Birth equity is a transformative movement in public health and maternal-infant care that shifts the focus from treating medical conditions to addressing the social and structural conditions determining a person’s health before, during, and after pregnancy. Achieving birth equity ensures that every person has the fair opportunity to experience an optimal birth and a healthy start to life. This goal is driven by persistent differences in health outcomes across various populations, making it a central issue of social justice and public health policy.
Defining Birth Equity Versus Equality
Birth equity is defined as the assurance of the conditions necessary for optimal births for all people, requiring a sustained effort to address racial and social inequalities. This differs from “birth equality,” which means giving every birthing person the exact same resources and care. Equality assumes everyone starts at the same place and needs the same support, a premise that ignores systemic disadvantage.
Equity recognizes that historical and current injustices have created different starting points, necessitating tailored support to achieve the same positive outcome. For maternal health, this means actively providing resources, such as doula support or guaranteed housing, to those whose environments have historically put them at a disadvantage. This distinction guides the movement toward changing systems rather than just treating symptoms.
Understanding Current Disparities in Maternal Health Outcomes
The urgent need for birth equity is demonstrated by quantifiable differences in maternal and infant health outcomes across racial and ethnic lines. These disparities are stark in maternal mortality rates: Black women face a rate of 50.3 deaths per 100,000 live births, more than three times higher than the rate for White women (14.5 per 100,000). This gap persists regardless of a mother’s socioeconomic status or educational attainment.
Severe maternal morbidity (SMM)—life-threatening complications during or after childbirth—is also disproportionately high for minority groups. Black, Hispanic, and American Indian/Alaska Native women experience SMM at rates up to 2.1 times higher than White women. Infant outcomes reflect this pattern, with Black infants having the highest preterm birth rate at 14.7%, nearly double the rate seen in Asian/Pacific Islander infants (9.3%) and substantially higher than the rate for White infants (9.5%). Furthermore, the infant mortality rate for the non-Hispanic Black population (10.8 per 1,000 live births) remains significantly higher compared to the non-Hispanic White population (4.6).
Root Causes of Systemic Inequity
The disparities in birth outcomes are rooted in pervasive systemic and structural factors. Structural racism, operating through institutional policies and practices, is a primary driver. Historical practices like redlining and residential segregation have created racially and economically isolated neighborhoods with chronic underinvestment, leading to unequal access to quality jobs, safe housing, and healthcare facilities.
This structural disadvantage is compounded by implicit bias within healthcare settings. Unconscious attitudes held by medical providers can lead to differential treatment, such as dismissing the pain or symptoms reported by Black birthing people, resulting in delayed diagnosis or inappropriate management. The cumulative stress from navigating these unjust systems is known as “weathering,” which causes accelerated biological aging and increased susceptibility to complications like pre-term birth.
A lack of culturally congruent care further exacerbates these problems. For birthing people who do not speak English or who come from marginalized cultural backgrounds, a lack of translators, culturally-aware staff, and respectful communication creates significant barriers to accessing and understanding their care. When patients feel disrespected or unheard, they are less likely to fully engage with the healthcare system, leading to poorer continuity of care and adverse outcomes.
Frameworks for Achieving Equity
Moving toward birth equity requires deliberate, multi-level systemic change. One approach involves promoting and reimbursing community-led care models, such as doula programs. Access to doula support, which provides continuous emotional, physical, and informational assistance, is associated with a reduction in adverse outcomes, including lower preterm birth rates for Black and Hispanic participants. States are increasingly covering these non-medical services through Medicaid to expand access.
Another systemic shift involves implementing mandatory anti-bias training for all perinatal providers, such as California’s Dignity in Pregnancy and Childbirth Act. This training helps providers recognize and mitigate unconscious biases and address the impact of historical oppression on patient care. A related element is the push for greater data transparency by standardizing the collection of self-identified demographic data (including race, ethnicity, and language) to accurately track disparities in care quality and outcomes.
Addressing Social Determinants of Health
Achieving true equity demands addressing the social determinants of health, which contribute to up to 80% of health outcomes. Policy changes focus on resource redistribution and strengthening social supports. Examples include extending Medicaid coverage for mothers for a full year postpartum and integrating screenings and referrals for housing instability, food insecurity, and transportation access into perinatal care. These broad, cross-sector efforts aim to dismantle the root causes of inequity and build a system where optimal birth conditions are a reality for everyone.