By Dr. Christina Pardo, M.D., M.P.H.
We know that in New York City, Black and brown communities suffer disproportionately from everything, particularly from financial distress and unequal access to education.
In the health sector, Black women have been subjected to decades of abuse and neglect that have led to unacceptable disparities in health outcomes, including more pregnancy-related deaths. These disparities, backed by data, are now accepted as the result of racism at the individual and systemic levels.
In my experience as a Black woman, a Haitian-American, a physician and community leader, I have observed firsthand that the statistics only touch the surface of how racism and discrimination affect our community. It is painful to watch Black women suffer disproportionately from poor maternal health outcomes, with the ‘marginalized’ being both the most at risk and yet the most neglected.
Our health by the numbers
In New York City, Black women are eight times more likely to have a pregnancy-related death compared to their white counterparts. Black women are also more likely to have a Severe Maternal Morbidity, which is considered a “near miss” before death.
Within this vulnerable group, women born in Haiti have the highest rate of Severe Maternal Morbidity, with a rate of 494.0 compared to 229.8 for U.S.-born women, according to the latest available data. East Flatbush, home to the city’s largest Haitian community, has the highest rate of Severe Maternal Morbidity in New York City.
While efforts to address maternal health disparities like Severe Maternal Morbidity have been justifiably focused on the Black community at large, disparities within Black subgroups like Haitians need to also be addressed. The need is all too evident in both the presence of and inattention to the health disparities impacting the Haitian community.
The contributors to these unacceptable disparities are not a result of biology, but of racism. But for us Haitians, we know very well that racism extends beyond race.
This is why I call on all Haitian-Americans to investigate, address and advocate on behalf of our community.
Why we need to stand up for our community
The Haitian community is the secondlargest Black foreign-born population in the United States, according to the 2010 U.S. census. It faces unique barriers due to its history, culture language. It has been the subject of unique stigma and discrimination, most notably for the unscientific categorization as one of the so-called ‘Four H’ of risk factors for AIDS. This stigma and discrimination continue, with even the President referring to Haiti as a “sh*thole” country.
In central Brooklyn, where I work, I have seen how stigma and discrimination affect Haitian immigrants. Unless they seek assistance from somebody of the same cultural background and language capability, they are less likely to receive equivalent or adequate support and assistance. I have also heard countless comments stigmatizing Haitian immigrants based on culture, perception and, frankly, the belief that Haitian immigrants are of a lower socioeconomic status.
While the institution of medicine and public health have increased focus on listening to black women, like the CDC’s Hear Her campaign, I have heard lth practitioners and nurses dismiss the expressed pain of Haitian women by stating, ‘Of course she is complaining, she is Haitian.’ How do the current campaigns address stigmatized groups within the Black community?
The role and impact of this implicit bias extend past race to include also socioeconomic status and ethnicity. And the perpetrators of these beliefs have not been restricted to any one race or ethnicity.
With the knowledge and awareness of these unique barriers, it came as no surprise to learn that in New York City, it is women born in Haiti who have the highest rate of Severe Maternal Morbidity. As stated, maternal health disparities are a result of barriers to care, the social determinants of health within communities and racism.
While this trifecta is more pronounced for Haitian women, even more appalling is the lack of focused and intentional study and intervention. Despite numerous, important initiatives made available by the city and state, officials and providers fail to recognize that the Black community is not monolithic. However, it is necessary to have an understanding of the unique barriers and to implement targeted interventions.
In this regard, we have failed the women who suffer the most from severe maternal morbidity. Just as representation matters in addressing black-white health disparities, representation matters in addressing specific communities.
Further, it is my belief that disparities affecting the Haitian community extend beyond SMM. Evidence of which is absent secondary to the lack of intentional study of the health status of the Haitian population. Haitians are most often grouped demographically as Black or African-American for research purposes. Although historically there have been evaluations of health among the Haitian population in New York City, there are relatively few currently. Research in Haitian communities of Florida and Boston revealed Haitian health disparities exist even within racial health disparities.
As I write this, we are more than eight months into a worldwide COVID-19 pandemic. The mandate is clear and urgent: we must improve the health care inequity that Black women face. It is no longer satisfactory to be “not racist”. Inaction on racist policies that have existed for decades because, in pretending that we are “color blind” and failing to act and address our health care disparities, have caused further harm to Black women.
It is also essential for us as a society to realize that racism does not end with race. Further, we must understand how ethnic and demographic groups, like the Haitian community, suffer disproportionately.
Introducing “Sante Fanm Se Lavi”
It is for these reasons, we at Life of Hope have started the initiative, ‘Sante Fanm Se Lavi’, a Creole phrase that means “Women’s Health is Life.” An understanding of the unique barriers is essential to addressing effectively the health and wellbeing of any marginalized, and so-called “hard-to-reach” community.
The voice, culture and needs of the community are required at the table to have meaningful impact. Further, those serving at the table need to have a stable, active and trusted presence in the community. This presence and trust have been maintained for over 10 years by co-founders Porez and Father Juan Luxama.
Similar initiatives to address Haitian health disparities have been developed in Florida. As part of this effort, policymakers, donors, philanthropists foundations are needed to help actively engage and address our ‘marginalized’ communities.
Providing care with cultural humility
Part of Sante Fanm Se Lavi’s mission is to develop targeted interventions for immigrant communities, including recruiting healthcare personnel that can engage with the community and barriers to care and services. Another key component is to engage the local healthcare community to assist in developing cultural humility as it relates to the community we serve.
Further, cultural humility and awareness is needed among researchers and public health professionals so that they understand the importance that culture and ethnicity play in health engagement and outcomes. We must advocate for an inclusive workforce that appropriately represents the community that it serves, not just racially, but ethnically and linguistically. A workforce that is trained in cultural humility and who can be held accountable for providing our community with quality care that is equitable and unbiased.
It is within our power and to positively impact our community. We seek your partnership and support to reach our goal of reducing health disparities that affect our community. We have all the necessary pieces, and the time is now for a collective, renewed focus to address OUR community here in New York City.
Dr. Pardo is an obstetrician/gynecologist based in Brooklyn, New York, and Chair of Sante Se Lavi (Health is Life) for Life of Hope. In a follow-up installment, Dr. Pardo will provide more information on women’s health disparities and recommendations for Haitian women to maintain healthier lives.
Follow Dr. Pardo on Twitter @DoctorChrys for more about social justice, racial equity Haiti.