Every year, preventable maternal deaths demonstrate striking disparities within our global health systems. In 2017, 295,000 women died during pregnancy, childbirth, or the postpartum period. The majority of these mortalities were preventable and/or occurred in low-resource settings. While the World Health Organization, various nonprofits, and other organizations routinely collect statistics on maternal mortality, understanding the full scope of global maternal health inequity across socioeconomic, racial, and ethnic groups remains a challenge. As students who are passionate about health equity and believe that no one should be at risk of death while giving birth in the 21st century, we want to raise awareness about this issue here at Brown and use our collective power as students to help address this important issue. As student leaders of Brown Students for Saving Mothers, we operate a chapter of an international nonprofit organization of physicians, midwives, community health workers, and other allied health professionals working with governments and local organizations toward eradicating preventable maternal deaths and birth-related complications in low-resource settings.
Consider the fact that Black women are three to four times more likely to die from pregnancy complications than white women, and Indigenous women are more than two times more likely to die from pregnancy complications than white women. In the United States, Black, Indigenous, and Brown birthing individuals bear the brunt of this morbidity and mortality. Multiple, complex factors contribute to these disparities: structural and systemic racism, community and social contexts, quality of care received, stress, exposure to trauma, and countless other factors.
What is perhaps most striking is that the United States pours significant amounts of money into its health care system, yet it remains dismal and fractured, boasting the highest maternal mortality rate in the developed world. Many barriers have been identified in accessing health care in the United States, including medical distrust in historically harmed communities, discrimination, lack of health insurance coverage, provider shortages in rural areas, lack of culturally sensitive care, anti-abortion restrictions, and lack of comprehensive sex education. The Western medical system also has a tendency to overmedicalize birth so severely that midwives, who provide medical care in all stages of pregnancy, and doulas, who provide emotional and physical support in all stages of pregnancy, are virtually omitted from the birth process. Instead, for the majority of pregnant people, physicians are involved. Despite this overemphasis on biomedicine, the United States has failed to establish an equitable health care system to support birthing individuals.
But community health workers, such as doulas, should form the backbone of health care systems as they can help to alleviate significant health disparities. Studies have shown that pregnant people who received support from a doula were more likely to have spontaneous vaginal births and less likely to have costly Cesareans, epidurals, pain medications, and forcep-assisted births. Pregnant women who received continuous support from doulas were 39 percent less likely to receive a C-section, had a shorter duration of labor, and were 31 percent less likely to be dissatisfied with the birth experience. Doula care also has also been shown to improve birth outcomes among birthing BIPOC by disrupting negative social determinants of maternal health. However, BIPOC face tremendous barriers in accessing doula support. For decades, activists both locally and abroad have advocated for equitable access to doula services and changes in legislation. In Rhode Island, the RI Doula Reimbursement Act—crafted by policymakers, doulas, families, and healthcare providers—ensures that doula care is covered by insurance and sets the precedent for doulas to be paid more fair and liveable wages.
As a student-based chapter, Brown Students for Saving Mothers attempts to grapple with many of the global issues presented here, while also remaining grounded in the local community. Every week, we aim to discuss different social, anthropological, and medical topics that intersect with or directly concern maternal morbidity and mortality. For instance, we have explored topics such as racial disparities in relation to Covid-19, the intersection of mental and maternal health, experiencing cancer during pregnancy, Indigenous maternal health, migrant experiences of pregnancy and motherhood, the significant role of doulas, and more. We aim to bring in guest speakers and recently hosted a mentorship session with Dr. Taraneh Shirazian, the founder of Saving Mothers and an OB/GYN. Our goals are to educate, fundraise, and take actions to reduce and alleviate global women’s health inequities, especially maternal morbidity and mortality.
The work done by our chapter and Saving Mothers has been especially crucial during the current Covid-19 pandemic. Although it was initially unclear how Covid-19 impacts a pregnancy and the postpartum period, recent studies show that pregnant individuals infected with Covid-19 had worse maternal and fetal outcomes (such as higher rates of postnatal depression, stillbirth, maternal mortality, and ruptured ectopic pregnancies) compared to populations before the pandemic, particularly in lower- and middle-income countries. In addition to complications caused by Covid-19, poor maternal health has been exacerbated by national lockdowns and disruption to health care services, such as important obstetric care. It has become increasingly clear that action must be taken immediately.
In response to these troubling statistics, Saving Mothers, along with community health workers, have been monitoring the Covid-19 crisis and working tirelessly to provide mothers with basic supplies, such as groceries, baby formula, and diapers. Globally, Saving Mothers has also been working to provide Covid-19 kits with essential items for mothers, health care providers and traditional birth attendants. In low-resource settings, Saving Mothers has also continued to train local doctors, nurses, and birth attendants to deliver ultrasounds, prenatal care, family planning services, and telemedicine. As a student chapter, we spent the last semester raising funds to cover the costs of safe birth kits, which prevent infection and birth complications during childbirth. Although our actions as a student organization may appear minute in the grand scheme of things, small wins lead to cultural shifts in the way we view birth and the way we support pregnant people.
When all is said and done, our hope is that the greater Brown community will become better informed about inequities in global maternal health. While Saving Mothers may appear to be confined within the realm of public health, it spans countless sectors and fields that students are actively pursuing, including but not limited to politics, biomedicine, sociology, economics, and gender studies. Regardless of what field or career one decides to pursue, Brown students have the power and ability to enact change. Finally, looking beyond the work of Saving Mothers, our local community is home to a robust number of significant activist groups—including but not limited to SISTA Fire RI, Umoja Nia Collective, and Doulas of Rhode Island—whose work is essential in mobilizing communities. These networks of individuals, groups, and organizations invested in advancing maternal health equity—and their resilience in the face of systemic challenges—will improve the conditions of life for pregnant individuals everywhere.