The World Health Organization designated 2020 as “The Year of the Nurse and the Midwife”. Despite the current state of the world suffering through a pandemic, the significance of this distinction for two of the oldest professions as foundational pillars for healthcare is that it raises awareness of the important contributions of nursing and midwifery.
In the US, we quickly recognized that we were unprepared and ill-equipped to handle a pandemic. As thousands perished, including many in the healthcare workforce, nurses and midwives selflessly risked their lives on the frontlines—a true testament to their dedication to service.
However, heightened awareness of our broken healthcare system has been underscored by racial inequities. In the midst of a viral pandemic, the world witnessed another public demonstration of the effects of a second pandemic. Multiple murders of innocent Black unarmed citizens at the hands of law enforcement provided a devastating reminder of the silenced pandemic of systemic racism that has plagued the US since its inception.
Health inequities in the US
The data are undeniable. Individuals who identify as Black, indigenous, and people of color are more likely to become infected and perish due to coronavirus disease 2019 (COVID-19) than White people.1 Black women in the US are three to four times more likely to die from pregnancy complications than White women regardless of education, insurance, or socioeconomic status.2-4 The death rate among Black males is significantly higher than their White counterparts.5,6 Systemic racism has been postulated as the root cause of the results we are witnessing today.
History of midwifery
The recent media trend to highlight racial and ethnic inequities in healthcare confirms what many nurses and midwives have known for a long time. For centuries, midwives have been frontline workers within their communities. Midwifery in the US was born from the free labor of enslaved Black and indigenous midwives who provided safe, effective, and unbiased care incorporating rituals and healing techniques passed down through generations. Misapprehension and awe of the strength and perseverance of these communities led to the banning and outlawing of traditional midwifery in the early 20th century. Many Black and indigenous midwives were killed and/or imprisoned while communities were stripped of their healers.
As midwifery made a resurgence through the work of prominent, colonized White European midwives under the guise of nursing, the history of Black and indigenous midwifery was erased. Recently, the true history of midwifery in America is being retold, incorporating the enormous contributions of Black, indigenous, and immigrant midwives who were previously silenced. October 4 to 10, 2020, is National Midwifery Week, created by the American College of Nurse-Midwives to celebrate and recognize midwives and midwife-led care annually.
Some medical organizations have begun to acknowledge the abhorrent practices of racism by past figureheads, such as Dr. J. Marion Sims who used enslaved Black women to practice his gynecologic surgical techniques without the use of anesthesia.7 Nursing and midwifery can be exemplars for truth and reconciliation; both professions are well poised to lead the charge in creating actionable steps to address many healthcare issues. In fact, numerous members in our ranks have been and continue to be underrecognized change agents from the bedside to the boardroom.
While COVID-19 may have interrupted our plans for social gatherings and celebration during the Year of the Nurse and the Midwife, it has provided the unique opportunity to slow down, reflect on the past, acknowledge the present, and develop plans to change the future. Let us all hope that any changes put into action are for the better health of our nation and the world.
2. Centers for Disease Control and Prevention (CDC). Pregnancy-related deaths. 2019. www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm
3. Kalata M, Kalata K, Yen H, Khorshid A, Davis T, Meredith J. Community perspectives on the racial disparity in perinatal outcomes [published online ahead of print, 2020 Jul 13]. J Matern Fetal Neonatal Med
4. Howell EA. Reducing disparities in severe maternal morbidity and mortality. Clin Obstet Gynecol
5. Arias E. United States life tables, 2017. Natl Vital Stat Rep
6. Age-specific mortality among Blacks or African Americans - United States, 1999–2015 [published correction appears in MMWR Morb Mortal Wkly Rep. 2017 May 12;66(18):490]. MMWR Morb Mortal Wkly Rep
7. Wailoo K. Historical aspects of race and medicine: the case of J. Marion Sims. JAMA