A recent article by Kimberly Seals Allers discusses how COVID-19 safety restrictions related to giving birth and breastfeeding could potentially disproportionately harm black and Native American women.

Some hospitals are now classifying not only family members of laboring women but also doulas as “visitors,” banning them from entering hospitals or assisting with births.

On March 24th, the Mount Sinai and New York Presbyterian hospitals in NYC announced that no one could be in a hospital room with a laboring person– even spouses and partners. On March 27 the NY State Department of Health released information a health advisory stating that they considered one support person essential for a laboring person. However, this policy still only allows one additional person in the room, meaning a laboring person cannot have both a partner and a doula in the room. There are reports of infants being immediately separated from breastfeeding mothers without a medical reason. Additionally, it is unknown what restrictive policies hospitals will introduce as the pandemic spreads across the country.

While these restrictions can cause stress and harm for all laboring women, they risk disproportionately harming women in minority groups. According to The Giving Voice to Mothers study,

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Among mothers with low socioeconomic status, 18.7 per cent of white women reported mistreatment compared to 27.2 per cent of women of color. Indigenous women were the most likely to report experiencing at least one form of mistreatment by health-care providers during birth, followed by Black and Hispanic women.

And, as Allers points out, doulas have been proven to improve birth outcomes for black women, who are two to three times more likely to die from complications during or after childbirth. In New York City, the black maternal mortality rate is 12 times higher than that of white women.

Black breastfeeding rates are also threatened. Peer-based programs that have helped increase breastfeeding rates among black women—from WIC peer counselors to local breastfeeding “clubs” like those created by the Black Mothers Breastfeeding Association in Detroit—must be shut down due to necessary physical distancing. Birth and breastfeeding research illustrates that Black and Latina women do better with social support, including actively engaging male partners and extended family members, including grandparents. History tells us that when breastfeeding in the black community is disrupted systemically, there are lasting impacts.  

As policy makers and health care workers scramble to respond to this unprecedented pandemic, we must be cognizant of the increased risk for traumatic birth and how those risks may be disproportionately distributed amongst racial and ethnic groups, raising serious concerns for meeting the biomedical principle of justice. This pandemic will magnify existing inequalities and injustices in the US healthcare system, and the increased risk that women of color face during labor, delivery and breastfeeding could be further aggravated and cause additional harm.

A FINAL NOTE: Some hospitals that had instituted these restrictions have walked them back, allowing at least one visitor with a laboring woman, after criticisms of just this sort. These hospitals deserve praise for quick responsiveness, though IJFAB Blog editors do hope that other hospitals will take this issue into consideration during initial formulation of pandemic response protocols and clinical care guidelines.