In the United States, Black infants die at more than twice the rate of white infants, an indicator that underscores profound racial disparities in health care. One significant contributing factor is the lack of diversity within the health care workforce. Increasing the diversity of health care providers, particularly in maternal care, is a crucial step toward reducing the disproportionately high Black infant mortality rate.
The infant mortality rate is the number of deaths before infants’ first birthdays for every 1,000 births. It’s often used as an indicator of a country's overall health, with lower rates in healthier countries. For nearly a century, Black infants have been disproportionately likely to die within their first year of life. In 1935, the mortality rate for Black infants was 81.9 deaths per 1,000 live births, while the rate for white infants was 51.9 per 1,000. Today, Black infant mortality is still the highest of all racial and ethnic groups (PDF).
What does research say about the link between health care worker diversity and health outcomes?
A growing body of evidence confirms that diversifying the health care workforce can improve health outcomes. For example, Black and Latinx physicians are more likely to provide services in communities of color and to people with complex health issues because of poverty and unmet social needs.
In addition, patients who are the same race or ethnicity as their providers report better outcomes and are more likely to be prescribed preventive care. Those whose providers speak the same language are more likely to report receiving quality care. Evidence shows that diversity on health care teams improves decisionmaking, health outcomes, productivity, revenue, and understanding.
However, equitable representation of Black, Latinx, and other communities of color is lacking in the health care workforce. As a result, though a pregnant Black person might prefer to see a provider of the same race, the proportion of Black OB/GYN residents declined between 2014 and 2019. In 2020, a national report found that though Black people make up 12–14 percent of the US population, only 7 percent of midwives identified as Black or African American (PDF).
How can we achieve a more diverse health care workforce?
Recent Urban research suggests that pathway programs and other strategies to specifically increase the number of Black birthing clinicians and Black nurses could help diversify the health care workforce and, in turn, reduce Black infant mortality rates. Audiences for these recommendations include state and federal policymakers, philanthropies, higher education, and health care systems.
Pathway programs provide academic, financial, and social supports to underrepresented students to help them enroll and stay in medical school. These programs help students face educational demands, navigate professional development opportunities, and deal with microaggressions and bias.
To address the shortage of Black birthing clinicians (PDF), the evidence points to offering financial support to Black maternal health trainees and clinicians. This includes developing additional training and support programs and removing barriers that limit the practice of Black midwives. Additionally, working with Black K–12 students will help foster future participation in the field.
Finally, expanding financial support available to Black nursing trainees and clinicians could increase the number of Black nurses. Programs like the federal government’s Nurse Corps Loan Repayment Program could help alleviate the disproportionate debt Black students take on to finance their educations. In addition to financial aid, developing and sustaining training and support programs can improve the diversity of hospital nursing staff, especially in leadership positions.Nurses of color who work in hospitals and nursing homes are the most likely to experience racism and discrimination. Supporting their contributions and ensuring all staff members and students understand the importance of eliminating inequities will help create a more diverse workforce.
By fostering inclusion and combating discrimination in the health care profession, these strategies could help more Black professionals enter and stay in the maternal care workforce and, in turn, reduce the unacceptably high Black infant mortality rate.
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