1. Callister, Lynn Clark PhD, RN, FAAN

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In 2016, the Alliance for Innovation on Maternal Health launched their patient safety bundle on racial and ethnic disparities in maternity care. Work is underway, yet disparities continue to exist in the health of childbearing mothers and their babies that are of continuing and increasing concern. Population health is a concept related to the social determinants of health including human health, environmental resilience, and social and economic equity. Racism is a determinant of health. In the 2020 Institute for Nursing Leadership, the American Academy of Nursing (2020) focused on racism and health equity, concluding that "Nurses need to critically examine how they relate to the populations they serve" (p. 4).


The Reduction of Peripartum Racial/Ethnic Disparities Bundle focuses on the achievement of health equity (Howell et al., 2018). As part of a quality improvement project on care of childrearing women and their newborns at in-patient and at outpatient health care visits, clinicians completed a self-evaluation of ways their care either did or did not address health equity among diverse clientele. During the project, activities were provided to help improve the equity of care. There was a significant increase in the quality of care for racial and ethnically diverse women and their newborns (Arrington et al., 2021). It is essential that nurses move beyond words to action. This bundle facilitates health equity.


Somali women constitute the largest group from East Africa immigrating to the United States and may have experienced genital mutilation. There are differences in health care seeking behaviors among Somali refugee, immigrant childbearing women, and Caucasian women giving birth in Sweden (Wallmo et al., 2020). Somali women used less pain alleviation while giving birth and birth is seen as a women's issue only, with a preference for a female health care provider. Postpartum depression was not acknowledged among the Somali women. They reported that they felt discriminated against and ignored. It is essential that nurses and midwives understand and acknowledge cultural differences in order to provide culturally competent health care.


An exemplary program has been implemented among immigrant and refugee communities in Southeast Seattle, Washington. In collaboration with the Somali Health Board, the University of Washington developed the Mama Amaan (Safe Mother) Project: African Mother to Mother Antenatal Assistance Network (AMAAN). The initiative includes improvements in community health care and health education with the implementation of group prenatal care for Somali women provided by local doulas. These providers assist those who are underserved and reproductively vulnerable to promote healthy peripartum outcomes.


The initiative is conducted in collaboration with Parent Trust for Washington Children and Somali midwives, doulas, and nurses on the research team to improve the quality of the Great Start Professional Community Childbirth Educators Workshop. Childbearing and childrearing Somali women come together monthly in five different locations for lessons on physical, mental, and emotional components of the childbearing year. There is a spirit of community as the women gather. Activities include the administration of a maternal depression screening tool to facilitate mental health care referral, and postpartum doula home visits that are culturally congruent. Dads as Doula (DaD) workshops are also held for partners of pregnant women who are participating in the initiative to enrich family perspective of the birthing experience. There is much perinatal nurses can do to promote health equity and respectful maternity care. Get involved to make a difference.




Alliance for Innovation on Maternal Health. (2016). Reduction of peripartum racial/ethnic disparities (Patient Safety Bundle). Washington, DC: American College of Obstetricians and Gynecologists.


American Academy of Nursing. (2020). A critical conversation on health equity and racism summary report.[Context Link]


Arrington L. A., Edie A. H., Sewell C. A., Carter B. M. (2021). Launching the reduction of Peripartum Racial/Ethnic Disparities Bundle: A quality improvement project. Journal of Midwifery and Women's Health, online ahead of print April 29, 2021.[Context Link]


Howell E. A., Brown H., Brumley J., Bryant A. S., Caughey A. B., Cornell A. M., Grant J. H., Gregory K. D., Gullo S. M., Kozhimannil K. B., Mhyre J. M., Toledo P., D'Oria R., Ngoh M., Grobman W. A. (2018). Reduction of peripartum racial and ethnic disparities: A conceptual framework and maternal safety consensus bundle. Obstetrics & Gynecology, 131(5), 770-782.[Context Link]


Wallmo S., Allgurin K., Bertero C. (2020). The lived experience among Somali women of giving birth in Sweden: An interpretive phenomenological study. BioMed Central Pregnancy and Childbirth, 20(1), 262.[Context Link]