Birth equity: A guide for employers

Birth equity is the effort to ensure more optimal birth conditions for all and address the racial and social impact of the current disparities and inequities in birth outcomes. The term was coined by Joia Crear-Perry, MD, President and Founder of the National Birth Equity Collaborative (NBEC).

In the U.S., pregnancy and childbirth-related health discrepancies between Black and white people are stark. Black women are three times more likely to die from pregnancy-related causes compared with white women. Black infants are significantly more likely to be born preterm than white infants and are twice as likely to die before their first birthday. Employers have a role to play in understanding and promoting birth equity and improving access to high-quality, culturally competent care.

The impact of birth equity

The history of racism in gynecological care specifically can be traced back to the beginning of the field. Often coined the “father of gynecology,” John Marion Sims greatly influenced the field and invented tools still used today, such as the speculum. However, he did so by conducting painful experiments on enslaved Black women.

Sims’ oppressive practices have many echoes today. It’s well documented that BIPOC patients are more likely than white patients to have negative, devaluing, or disrespectful interactions with medical providers. For example, Black women are more likely than white women to report having been pressured by a clinician to use a contraceptive. Black people’s concerns about their health and pregnancy are more likely to be dismissed. Tennis star Serena Williams famously shared that she had trouble getting doctors to take her concerns seriously when she developed a blood clot in her lungs after her C-section. 

Black people are also less likely to have access to health services, family planning, or prenatal care. And while lack of healthcare access is an important factor to address, socioeconomic and risk factors alone don’t account for these discrepancies. Even college-educated Black women die at higher rates of pregnancy-related causes than white women who didn’t finish high school. Instead, studies show that the cumulative impact of ongoing racism throughout a Black person’s life has a significant impact on health and pregnancy outcomes. Achieving birth equity requires interventions and policy developments that address challenges throughout the lifespan, not just during pregnancy.

"Today, the systemic challenges that underlie the disparity in outcomes for Black people remain," said Dr. Crear-Perry. "When comparing maternal health in the ten richest countries in the world, the United States comes in dead last. We must adequately address maternal health inequities to eliminate birth equity disparities."

How benefit professionals can support birth equity  

For employers, supporting birth equity means understanding and continuously educating yourself on history, supporting inclusive benefits, and providing access to culturally competent care. 

Culturally competent care is a system of care that respects cultural differences such as language, communication styles, beliefs, attitudes, and behaviors. In the U.S., sharing a racial or cultural background with one’s physician can lead to higher patient satisfaction, better adherence to medications, and better outcomes. Research shows that considering both culturally competent care and cultural humility is needed when working toward equity. Cultural humility seeks to improve care for all but focuses on critique and self-evaluation to address power imbalance. At Carrot, we’ve created a feature for BIPOC members to request a BIPOC provider, should they choose. Although culturally competent care can come from other providers, we believe that representation is an important part of the puzzle. 

Here are some other ways to support and move toward birth equity:

  • Share resources around birth and after birth with employees
  • Include resources on mental health in your discussions on health and birth equity
  • Prioritize the needs, health, and well-being of people of color
  • Invest in culturally competent care and diverse providers
  • Respect and listen to the experiences of marginalized groups
  • Understand and unpack white supremacy and bias in the healthcare system through working groups and ERGs your care and services

Another way to support is to provide your employees with outside resources. Consider sharing resources around birth and after birth, mental health, or local community support. For example, organizations like Health in Her Hue work with parents to connect with culturally competent care at any point in their lives. The Shade of Blue Project offers mental health resources for Black people before, during, and after childbirth. You may also want to do research on your own community to offer local resources.

Support inclusive health benefits 

Inclusive benefits can help close health gaps and provide accessible care to your employees. Two inclusive benefits to consider for birth equity are mental health and fertility benefits. For the BIPOC community in particular, mental health benefits can be especially helpful given the additional stress of working and raising a family in a prejudiced system. 

Comprehensive fertility benefits can provide employees with access to high-quality, culturally-competent providers and specific information about fertility and pregnancy challenges. Research found that 60% of pregnancy-related deaths were preventable through interventions like patient knowledge, provider support, and healthcare coordination. 

In order to change the current birth outcomes for Black people, benefits professionals must learn about birth equity and how to support healthy pregnancies and families in the workplace. Listening to Black people’s experiences, researching inequities, supporting inclusive benefits, and providing culturally competent care can all help support better birth outcomes for everyone. And whatever actions you take, make sure you're creating a plan that's designed with long-term goals in mind.

“When something happens in the news, that’s when people tend to focus hard on these issues,” said Raquel Hammond, NMD, Director of Integrative and Preventive Medicine at Carrot. “But it’s not sustained. More than just providing support or building awareness, we have to make sure that as companies, that effort is sustained over time."

Want to learn more about how fertility care can support birth equity? Contact Carrot.

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