By Kieona George
Most people know what pregnant women are supposed to avoid during pregnancy. Foods that make them nauseous, strenuous exercise, caffeine and more serious things like drugs and alcohol.
But there’s another threat to a safe pregnancy for women of colour. One of the places where this threat can occur is in the office of a healthcare provider. And a possible solution lies in classrooms at Ryerson.
A threat to a safe pregnancy for women of colour in Canada is the inequitable treatment they may receive in the healthcare industry. Systemic racism, discrimination and negative treatment from healthcare providers add an intense stress to pregnant women of colour that can manifest in conditions that complicate pregnancies and can lead to the death of the mother or child. Since sufficient data is not present in Canada yet, in the United States where such research was conducted, it was found that Black women are three to four times more likely to die a pregnancy-related death than their white counterparts.
How is Ryerson preparing health professionals?
Sociologist and professor of Working Across Midwifery, Nadya Burton, teaches students how the course with the goal to learn how to provide skills and compassionate care as midwives in the context of health and equity. The course pays special attention to how power is distributed in society and social justice.
“How do I, as a midwife, work with my own identity in relation to the identity of my client,” said Burton. “If I’m a white midwife and I’m providing care to a Black or Indigenous client, how do I make sure that I’m attending relationships with power and having some knowledge of what the experience might be like for that person in the healthcare system.”
Students complete theoretical readings and critical reflection assignments with the ability to pull from other communities. The course is nothing short of difficult when the lived experience of some students are also what is being studied.
Black women are three to four times more likely to die a pregnancy-related death
“And that is a painful and crappy experience for those students,” said Burton. “It sucks that they have to sit in the class and watch their white peers kind of struggle through those issues and come to terms.” And not just race, but for many identities and issues the course looks at.
Pregnancy can be stressful for any mother. But medical providers have not realized the connection between the maternal mortality for women of colour and how the actions of healthcare providers contribute to the racial disparity.
“Everybody’s body changes during pregnancy and they feel uncomfortable…But if you add on top of that poverty, [systemic racism], [and] that even to get to your office this morning this client had to go through a Mount Everest,” said the director of the midwifery program at Ryerson, Karline Wilson-Mitchell.
Wilson-Mitchell has been practicing midwifery since 1992 and has taught the profession at multiple universities.
Equitable care over equal treatment
“Treating everyone the same is actually not fair, not just, not culturally sensitive and not best practice,” said Wilson-Mitchell. These social occurrences have caused the need for different kinds of medical care that has not been acknowledged widely in the healthcare industry.
Weathering, a health condition first written about by Dr. Arline Geronimus in her report in 1992 connected stress and Black infant mortality with a theory that describes the weathering of Black women’s bodies as a result of the repeated exposure to racism, discrimination, and negative treatment. Weathering is not a condition for all women but one that would require equitable care than equal treatment.
Everybody’s body changes during pregnancy and they feel uncomfortable…But if you add on top of that poverty, [systemic racism], [and] that even to get to your office this morning this client had to go through a Mount Everest
Brookings, a non-profit for public policy organization, found that a Black woman with an advanced degree is more likely to lose her baby than a white woman with an eighth-grade education.
“Health is more than just the absence of disease, it’s actually having access to all the resources that you need to be your best. To be able to perform optimally,” said Wilson-Mitchell.
The importance of access to healthcare and the consequences when it’s inaccessible is what Ryerson nursing students learn in the culmination of their third year. The first semester is dedicated to the introduction of community health, and the second semester is where students apply their knowledge in subjects such as maternal child health and mental health.
Corinne Hart, associate professor and head of the nursing theory and practice courses describes the curriculum as critical theory to lead students to think in a social justice perspective about health and their roles as nurses. “Part of what they’re doing there too is looking at issues of social justice and equity and how come some people have access to health and other people don’t.”
Students have a photo assignment where they take a photo of something that represents a community health inequity and write a paper on how nurses can be part of the solution. “All of the things that make people vulnerable is what we spend a year looking at,” said Hart.
Some students get placements in low-income marginalized communities and have to apply and use theory from class in action. Students are encouraged not to just accept what they’re seeing but unpack it and think about why it is, said Hart.
Changing the language used with patients, self-reflection about bias, and listening to patients and their underlying messages are strategies Hart thinks healthcare professionals can apply in their offices. “So that they’re not stereotyping or stigmatizing or setting people up for failure.”
“They’re not trying to be difficult, they’re trying to cope with the stressors of living in this world…” said Wilson-Mitchell. “All of the family stressors that we go through during pregnancy and they may be going through it in a unique way because of the intersectionality of the oppression.”