The Bumpy Road to Perinatal Health Equity
The Paradox
In 1963, during “A Talk to Teachers,” James Baldwin described the paradox of education as, “precisely at the point when you begin to develop a conscience, you must find yourself at war with your society.” Baldwin was part of a generation that believed in the responsibility to act on one’s conscience. In today’s world of performative activism, Baldwin’s paradox is on full display. Many proudly display banners of antiracism such as “Black Lives Matter” and “Maternal Health Equity,” without consequence or change in their daily routines. Few take the brave steps required to achieve what we claim to want. We declare our maladjustment to an unjust society, but struggle to change it meaningfully.
First Steps
A few years ago, I decided to follow my conscience and change my routine. I knew I needed to do more and bring more of myself to my work as a midwife. For my Doctor of Nursing practice scholarly project, I launched the Alliance for Innovation in Maternal Health’s Reduction of Peripartum Racial and Ethnic Disparities Patient Safety Bundle at my hospital. I thought, “yes, here’s my chance to share my passion for social justice and reflect the light of hard-working women and men who made it possible for me to be here.” So, I proceeded, grew, struggled, and worked my butt off to achieve minor milestones along an unclear journey. Along the way, I realized that despite all our beautiful, symbolic gestures, we don’t begin to know what health equity is. If we did, we would recognize that Baldwin is right: we are at war, not just with some big, horrible, external monster of a racist system, but with ourselves. Our kind, beautiful, well-intentioned selves are embedded in systems of inequality, racism, classism, and gender discrimination. True transformation will be hard and painful. It will require us to be fearless and tireless.
Looking Forward
The Reduction of Peripartum Racial and Ethnic Disparities Patient Safety Bundle is not a quick fix. It’s a gentle start to a long, brave journey down a path that doesn’t exist. At the ACNM 66th Annual Meeting, I’ll present my quality improvement (QI) project via a recorded podium presentation and share lessons learned and recommendations for future perinatal health equity work in hospital settings. Dismantling racism is a great metaphor for what we must do to achieve health equity. I hope we recognize that we must dismantle parts of ourselves, parts of our profession, and parts of the medical establishment that we’ve embedded ourselves in to achieve this. Most importantly, we must be ready with architects, healers, and builders to someday put ourselves and our society back together, hopefully healed, just and free.
You can learn more about “Launching Perinatal Health Equity: A Quality Improvement Project” at the upcoming ACNM 66th Annual Meeting, held virtually May 23 – 25, 2021. During my session, we’ll consider:
- What lessons were learned while implementing the Reduction of Peripartum Racial/Ethnic Disparities Bundle?
- What is perinatal health equity?
- What evidence exists to support perinatal health equity initiatives?
- How can we measure perinatal health equity?
In addition, look out for a forthcoming article on this QI report in an upcoming issue of the Journal of Midwifery & Women’s Health!
Lauren Arrington is a midwife and faculty member at Frontier Nursing University. She also practices full-scope midwifery at the University of Maryland St. Joseph Medical Center. She has served as a maternal health advisor for Jhpiego and a volunteer for ACNM’s Division of Global Health. In 2020, she received her doctorate in nursing practice at Duke University and led a perinatal health equity quality improvement project as part of her degree. She is a Margolis Health Policy and Management Scholar and recently joined the Board of Commissioners for the Accreditation Commission for Midwifery Education.
