Impact of Institutional Racism on Maternal and Child Health

Structural and/or institutional racism – racism that began with enslavement of Black people -  was embedded in our earliest institutions, and has continued to influence policies and practices.  Understanding the history of how racism has been baked into our systems is an instrumental step towards dismantling policies and practices that negatively impact maternal and child health outcomes.  In doing so, healthcare providers can provide culturally competent, compassionate care that recognizes why people of color may mistrust health care institutions, examine organizational, state, and federal policies, and work together to eliminate policies that stem from institutional racism. 

There are four key injustices that have negatively impacted Black mothers and young children.  These are a high-level summary and not a comprehensive list of historic injustices.

1. Unequal Access to Resources

Historically, American systems excluded Black women from support and resources provided to white women, an inequity made larger by the welfare system.  When the 1935 Social Security Act was passed to include welfare benefits of unemployment and social security, it was anticipated to assist all children and families in need.  Instead, predominantly white children and families gained assistance because Black people were predominantly excluded.  The act excluded farm workers and domestic help – jobs often held by African Americans during the 1930s.

2.  Housing Discrimination

Due to the process of “redlining” in the 1930s where neighborhoods where mapped based on how secure of an investment it was and redlined neighborhoods were mapped with the highest risk.  These areas were predominantly occupied by Black families.  These neighborhoods rarely qualified for federal housing assistance or local bank loans, becoming underdeveloped as a result.  This created a cycle that prevented further investment.  While banned more than 50 years ago, its impact continues today. 

3.  Breastfeeding

Black women have the lowest rate of breastfeeding initiation and continuation compared to other racial and ethnic groups.  This disparity is an effect from the practice of wet nursing required by enslaved mothers to nurse white children, often at the expense of their own children.  Black children became sicker and more needy which built a negative narrative on the health and wellbeing of Black children that continues today. 

4.  Mistrust of Health Care Institutions

Experimental reproductive surgeries were commonly tested on enslaved Black women, oftentimes without the benefit of anesthesia.  Exploitation continued after abolition, with enforced eugenics programs that sterilized Black women.  Health care segregation continued until the mid-1960s, with Black families barred from quality hospitals and care.  Even after the Civil Right Act, historically Black hospitals and clinics remained under-resourced.  These historical practices and impact have led to mistrust of health care institutions from people of color. 

Structural racism creates barriers that limit opportunities for people of color, including access to prenatal health care, social services and other supportive programs which are critical to having healthy babies. When it isn’t addressed within an organization or system, the inequities continue to grow, creating an even larger racial divide.

At Every Baby Guilford we are acknowledging that racial inequities caused by structural racism play a critical role in the number of infant deaths in Guilford County.  By understanding past events, our community can better understand the cause of infant  disparities and identify solutions that move toward an equitable future.

Source: National Institute for Children's Health Quality

Key Events in U.S. History that Shape Black Maternal and Infant Health

Reinforcement of the trauma of slavery in legal and healthcare institutions and ideologies has created intentional barriers to care and stripped Afro-descended women of autonomy in care.  

At Every Baby Guilford We Value:

The holistic health of individuals: We acknowledge that birth outcomes are a mirror of our community’s investment in families and work towards creating environments that support lifelong health.

Dismantling racism:  We are disrupting institutionalized racism. By confronting our own biases, we deconstruct the racism in us.  In doing so, we recognize it in systems and can identify organizational policies, procedures, and practices that result in a higher rate of Black infant death.  

A radically inclusive, community driven approach: We intentionally bring together residents and organizations, respecting the experiences and perspectives of those most impacted by infant death.  Together, we create equitable systems for long-lasting change. 

Urgent action: Our measure of success is the elimination of disparities in infant mortality in Guilford County. The future of our work depends on the actions we take today to transform policies, enhance programs, and be a visible, vocal change agent for our community.