The COVID-19 pandemic has forced a closer look at the racial inequities in the health care system. The disproportionate maternal morbidity and mortality affecting Black and Native women has long been recognized, but despite efforts to close this gap, it continues. An article in The New York Times offering guidance to Black mothers on how to communicate with providers to acknowledge racism and the higher risk of death and poor outcomes focuses on this issue (Chidi & Cahill, 2020). It also provides direction to clinicians on how to respectfully care for their Black patients with an emphasis on how racism affects outcomes (Chidi & Cahill). The need for this type of article for Black women and their care providers highlights the known inequities in maternity care, but also may show a growing willingness to improve. A Joint Statement (2020) addressing racism was published in August 2020 and included the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, and other professional organizations with members who care for women. Actions to be taken to address and eliminate racism included collaboration, education, recognition, research, and a commitment to caring for patients and communities. A key aspect is providing equitable health care to all communities, which is not always the case in many parts of the United States. Of note, no nursing organizations were included in the joint statement, an unfortunate omission that may further widen gaps, as nurses provide the majority of direct patient care, and thus are critically important in antiracism work.

Many Black and Indigenous People of Color have a long-standing distrust of the health care system in part due to a history of research and experiments performed without their consent. One potential solution is through community-based health care that allows care teams from within a patient's home community to act as the health care provider or as support liaisons to provide reassurance, education, and trust in the care being given. Midwifery care, community birth settings, and support of a doula throughout pregnancy, childbirth and into postpartum can provide patient- and family-centered care and experiences, and can lead to improved birth outcomes (Sakala et al., 2020). A new hybrid model of care, "community-led and community-based perinatal health worker groups," which provide a range of services including evidence-based care models in one grouping to meet the needs of a community, especially communities of color is detailed by Sakala et al (2020). One significant barrier is lack of insurance coverage. Sakala et al. urge federal and state lawmakers to improve insurance coverage for these services, lift the barriers to birth centers and midwives to attain certifications and licensure, and to create equal pay for equal services, regardless of the licensed provider attending the birth. Widening the availability of certified midwives and licensed birth centers could potentially bring more competent health care workers into communities where this care is lacking.

Restricting the ability to attain a safe home birth with a certified midwife, limiting overall access to midwifery care, birth in licensed birth centers and trained doula care due to either licensing issues or lack of insurance payment, furthers inequity so that only those of a high enough socioeconomic status have the option of choosing to access and pay out-of-pocket for these services. Not allowing all options as a choice in pregnancy, birth, and postpartum care may further widen the outcome gap for many people and those at highest risk who could potentially benefit the most, but may not have the option. "Eliminating inequities in women's health care requires transformational change" and it is past due for this change to occur (Joint Statement, 2020). Nurses can partner with professional colleagues and women to make this a reality.

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