After the alarming findings on disparities in maternity care were published by the CDC, The American Journal of Managed Care® interviewed Veronica Gillispie-Bell, MD, MAS, head of Women’s Services at Ochsner Medical Center, Kenner, director of Quality for Women’s Services for Ochsner Health, and medical director of the Louisiana Perinatal Quality Collaborative and Pregnancy Associated Mortality Review for the Louisiana Department of Health.
Can you explain the systemic role that impacts the disparities in maternity care identified by the study?
When we think about respectful care, and we think about why that may not be happening, we have to go back to the historical context and how we have stereotypes. Black women, Latino women, Native American women, what we have been told about who these women are. I, in particular, because I am Black, identify with the stereotypes that have been used to describe Black women. So, I can explain from that perspective, that there are 4 archetypes that have been used to describe Black women starting from slavery going into the [1980s]. The last archetype was the “Welfare queen,” which was something that was mentioned in the Reagan administration when he was running for president.
For individuals that have not had a lot of interaction with Black women, these are the stereotypes that frame how we think about who Black women are; and none of these stereotypes are ones that would garner respect.
So, if that is what you think, and this is a stereotype and a bias that you have about Black women—and it’s unconscious, it’s not anything intentional, it’s not being overtly racist, or anything like that; so I don’t want to get that confused, it’s an unconscious bias. But if that is what you feel about Black women—that they’re loud, that they’re boisterous, that they’re uneducated—and these biases are not just because of the historical part, but there have been studies done on medical students and residents to show that this is how they characterize what they think about Black women.
So, if that is what you’re thinking, then exactly how respectful are you going to be when you provide that care? We really have to work on our, again, implicit bias: acknowledging it, understanding it, and doing the work to try to change it.
It is also those biases that then affect some of the decisions that are made on a macro level that impact the social determinants of health, as well. So then, as a Black woman coming in—and this is not true of all Black women that received disrespectful care, or that have these disparities—but if you are a Black woman, where you are in a racially residential segregated area, you are more likely to have had your social determinants of health impacted.
So you’re coming into the health care system already behind the 8 ball because you haven’t had the same access as your counterparts. And then you come in, and then you’re further disenfranchised because of the biases that we have towards Black women, and that then impacts the way we deliver health care, and all of this further leads to the negative outcomes that we’re seeing, especially in the maternal space for Black women.