The Urban Indigenous Woman: Indigenous Women’s Health Disparities Part 2

By: Aaminah Shakur

In the last post we talked about general health disparities Indigenous women face and ways to try to access appropriate care. In this post I would like to talk about pregnancy and childbirth-specific disparity issues.

When I made the decision to study to be a doula it was because I saw a huge issue in my own urban community around pregnancy and birth. I have worked in many fields and capacities, including in a counseling agency, as a trainer and scheduler of medical and social services interpreters and in an administrative capacity to a children’s health non-profit addressing access to care for children with Medicaid insurance. In all three of those jobs I had opportunities to see that parents of color deal with so many issues around access to services for their children but also for themselves. I witnessed from a slight distance the very clear racial disparities that were underlying issues not only of access to care but also quality of care, how pregnant women were treated by care providers and what options they were “allowed” to have around their pregnancy and birthing experience.

For example, I provided extensive emotional support to both an interpreter and the social worker involved in a case where a Somali immigrant mother was told by Child Protective Services she must accept ultrasounds and amniotic fluid index procedures every other week, and she could not give birth at home with her mother but was required to have the baby in the hospital. In this case, the pregnancy had shown no issues or concerns to warrant the intrusive testing and the mother did not want them. I had already noted a pattern of local hospitals requesting interpreters for Spanish, Somali and Vietnamese patients needing these otherwise uncommon tests done every other week. The same names were passing my desk for the same procedures over and over again, and interpreters were telling me of fears the mothers had and threats they received when questioning why they needed the tests so frequently. When the Somali mother went into labor with her sixth baby and was unable to get to the hospital quick enough because of extreme weather and a very short labor, all of the children were removed from her care. The social worker fought hard on the mother’s behalf and eventually they were returned, but the fact that they could be taken is the problem – and a threat that many women of color live under.

My own birthing experience in 1996 was marked by feeling bullied and harassed the moment my mother was not with me to push people out of the room. I felt at the time that it was specifically related to being on Medicaid and a single parent, as my son’s father was in prison. Medicaid and single motherhood are both demonstrably common experiences for many Indigenous women. Being a single mother has become normal, and the effects of single parenthood and racially-biased healthcare on a lifetime of poverty are profound. Anecdotal evidence cites frequent perceptions of “being treated differently” as a single and/or Medicaid-receiving mother of color.

In some cases the issue is lack of time and attention given by the doctor, including whether they are providing necessary advice and basic health information in an accessible and caring way. Sometimes the problem stems from doctors and office/hospital staff that are simply hostile or uncaring toward certain mothers in both subtle and overt ways. Although the ACA makes health insurance coverage more accessible, and some states have expanded Medicaid under it, there are still many women who have gone without basic healthcare for so long that irreparable damage has been done. This, combined with a lifetime accumulation of racism-caused stress and trauma, means that both a mother’s and her baby’s lives are at increased risk. When the care they do receive is also brusque, biased, unnecessarily intrusive and/or limited in scope those risks are then magnified. Consider also how many states are beginning to enforce arbitrary restrictions on how poor pregnant women and mothers access food and even their own money, and it is clear that we are dealing with a systemic issue of great magnitude.

Under such conditions, it is difficult to offer solutions that individual urban Indigenous women can utilize to better their situation. What we need are concerted communal efforts that don’t place the weight on overburdened individuals to fix this mess. Culturally competent community doula programs are one route of successful systemic change. Returning to our ancestral traditions and knowledge, decolonizing Indigenous pregnancy and childbirth, is another.

What ideas do you have? What supports do you wish you had? Dream big, and let’s find ways to make our dreams happen, together!