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  • Writer's pictureKomal Keerthy

Can we overcome racial disparities in maternal and reproductive health?

Exploring the persistent challenges faced by Black women in the United States.

Racial and ethnic disparities in maternal and reproductive health have persisted in the United States for centuries. Despite technological advancements, Black women still face higher rates of complications and death during childbirth than White women. These disparities are rooted in systemic injustices such as discrimination, racism, and socio-economic inequalities.

Structural racism, which permeates systems and institutions, plays a significant role in perpetuating health disparities. Housing segregation, exemplified by policies like redlining, continues to impact reproductive health outcomes. Black and Latinx neighborhoods experience higher levels of poverty, lower-performing schools, and limited access to quality healthcare, resulting in adverse birth outcomes.

Structural racism also affects healthcare utilization and access. Lack of private sector investment in certain neighborhoods leads to a tiered healthcare system based on proximity to facilities and reliable insurance coverage. Limited access to prenatal care, reproductive health services, and specialized care disproportionately affects individuals living in poor and under-resourced neighborhoods. Racially discordant provider-patient relationships contribute to discriminatory treatment and ineffective care.

Policies and actions are needed to achieve health equity. The "R4P" (Remove, Repair, Restructure, Remediate, Provide) approach and the 3R Model (Retrofit, Reform, Reimagine) can guide efforts to address systemic inequalities. The 3R framework, proposed by Monica McLemore, outlines a comprehensive approach to advancing health equity. It involves retrofitting existing systems, reforming structures and institutions, and reimagining healthcare to address disparities. It emphasizes the need for fundamental shifts rather than superficial changes. By promoting inclusivity, challenging discriminatory practices, and envisioning new models of care, the 3R framework aims to create sustainable change and ensure equitable access to healthcare. It aligns with the R4P (Remove, Repair, Restructure, Remediate) approach in addressing structural racism and healthcare disparities. This framework focuses on removing power structures that perpetuate inequality, repairing systems by considering the historical context of racism, restructuring policies and institutions, and remedying immediate needs. By dismantling discriminatory practices, promoting equity, and addressing the root causes of disparities, the R4P framework aims to create lasting change in the healthcare system. Both frameworks emphasize transformative actions for achieving health equity.. Concrete actions should include universal access to healthcare and insurance, diversifying the workforce, and building a comprehensive reproductive health system that offers racially concordant care. Additionally, integrating reproductive health services with family planning, primary care, and other specialties can ensure holistic support.

To promote racial concordance in healthcare, medical and midwifery education should prioritize culturally responsive training programs and provide mentorship opportunities for aspiring Black and Latinx healthcare professionals. Federal initiatives, such as expanding Medicaid coverage and implicit bias training for healthcare providers, are promising steps toward reducing maternal mortality and morbidity rates.

Community-led initiatives that center on women of color and harness social support networks are crucial. Models like group prenatal care and collaborations with local partners can improve outcomes and challenge structural racism. However, more significant financial investments and bold policies are necessary at the federal and regional levels to operationalize these approaches and achieve lasting change for Black women and their families.


Golden, B., Asiodu, I. V., Franck, L. S., Yayra, C., Martín, D. F., Youngston, T., & McLemore, M. R. (2022). Emerging approaches to redressing multi-level racism and reproductive health disparities. Npj Digital Medicine, 5(1), 1-4.


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