M Health Fairview takes action to eliminate racial and ethnic bias in pregnancy and delivery care
In 2023, the maternal mortality rate in the United States was 18.6 deaths per 100,000 live births. For people who identify as Black, the mortality rate is even higher: 50.3 deaths per 100,000 live births, or more than double the national rate. And in Minnesota, Black mothers are more than twice as likely to experience pregnancy-related complications compared to their white counterparts, according to a 2019 study. This stark disparity in maternal health outcomes highlights a critical issue in healthcare that requires systemic change.
At M Health Fairview, we are committed to making pregnancy safe for everyone. In late 2023, the Center for Community Health Equity launched the Birth Justice Initiative in collaboration with local community advocates. The Birth Justice Initiative is a cross-functional group of employees representing health equity and maternal healthcare. The group is focused on eliminating racial bias in maternal healthcare and improving patient outcomes.
"The disparities in maternal health outcomes, particularly for those who are Black, Indigenous, and People of Color (BIPOC), highlight an urgent need for systemic change,” said Taj Mustapha, MD, an internist and pediatrician and the M Health Fairview chief equity strategy officer. “We are committed to eliminating barriers to equitable care and ensuring that every pregnant person receives the highest standard of support – from early prenatal visits to culturally responsive birthing environments.”
Addressing delayed prenatal care
The Birth Justice Initiative quickly found that people who identify as BIPOC tend to have their first prenatal checkup later than their white counterparts. On average, BIPOC individuals receive prenatal care at 12.6 weeks of pregnancy, which is considered late and increases the risk of complications. In comparison, white-identifying individuals are seen at 10.6 weeks on average. White-identifying people also average 11 prenatal visits while BIPOC people average 9.7 visits.
“We know that earlier prenatal care is critical for a healthy pregnancy,” said Melissa Hasler, CNM, director of nurse midwives at M Health Fairview. “Starting prenatal care earlier reduces risks for both the pregnant person and baby, and we are working to ensure that everyone has access to timely care.”
Race and ethnicity questions removed from screenings
The committee found that several commonly used maternal health screening tools include questions about race and ethnicity. These tools are built into the medical record systems used by many health systems across the nation. While some groups are at higher genetic risk for certain diseases, race and ethnicity questions can accidentally introduce bias into medical decision-making. To remove potential bias, M Health Fairview has updated our screening standards:
- Genetic screening
Genetic screening identifies risk for hereditary medical conditions, like cystic fibrosis or sickle cell disease, before birth. Previously, genetic carrier screenings were influenced by race and ethnicity. Now, race and ethnicity are no longer factors in determining what genetic tests are offered by M Health Fairview. “By removing race-based criteria from genetic screening, we are providing equitable access to testing for everybody, removing any opportunity for racism-based decision making early on,” Hasler said.
- Maternal serum screening
Maternal serum screening is a blood test that looks for risk of chromosomal and birth differences. Traditionally, the screening used race to adjust the probability of certain birth differences, like spina bifida and Down syndrome. This adjustment was found to be inaccurate. M Health Fairview has replaced the race and ethnicity-based formula with one that is universal and more accurate for all patients.
- Trial of labor after cesarean (TOLAC)
TOLAC is a planned or vaginal birth after a previous Cesarean section. Providers may use TOLAC calculations to predict a person’s chance of a successful vaginal birth after C-section. Historically, those calculations included racial factors that disproportionately flagged Black individuals as more likely to experience complications. M Health Fairview has adopted a non-race-based TOLAC tool developed by the Society of Maternal and Fetal Medicine, ensuring that decisions about vaginal delivery after a C-section are based on medical rather than racial factors.
“By removing race-based biases in medical screenings and advocating for inclusive policies, we are taking meaningful steps toward ensuring that every parent has a safe and empowering birthing experience," Mustapha said.
“This is a huge opportunity for us not to just make everything equal, but to actually create a system that gives equitable outcomes instead of equity within the process,” Hasler said.
Some providers have already implemented the changes, which will be rolled out universally across M Health Fairview in July 2025.
In addition to revising our screening protocols, the M Health Fairview Birth Justice Initiative is advocating for medical record companies to remove race and ethnicity-based questions from their systems to promote fairness in maternal care nationwide.
Screenings offered to everyone
M Health Fairview is introducing new screenings for social determinants of health and lead exposure for all pregnant people. Social determinants of health are factors of daily life that can have a larger effect on health than medical care alone. Our health system has resources available, including food support programs, for those in need.
Lead toxicity is another serious risk to pregnant individuals and can lead to complications and preterm birth. We are screening all pregnant people for lead exposure, which helps us act early to prevent these harmful effects.
Culturally congruent care
As part of the Birth Justice Initiative work, we also interviewed 649 people who gave birth in our health system and sought input from doulas – professionals who support birthing parents and are not employees of our health system. Based on their feedback, our staff rewrote policies to enhance culturally congruent care, which tailors healthcare to the specific cultural values of the patient.
For example, some cultures prefer a slower approach to using medication to induce labor compared to mainstream American practices. Building a more understanding and supportive hospital environment fosters more trust and collaboration between patients, their partners, and care providers.
“Having a supportive birthing environment isn’t just about improving patient outcomes; it’s about creating a space where birthing people and their families parents-to-be feel empowered, respected, and heard,” Hasler said.
A long-term commitment
The M Health Fairview Birth Justice Initiative is just one step in our ongoing commitment to health equity. We recognize that systemic barriers in healthcare won’t be dismantled overnight, but we are making tangible, data-driven changes to ensure that every patient receives the highest standard of care – free from bias and built on a foundation of respect, compassion, and cultural understanding.
As part of this effort, we will continue to collect feedback, review our policies, and collaborate with patients, community members, and healthcare providers to create a future where maternal health outcomes are equitable for all.
