Based on the data presented above, it is clear that much still needs to be done to eliminate maternal health disparities in Massachusetts. However, a few individuals and initiatives have been instrumental in beginning to address health disparities in the state.

The Traditional Childbearing group, Inc., founded by Shafia Monroe in the 1980s, provided women from the African American communities in Boston with midwifery services. The members were “community midwives” who visited women in their homes to deliver prenatal care, providing more comprehensive care than a clinic could, and making care more accessible and affordable for women living in poverty and without insurance. Without the service of these midwives, these women would have been left without prenatal care and without the support they needed to have happy and healthy pregnancies and labors. Shafia and her team also educated the community and health professionals about the value of midwifery and provided classes to the community on topics such as breastfeeding and parenting, improving the health of young children. Monroe has since moved to Oregon and founded the International Center for Traditional Childbearing, where she continues serving women of color. According to the ICTC website, the mission of the organization is the following:

The ICTC mission is to increase the number of midwives, doulas and healers of color, to empower families, in order to reduce maternal and infant mortality. ICTC outreaches, recruits and trains women, men, and young girls in traditional and contemporary birth practices as a strategy for improving birth outcomes, increasing breastfeeding rates, and capacity building.  ICTC provides four training programs to meet its mission.

The Traditional Childbearing Group, Inc., while no longer operating in Massachusetts, was vital to the communities it served in Boston, and has left a gap waiting to be filled by others who want to improve health outcomes for minority women. For more information on the amazing work that Shafia is doing now in Oregon, visit: http://ictcmidwives.org/

The need for measures to eliminate health disparities in Massachusetts is clear and urgent. According to the National Conference of State Legislatures, these are a few pieces of legislation that are being considered in Massachusetts Congress, which would begin to address health disparities in the state.

• HB 1916 / SB 1022 Establishes a State Health Service Corps to provide comprehensive team-based health care at community health centers that bridges geographic, financial, cultural and language barriers for the medically underserved. Pending, Carryover.
• HB 1957 Requires the Department of Public Health implement a program for health literacy in healthcare facilities, pharmacies and health centers. Maintains that cultural competency enables organizations to work effectively in cross-cultural situations and developing and implementing a framework of cultural competence in health systems is an extended process that ultimately serves to reduce health disparities and improve access to high-quality health care. Pending, Carryover.
• HB 2071 / SB 985 Creates the office of health equity within the executive office of health and human services; provides the office will be served by a director who reports directly to the secretary of health and human services. Outlines duties, including coordinating commonwealth activities to eliminate racial and ethnic health and health care disparities, preparing an annual report card, reporting to the governor, legislature and health disparities council. Pending, Carryover.

None of these measures have been passed yet. If you are passionate about health disparities and believe that one or more of these bills could help eliminate them, contact your local representatives and encourage them to support the bill(s).

More information on these bills, and those in other states can be found at:
http://www.ncsl.org/research/health/2013-health-disparities-legislation.aspx

Midwifery and health disparities
Unfortunately, midwifery is not immune to the effects of institutionalized racism and structural violence. In fact, our community has been guilty of perpetuating racism, sexism, homophobia and other forms of discrimination. This in turn fuels the health disparities and hurt that are so harmful to ALL of us. Usually, discrimination and inequity is born of ignorance, a lack of awareness of both the problem and the tools for solving the problem. Many people in this country have not learned the skills one needs to recognize and address inequity, and so unknowing allow it to thrive. Because midwives serve everyone, everywhere, and because midwifery in this country grew out of a strong tradition of serving every woman, no matter what, we feel that developing the tools to recognize and address racism and other forms of discrimination is VITAL to midwifery education. We expect an active commitment to anti-racism from all our students in our Basic midwifery course and we provide support to our students in order to develop the skills to recognize and talk about discrimination, including racism, sexism, homophobia, and ableism, as well as systems of power and privilege. As professionals, we strive to foster equity in our line of work and promote public discussion about health disparities and how we can change our systems and behaviors to eliminate them.