancements in sexual and reproductive healthcare, black women in the US are being left behind. They report receiving disparate care and have worse outcomes compared to women of all other racial/ethnic groups.
Racial disparities in sexual and reproductive healthcare and outcomes experienced by black women persist even when factoring in individual differences such as income, education or medical conditions such as hypertension.
We need to understand how structural racism contributes to disparities in sexual and reproductive health outcomes between black and white women in the US and respond with policies that get at the root causes.
How is structural racism measured?
In the US, where I conduct my research, structural racism has been used to systematically advantage white people over black people through the implementation of laws such as the Social Security Act 1935, which established old-age employment and unemployment benefits and insurance excluding domestic servants and agricultural workers — largely represented by black men and women at the time.
My colleagues and I found that black women who live in highly segregated counties give birth to infants approximately three days earlier than white women who live in similar counties.
Our research also showed that black women who lived in racially and economically disadvantaged neighbourhoods were more likely to have a preterm birth and experience an infant death compared to black women who lived in racially and economically advantaged neighbourhoods.
However you measure it, these disparities aren’t about anything black women are doing. It comes down to their access to community resources and systems of support.
How does racism show up in the lives of black women?
Our study team talked with black women across the reproductive lifespan who reside in Oakland and Fresno, California about how they define and conceptualise structural racism. Women shared that structural racism impacts their day-to-day lives and sexual and reproductive health outcomes.
“[Structural racism] has a trickle-down effect forming and perpetuating racist ideas and stereotypes,” one Pregnant Focus Group in Oakland, California said.
Some of the impacts they raised included:
Segregation and lack of community resources: Black women shared that communities are still segregated. Predominately black communities lack access to healthy food options, acceptable transportation and safe neighbourhoods in comparison to predominately white communities.
Disrespectful and inadequate medical care: Black women shared there are a lack of black providers and staff at medical facilities, which often results in poor patient-provider communication and treatment.
How can we address structural racism?
In partnership with black women in Oakland and Fresno, California, we used the Research Prioritisation Strategy to develop policy recommendations to address structural racism. Two high-priority areas were identified to address structural racism in each geography:
Equitable housing opportunities: enact policies to increase access to equitable housing opportunities and community resources in black communities in Fresno. This could include:
- Anti-discriminatory policies to expand access to credit for home ownership for black women, individuals and families.
- Expanding housing assistance eligibility requirements to support both low- and middle-income black women and families.
- Programs offering subsidies in the form of down-payment assistance for home ownership.
- Policies preventing higher gasoline prices in low-income communities of colour.
- Policies that acknowledge and give reparations for community land ownership where their own food is grown and the community gives and receives from it.
Improve black women’s access to and quality of medical care: enact policies to increase provider and staff diversity, as well as supports for black women before, during and after pregnancy in Oakland. This can include:
- Mandate holistic (i.e., nutrition, breastfeeding support, mental health) postpartum information-sharing and resources before hospital discharge.
- Mandatory coverage (i.e., no cost) of doulas and midwives by all types of health insurance.
- Funds for black women in the form of transportation stipends for health-seeking activities (i.e., self-appointments, pediatric appointments, groups, classes).
- Funds to develop and sustain establishing, improving and maintaining programs for screening, assessments and action to address black patients’ report of their experience with health care providers, similar to protocols for mental health awareness and treatment.
- Quality assurance policies that ensure health care providers are giving all information so black women can make informed choices for themselves and their families (including vaccinations, labor and delivery, family planning/birth control methods).
There is strong evidence showing that structural racism has negative impacts on black women’s sexual and reproductive health outcomes. Black women are ready for action-oriented policies and programs to increase access to housing and quality medical care, as well as community resources to improve their health outcomes and experience experiences before, during and after pregnancy. — Brittany D. Chambers
Dr. Chambers and community members from Oakland and Fresno will be sharing more policy recommendations on Thursday, September 26, 2019 in Fresno, California at the West Fresno Family Resource Center. More information about this event will be forthcoming here.