Ebonee Lennord knows Black patients are not getting equitable treatment during pregnancy and childbirth, and she’s doing her part to change that.
The McMaster medical student says she was inspired to research maternal and neonatal health disparities in Canada’s Black communities after seeing a presentation on the subject at a conference for aspiring physicians.
“I couldn’t help but tear up, thinking about my grandmother, my mom, and all of the Black women in my life who have been pregnant, and wondering what they’ve gone through,” says Lennord, who is working toward becoming an obstetrician and gynecologist.
Before she has the opportunity to address those disparities as a physician, she’s getting a big picture understanding of what Black communities experience, by looking at the data available on a national scale.
She led a scoping review of that data, published in the Canadian Journal of Public Health, that found there is a severe lack of information, with only six cohort studies that contained adequate race-based data for maternal and neonatal health outcomes.
Even with the limited data, the picture was clear: Black individuals were found to have higher rates of preeclampsia, gestational diabetes, and inadequate gestational weight gain.
Infants born to Black individuals had higher rates of spontaneous fetal loss, perinatal mortality, preterm birth, small for gestational age infants, low Apgar scores, congenital heart disease, and admission to the neonatal intensive care unit.
Gathering this evidence to better understand racial and ethnic disparities in maternal health care is part of the work involved in CanHEAL: The Canadian network for Health Equity using Advanced data Linkage, says senior author Giulia Muraca, an associate professor of obstetrics and gynecology at McMaster.
“When we look to the epidemiologic literature to support what we know about Black people’s reproductive and pregnancy experiences from qualitative studies, there are no national statistics we can cite because Canada historically doesn’t collect information on race,” says Muraca.
“This ‘colour-blind’ policy feeds into a cultural and political resistance that frames a focus on race as ‘un-Canadian.’ If we don’t collect information on the ways people are seen and treated in the world, we blind ourselves to the inequities that shape their health and lives.”
While the U.S. has plenty of documented evidence of Black women experiencing adverse pregnancy outcomes, Muraca says that evidence doesn’t enable Canadian stakeholders to advocate to governments in this country for change.
The review also notes that Canada’s unique history, politics, immigration patterns, and health-care delivery model prevent other countries’ evidence from being directly applicable.
Of the six studies examined through the review, one was national, another was based in Quebec, and the remaining four were all set in Ontario.
Muraca says the authors of these studies did the best they could with the limited data available, but says this review proves that better data collection is necessary.
“CanHEAL is a team of maternal and neonatal care providers, epidemiologists, people with lived experience, and community advocates, guided by ongoing engagement with the Black Reproductive Health Working Group. Our aim is to understand racial disparities in maternal and perinatal health in Canada and to investigate the causes of these disparities.” says Muraca.
“Reporting is only the first step. Our ultimate aim is to translate what we learn into interventions and tools that reduce, and eventually eliminate, these disparities.”
Emphasizing that evidence leads to concrete action, the review highlights that race-disaggregated data collected during the pandemic demonstrated higher rates of COVID-19 infection among racialized communities due to systemic inequalities in housing and employment, which guided policy adjustments like allocating vaccines to high-risk neighbourhoods.
Lennord says having more data can help guide larger-scale decision making in health care, but it can also inform how physicians interact with patients. She cited a qualitative study she read that wasn’t included in the review, which heard from two dozen Black women receiving obstetric care in Toronto.
“They said they felt dismissed and that they weren’t being heard, which says to me that we need to make changes within each patient interaction to ensure that everyone is treated equitably,” says Lennord.
“Different people might share the same diagnosis but how they experience that diagnosis might vary widely from person to person.”
The review also calls for the data to be collected in conjunction with community partners, ensuring marginalized voices can be involved in policy development and the responsible use of that data without making existing health inequities even worse.
Working to earn the trust of those who are being hurt most by these disparities is a crucial part of equitable health care says Lennord, noting that Black women were historically subjected to medical experimentation and that impact has not been forgotten.
“I think of how the field of obstetrics and gynecology was built on enslaved Black woman,” says Lennord.
“Even now, we haven’t truly acknowledged that or created space for the Black experience within health care, and I hope this research allows us to change that and elevate the voices of those who have been silenced for too long.”