In a world where healthcare equity should be an unquestionable priority, systemic racism represents a major obstacle, particularly in the area of prenatal care. The article “The Impact of Systemic Racism on Access to Prenatal Health Care: A Challenge for Equity” delves into the heart of this alarming issue, highlighting the multiple facets by which systemic racism deprives pregnant women of minorities of equitable access to essential care.
Through an in-depth exploration of systemic barriers, institutional racism, access to reproductive health education, socioeconomic factors, lack of diversity among healthcare professionals, the need for culturally sensitive practices, community support, and the psychological impacts of racism, this article seeks not only to diagnose the symptoms of this inequality but also to prescribe a series of concrete strategies to eradicate systemic racism from prenatal care.
I. Systemic Barriers to Access to Prenatal Care:
Systemic barriers that hinder access to prenatal care are a major public health issue, particularly affecting women from low-income and minority communities. These barriers do not just reflect isolated problems but are deeply rooted in the structures and policies that shape health systems across the world. To fully understand their impact, it is essential to examine them in detail.
1. Lack of Health Insurance Coverage:
One of the main barriers to accessing prenatal care is the lack of health insurance coverage. In many countries, health care costs are exorbitant, making prenatal services out of reach for women who do not have insurance. This situation is particularly critical in the United States, where health insurance is often tied to employment, and may be non-existent for low-income, part-time workers, or those employed in informal or precarious sectors. Without insurance, the costs of consultations, medical examinations, and follow-up can become prohibitive, dissuading pregnant women from seeking necessary care.
2. The Shortage of Health Care Providers:
Another significant barrier is the shortage of healthcare providers in low-income and minority communities. This situation is exacerbated in rural or remote areas, where medical resources are often limited. Geographic distance from health centers can be a major barrier, particularly for women who do not have access to reliable transportation. Additionally, even in urban areas, clinics and hospitals can be overburdened and underfunded, which can lead to prolonged wait times and reduced access to quality prenatal care.
3. Linguistic Obstacles:
Language barriers constitute another significant systemic barrier. For women who do not speak the language primarily used in the healthcare system, navigating prenatal care can be particularly difficult. These women may experience significant challenges in understanding medical information, communicating with healthcare providers, and even making appointments. Lack of interpretation services or limited availability of educational materials in their native language may increase the risk of misunderstandings, inadequate diagnosis, and noncompliance with care recommendations.
4. Improvement Strategies:
To overcome these systemic barriers, it is crucial to adopt comprehensive and inclusive strategies. This could include expanding health insurance coverage to ensure that everyone, regardless of employment or income status, has access to affordable health care. It is also essential to invest in health infrastructure in underserved communities, including the recruitment and training of health professionals from these communities. Finally, to break down language barriers, it is necessary to offer interpretation and translation services and to develop multilingual educational materials.
By proactively addressing these systemic barriers, it is possible to improve access to antenatal care and ensure that all women, regardless of their socio-economic status or ethnicity, can benefit from support and quality care throughout their pregnancy.
II. Institutional Racism and its Effects:
Institutional racism in prenatal health care is a complex and deep-rooted problem that disproportionately impacts pregnant women from minority groups. This phenomenon manifests through a variety of systemic, often subtle, dynamics and practices that lead to inequalities in care and health outcomes.
1. Understanding Institutional Racism:
Institutional racism refers to policies, practices, and organizational structures that, although seemingly neutral, produce discriminatory effects on individuals based on their race or ethnicity. In the healthcare context, this can result in attitudes, behaviors, and decisions that consciously or unconsciously promote racial biases and stereotypes.
2. Manifestations in Prenatal Care:
In the context of prenatal care, institutional racism can manifest itself in a variety of ways:
– Stereotypes and Prejudices:
Healthcare professionals may unconsciously adhere to racial stereotypes that influence their clinical judgment. For example, inaccurate beliefs regarding pain tolerance among Black women may lead to an underestimation of their pain management needs.
– Health care access :
Minority women may be denied access to certain treatments or high-quality prenatal care due to institutional biases or discriminatory referral systems.
– Communication:
Language and cultural barriers can be exacerbated by a lack of will or resources to overcome these obstacles, thereby affecting the quality of communication between providers and patients.
3. Consequences of Institutional Racism:
The effects of institutional racism on prenatal care are broad and profoundly harmful:
– Late Diagnosis and Treatment Errors:
Biases can lead to inadequate clinical assessments, delays in diagnosing critical conditions, and errors in prescribing treatments. These errors increase the risk of complications for mother and child.
– Distrust of the Health System:
Repeated negative experiences can lead to widespread distrust in the healthcare system, dissuading women from minority groups from seeking prenatal care or following medical recommendations.
– Impact on Pregnancy Outcomes:
Collectively, these factors contribute to higher rates of prenatal complications, such as gestational hypertension, gestational diabetes, and preterm birth, particularly among African American and Native populations.
4. Strategies to Combat Institutional Racism:
To combat institutional racism in prenatal care, it is essential to adopt holistic and inclusive strategies:
– Training in Cultural Competence and Bias Awareness:
Healthcare providers should participate in regular training on cultural competency and implicit bias awareness to improve their interactions with patients from diverse ethnic and cultural backgrounds.
– Equitable Health Policies:
Healthcare institutions must develop and implement policies that recognize and actively address racial and ethnic disparities in health care.
– Improved Access to Care:
Implement initiatives to improve access to quality prenatal care for women from minority groups, including the deployment of health care providers to underserved communities.
– Promotion of Research:
Encourage research on racial and ethnic disparities in prenatal health to better understand and address the root causes of institutional racism.
By addressing the roots of institutional racism in prenatal care, it is possible to create a more just and inclusive care environment, where all women can receive the care and support they need for a healthy pregnancy and birth.
III. Access to Educational and Prevention Resources:
Access to educational and prevention resources plays a crucial role in prenatal health, particularly for minority pregnant women. Comprehensive and accessible information about the importance of prenatal care and the resources available is fundamental to ensuring that all pregnant women can make informed decisions about their health and that of their future children. This section details the importance of these resources and suggests strategies to improve their accessibility.
1. The Importance of Reproductive Health Education:
Reproductive health education provides women with the knowledge to understand the biological processes in their bodies, recognize the signs and symptoms of potential complications, and understand the importance of regular medical monitoring during pregnancy. This includes information on nutrition, exercise, stress management, and avoiding risks that may affect the course of the pregnancy. Unfortunately, women from some minority communities may have limited access to this valuable information due to language, cultural, or socioeconomic barriers.
2. The Challenges of Access to Information:
Several factors can limit pregnant women’s access to quality information on prenatal care:
– Linguistic Barriers:
Lack of educational resources in women’s native languages can prevent understanding and assimilation of essential information.
– Socio-economic disparities:
Women living in poverty may not have access to the Internet or other digital information sources, limiting their access to prenatal health advice.
– Lack of Cultural Representation:
Educational content that does not consider diverse cultures and beliefs may not resonate with women in certain communities, reducing its effectiveness.
3. Strategies to Improve Access to Resources:
To overcome these obstacles and improve access to educational and prevention resources in prenatal health, it is necessary to adopt a multidimensional approach:
– Development of Multilingual Material:
Create and distribute educational materials on prenatal health in a variety of languages to ensure information is accessible to a wider audience.
– Use of Diversified Communication Channels:
Employ a range of communication channels, including online, print, and via social media, to reach women in different communities. Awareness campaigns can also be delivered to community venues such as schools, churches, and community centers.
– Targeted Educational Programs:
Implement educational programs that are culturally sensitive and designed to directly engage minority communities. This may include workshops, seminars, and support groups led by respected members of the community.
– Partnerships with Community Influencers:
Collaborate with thought leaders, respected healthcare professionals in minority communities, and other influencers to promote the importance of prenatal care and the availability of resources.
– Integration of Health Education into Prenatal Care:
Ensure that reproductive health education is an integral part of antenatal consultations, allowing women to ask questions and receive information tailored to their specific needs.
By focusing on improving access to accurate and understandable educational and prevention resources, disparities in prenatal care can be significantly reduced. This will not only contribute to better health outcomes for pregnant women and their babies but also promote a more equitable and inclusive society.
IV. Socio-economic factors:
Socioeconomic inequalities are a major determinant of health and have a profound impact on access to prenatal health care. These inequalities can create or exacerbate significant barriers for low-income women, particularly those from racial and ethnic minorities, preventing them from receiving needed care during pregnancy. Detailed analysis of these factors provides a deeper understanding of the challenges faced and potential strategies to improve access to prenatal care for all women.
1. Impact of Socio-economic Factors on Access to Prenatal Care:
– Lack of Transport:
Access to transportation is a key factor in reaching antenatal care services. In rural areas or for low-income communities living in urban areas poorly served by public transportation, simply getting to a medical appointment can be a considerable challenge. The cost of private transportation or the lack of reliable and affordable public transportation services may prevent pregnant women from following a regular schedule of prenatal care.
– Inability to Take Paid Leave:
Many low-income women work in precarious or part-time jobs that do not offer paid leave. The inability to take time off for medical appointments without losing income may deter these women from seeking regular prenatal care. This problem is exacerbated for self-employed women or those engaged in the informal economy, where the absence of work directly means a loss of income.
– Health Care Costs:
Direct costs associated with prenatal health care, such as visits, tests, and treatments, can be prohibitive for low-income women. Even with insurance coverage, high deductibles, co-payments, and exclusions for certain benefits can make care inaccessible. For women without insurance, the cost of prenatal care can be an insurmountable barrier.
– Lack of Information and Awareness:
Socioeconomic inequalities also affect access to health information. Women in low-income communities may not have access to reliable educational resources or be unaware of the importance of prenatal care. Lack of health education may limit their ability to navigate the health care system or understand available care options.
3. Strategies to Improve Access to Prenatal Care:
To address these socio-economic inequalities, several strategies can be put in place:
– Improve Transport Accessibility:
Establish subsidized transportation programs or shuttle services to help pregnant women get to medical appointments.
– Paid Leave Policies:
Encourage or legislate for employers to provide paid time off for prenatal medical appointments, ensuring that women do not have to choose between income and their health.
– Subsidies and Financial Aid:
Provide subsidies or financial assistance to cover the costs of prenatal care for low-income women, thereby reducing financial barriers to accessing care.
– Education and Awareness Programs:
Develop and disseminate reproductive health education programs specifically designed for low-income communities, using accessible channels and taking into account language and cultural barriers.
– Strengthening Community Prenatal Care Services:
Establish and promote prenatal care clinics and services within low-income communities, making care more geographically and financially accessible.
By addressing the roots of socioeconomic inequalities and implementing targeted strategies to reduce barriers to accessing prenatal care, significant progress toward health equality for all can be made. women, regardless of their economic situation.
V. Lack of Diversified Representation:
The lack of diverse representation among healthcare professionals is an issue that has profound impacts on the quality of prenatal care and the overall experience of patients, particularly those from racial, ethnic, or cultural minorities. This situation can lead to a feeling of isolation, distrust, or even misunderstanding, which can in turn reduce the effectiveness of prenatal care. Addressing this question requires a thorough exploration of causes, effects, and potential solutions.
1. Causes of Lack of Diversity:
– Educational and Economic Barriers:
Barriers to entry into health professions for minorities often include educational and economic barriers, such as the high cost of medical school and limited access to quality training programs.
– Systemic Discrimination:
Bias and systemic discrimination within educational and professional institutions can deter or prevent minority individuals from accessing healthcare careers.
– Lack of Models:
The absence of healthcare professionals from diverse backgrounds in leadership and teaching roles may discourage minority youth from aspiring to these careers.
2. Effects on Prenatal Care:
– Communication and Understanding:Lack of diversity can lead to gaps in communication and understanding between healthcare professionals and minority patients, potentially due to cultural and linguistic differences that are not fully understood or respected.
– Distrust of the Health System:
Patients may feel distrust in a healthcare system that does not appear to recognize or value their cultural or ethnic identity, which may dissuade them from seeking regular prenatal care or following medical recommendations.
– Poorer Quality Care:
Lack of diversity can unconsciously influence the quality of care offered, leading to inadequate diagnoses, less effective treatments, and a poorer patient experience.
3. Strategies to Promote Diversity:
– Scholarship and Grant Programs:
Establish targeted scholarship and grant programs to support minority students in healthcare fields to reduce economic barriers to education.
– Training and Awareness:
Provide continuing education to healthcare professionals on cultural diversity, sensitivity, and cultural competence to improve communication and interaction with patients of diverse backgrounds.
– Targeted Recruitment:
Encourage the active recruitment of minority healthcare professionals, with an emphasis on creating a work inclusive environment and representative of the population served.
– Mentoring and Networking:
Develop mentoring programs and professional networks for minority healthcare students and professionals to provide support, guidance, and career opportunities.
– Research and Policy:
Encourage research into the effects of health professional diversity on health outcomes and use this data to inform policies aimed at improving representation in the medical field.
By increasing diversity among healthcare professionals, it is possible to create a more welcoming, inclusive, and effective prenatal care environment that respects and values all pregnant women, thereby improving health outcomes for mothers and their children.
VI. Culturally Sensitive Practices:
Adopting culturally sensitive practices in prenatal care is essential to providing adequate and respectful support to all pregnant women, regardless of their cultural or ethnic background. This approach recognizes that cultural beliefs, practices, and values significantly influence attitudes and behaviors related to pregnancy, childbirth, and postnatal care. By integrating cultural competence into prenatal care, providers can improve the quality of care, build patient confidence, and promote better health outcomes.
1. Importance of Culturally Sensitive Practices:
Culturally sensitive practices recognize the uniqueness of each patient and the impact of her culture on her experience of pregnancy. This approach allows healthcare providers to:
– Establish Better Communication:
Understanding cultural and linguistic nuances promotes more effective communication, reducing misunderstandings and increasing the clarity of information shared.
– Strengthen Confidence:
When patients feel their cultural beliefs and practices are recognized and respected, they are more likely to trust their healthcare providers and feel comfortable sharing crucial information about their health.
– Improve Adherence to Care:
Taking cultural beliefs into account in planning and implementing care can improve patients’ adherence to medical recommendations because they feel supported and respected.
– Promote Positive Pregnancy Experiences:
By recognizing the importance of cultural rituals and beliefs, healthcare providers can help create more positive and personalized pregnancy and birth experiences.
2. Strategies for Implementing Culturally Sensitive Practices:
– Cultural Competence Training:
Continuing education of health care providers in cultural competence is crucial to developing a deep understanding of diverse cultures and learning to provide respectful and appropriate care.
– Collaboration with Cultural Intermediaries:
The engagement of cultural intermediaries or mediators, who can serve as a bridge between healthcare providers and patients, to facilitate better understanding and communication.
– Personalization of Treatments:
Adapt care plans to accommodate specific cultural needs and preferences, including consideration of traditional remedies, birthing practices, and postnatal rituals.
– Creation of Inclusive Care Environments:
Arrange care spaces to be welcoming and reflect a variety of cultures, and ensure that educational materials are available in multiple languages and are culturally relevant.
– Community Engagement:
Collaborate with local communities to understand their specific prenatal care needs and to develop prenatal care programs that meet those needs.
– Continuous Evaluation and Adaptation:
Regularly evaluate the effectiveness of culturally sensitive practices and be prepared to adapt and evolve based on patient feedback and changes in the cultural composition of the population served.
By adopting culturally sensitive practices, healthcare providers can not only improve the quality and effectiveness of prenatal care but also promote health equity and help reduce disparities in maternal and infant health outcomes.
VII. Community Support and Support Networks:
Community support and support networks are fundamental to improving access and quality of prenatal care, particularly for minority pregnant women. These networks not only offer practical help and essential information but also play a vital role in providing emotional and psychological support to mothers-to-be. Actively engaging communities and strengthening support systems can transform the prenatal experience into a time of well-being and positivity.
1. Importance of Community Support:
– Reduction of Insulation:
Pregnancy can sometimes be an isolating experience, especially for women facing language, cultural or socio-economic barriers. Community support networks provide a space where they can share their experiences and feel understood and supported.
– Access to Information:
These networks provide crucial access to relevant and reliable information about pregnancy, childbirth, and postnatal care, often in formats and languages tailored to the specific needs of different communities.
– Encouragement of Healthy Practices:
Through education and shared experiences, support networks can promote beneficial health and wellness practices, increasing the chances of positive outcomes for mother and child.
– Emotional and Psychological Support:
The importance of emotional and psychological well-being during pregnancy cannot be underestimated. Support networks provide a safe space to express worries, fears, and joys, helping to reduce stress and anxiety.
2. Strategies for Strengthening Support Networks:
– Local Support Groups:
Creating and promoting local support groups where pregnant women can meet, share experiences, and receive advice provides a strong foundation for community support. These groups can be organized by health professionals, community associations, or even community members themselves.
– Peer Support Programs:
Peer coaching programs, where pregnant women or new mothers are matched with experienced mentors, can offer personalized support and encourage engagement with prenatal and postnatal care.
– Community Initiatives:
Initiatives that engage the entire community, including partners, families, and broader social networks, can help create a supportive environment that values and prioritizes prenatal health.
– Intersectoral collaborations:
Partnerships between healthcare providers, nonprofit organizations, educational institutions, and community leaders can strengthen the resources and support initiatives available to pregnant women.
– Use of Digital Technologies:
Online platforms and mobile apps can extend the reach of support networks, offering forums, advice, and educational resources accessible from the comfort of home.
– Community Awareness and Education:
Awareness campaigns that emphasize the importance of prenatal care and community support can help create a culture of well-being and mutual assistance.
Developing and strengthening community support networks is essential to ensure that all pregnant women, especially those from minorities, have access to quality prenatal care and receive the emotional and psychological support they need. By investing in these support systems, communities can improve health outcomes for mothers and their babies and build strong foundations for future generations.
VIII. The Psychological Impact of Racism on Pregnant Women:
The psychological impact of racism on pregnant women is a topic of critical importance, requiring special attention to fully understand the profound ramifications of this issue. Pregnant women, already facing the challenges inherent in pregnancy, may be subject to an additional level of stress when exposed to racism and discrimination. This stress is not only detrimental to their mental and emotional well-being, but it can also have significant consequences on their physical health and that of their unborn child.
1. Psychological effects of racism:
Racism and discrimination can cause a variety of emotional reactions in pregnant women, such as anxiety, depression, and feelings of isolation. These negative emotions can contribute to a state of chronic stress, known for its negative impact on health. Chronic stress triggers the release of stress hormones, such as cortisol, which can affect fetal development and increase the risk of complications during pregnancy.
2. Consequences on prenatal health:
Racism-related stress can lead to several prenatal health complications. For example, constant exposure to stress increases a mother’s risk of high blood pressure, known as preeclampsia, a condition that can be life-threatening for both mother and baby. Additionally, stress can lead to premature births and low birth weight, putting these babies in a vulnerable position early in life.
3. Long-term impacts:
The effects of racism and stress on pregnant women and their children are not limited to the prenatal period. Children born to mothers who experienced significant stress during pregnancy may be more likely to experience health and developmental problems throughout their lives. This includes emotional, behavioral, and learning disabilities, highlighting the critical importance of supporting pregnant women and combating racism in all its forms.
4. Support Strategies:
To mitigate these impacts, it is essential to provide adequate support to pregnant women facing racism. This may include professional psychological support, the creation of community support networks, and initiatives to raise awareness and combat systemic racism. Health professionals must be trained to recognize and address the effects of racism on prenatal health, ensuring an inclusive and supportive care environment for all women.
Understanding the psychological impact of racism on pregnant women is crucial for the development of effective support and prevention strategies. By addressing the root causes of racism and providing targeted support to pregnant women, it is possible to reduce the burden of stress and improve health outcomes for mothers and their children. The fight against racism in the context of prenatal health is not only a matter of social justice but also a necessity for the well-being and health of future generations.
IX. Public Health Policies:
Public health policies play a crucial role in determining the quality and accessibility of health care for the general population. However, to be truly effective and fair, these policies must be designed to take into account the varied and often specific needs of different groups within a population, particularly minority communities. Failure to integrate these considerations can lead to inadequate implementation of essential health programs, such as antenatal care, that do not adequately meet the needs of these communities.
1. The importance of inclusive policy design:
Inclusive public health policy begins with a thorough assessment of the unique health needs of all communities, with particular emphasis on those that are historically marginalized or underrepresented. This involves not only recognizing the cultural, linguistic, and economic barriers that may prevent access to care but also understanding the social determinants of health that disproportionately influence these communities.
2. Challenges specific to prenatal care:
When looking at prenatal care programs through the lens of inclusiveness, several challenges emerge, including:
– Geographic and financial accessibility:
Clinics and hospitals providing quality prenatal care are not always accessible to members of minority communities, particularly those living in rural or disadvantaged areas. Additionally, the costs associated with this care can be prohibitive for many families.
– Cultural and linguistic sensitivity:
Prenatal care materials and services are not always available in the culturally appropriate language or format, which may discourage members of minority communities from seeking or using these services.
-Lack of representation:
There is often a lack of minority healthcare professionals on prenatal care teams, which can lead to a lack of understanding of the specific needs and concerns of patients from these communities.
3. Towards an inclusive policy design:
To overcome these obstacles, it is essential to adopt a holistic and inclusive approach to the design of public health policies. This may include:
– Community engagement:
Directly involve minority communities in the health policy planning and implementation process to ensure their voices and needs are considered.
– Training in cultural sensitivity:
Ensure healthcare professionals receive adequate training to understand and respect the diverse cultures and perspectives of all patients.
– Adaptation of services:
Provide prenatal care programs that are flexible and tailored to meet the cultural, linguistic, and economic needs of different communities.
– Increase in representation:
Encourage and support more minority healthcare professionals to enter the medical field and actively participate in the provision of care.
Ultimately, for public health policies to truly benefit all segments of the population, they must be designed with an awareness and appreciation of the diversities that characterize our societies. This requires an ongoing commitment to listening, learning, and adapting to the changing needs of all communities, ensuring no one is left behind in the quest for better health and well-being.
XX. Strategies to Combat Systemic Racism in Prenatal Health Care:
To effectively address systemic racism in prenatal health care, a comprehensive and inclusive strategy is needed. This strategy should not only address disparities in access to care but also institutional and interpersonal biases that affect the quality of care provided to minority pregnant women. Here is an in-depth exploration of the different components of this strategy:
1. Universal Insurance Coverage:
The first step toward equity in prenatal care is ensuring that all women, regardless of socioeconomic or ethnic status, have access to comprehensive health insurance. This involves implementing public policies that provide affordable and accessible health insurance coverage, explicitly including prenatal care. This coverage should also facilitate access to specialized care when necessary.
2. Diversification of Health Care Providers:
Recruiting and training healthcare professionals from diverse cultural and ethnic backgrounds can help reduce linguistic and cultural barriers to accessing care. This allows patients to feel more understood and respected, which can improve the quality of patient-practitioner interaction and, therefore, the quality of care received. Scholarship and mentoring programs for minority students in medical and allied health fields can support this diversification.
3. Anti-Bias Training:
Establishing mandatory training programs for all healthcare professionals on unconscious bias and stereotyping can play a crucial role in combating systemic racism. These trainings should aim to raise awareness about the impacts of racial bias on patient health and provide tools to practice patient-centered care that is respectful of all cultures and identities.
4. Psychosocial Support:
Providing psychosocial support to pregnant women, especially those experiencing discrimination or racism-related stress is vital. This could include counseling services, access to support groups, and peer mentoring programs. These services can help alleviate the negative impact of stress on the health of the mother and baby.
5. Supportive Communities:
Encouraging the creation of supportive communities, both online and in person, can provide pregnant women with a safe space to share their experiences, get advice, and feel less isolated. These communities can be particularly valuable to minority women, who may feel marginalized in more traditional healthcare spaces.
6. Research and Tracking:
Ultimately, it is crucial to support research focused on understanding racial disparities in prenatal care and the effectiveness of interventions intended to reduce them. Monitoring progress using accurate health indicators and publishing regular reports can help evaluate the effectiveness of strategies put in place and adjust policies and practices accordingly.
In short, combatting systemic racism in prenatal health care requires long-term commitment and collaboration from all stakeholders in the health care system, including governments, health care institutions, health professionals, and the communities themselves.
Conclusion :
Confronting systemic racism in prenatal health care is more than a moral imperative; it is a vital necessity for building an equitable society where every pregnant woman, regardless of race or ethnicity, has the right and opportunity to access quality care. The strategies presented in this article, ranging from improving access to care to diversifying health providers to education and community support, are crucial steps toward deconstructing systemic barriers.
It is essential that decision-makers, health professionals, and society as a whole, resolutely commit to the fight against systemic racism, by adopting inclusive public health policies and supporting culturally sensitive care practices. This fight requires a shared commitment to recognize, challenge, and eliminate the biases and inequities that infect our health systems. By asking ourselves what actions everyone can take to contribute to this vital effort, we can begin to envision a future where access to prenatal care is truly equitable.
What concrete steps can communities or institutions implement to address systemic racism in prenatal health care?
