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Excerpted From: Gabrielle Ploplis, Systematic Racism, Abortion and Bias in Medicine: All Threads Woven in the Cloth of Racial Disparity for Mothers and Infants, 35 Journal of Law and Health 370 (May 30, 2022) (259 Footnotes) (Full Document)


GabriellePloplisIn 1978, the United States District Court for the District of Delaware reached a decision in a case that may have had far wider implications than were likely anticipated. In NAACP v. Wilmington Medical Center, Inc. the court considered whether the relocation of most care components of Wilmington Medical Center from the inner-city hospital system to an outlying suburb was discriminatory as it related to health care available to underserved minorities. The center planned to close two divisions completely and significantly reduce another division to eliminate maternal and infant care services (among many other types of services) at that location, and provide them solely at the new suburban division. In this case, the plaintiffs argued that relocating hospital services to the suburban location would cause disparities in the availability of quality medical care for the poor, the elderly, ethnic and racial minorities, and the handicapped. At that time, 72% of the county's black residents lived in the City of Wilmington where the care facilities were located. However, the District Court rejected this argument stating that the plaintiffs could not make a prima facie case that the relocation violated Title VI of the Civil Rights Act of 1964.

This case and others like it across the country highlight one of the most influential factors of disparities in health outcomes for racial minorities: the lack of quality care available. What these cases and courts may not have considered when reaching their decisions was how the lack of quality care has contributed to the alarming rate of infant and maternal mortality among black and indigenous women.

Although there is a deep-rooted and national issue of discrimination in many aspects of medical care, this article will address the disparities in black and indigenous infant and maternal mortality compared to that of white infants and mothers. This issue will be addressed on the national scale as well as the state level. Both state and federal law have contributed to the racialdisparities in health outcomes for mothers and infants.

This note will argue that decisions like that of Wilmington Medical Center, Inc. have been one of many contributing factors in the disparity in mortality rates of both black and AmericanIndian/Alaska Native newborns in comparison to white newborns across the country. Part II will examine the current state of the law regarding issues of discrimination, accessibility of health care, and relocation and closure of medical centers that has disproportionately affect minorities in the U.S. Part III will discuss the statistics of white, black, and AmericanIndian/Alaska Native newborn and maternal mortality rates in the United States. Part IV will address the potential causes of this disparity, which include inadequate access to quality medical care for racial minorities, implicit racial bias, a demand for more minority doctors, and strict abortion restrictions. Part V will propose that a reduction in the racialdisparities in mortality rates for black and indigenous mothers and infants can be achieved by implementing comprehensive state-level “public-private” collaborations, and increasing availability and coverage of more birthing resources like midwives. Lastly, Part VI will conclude that current condition of federal and state legislation has not eliminated the racialdisparities in maternal and infant mortality rates, and further measures must be taken to achieve this goal.

[. . .]

Black and indigenous women and infants continue to experience disadvantage in quality and access of medical care. As a result, they experience much higher mortality rates than that of white women and infants. The law as it stands today is unequipped to address the racialdisparities in maternal and infant mortality rates. Therefore, legislative change and program development, such as reducing restrictions for midwives, is required to address this issue and reduce the racialdisparities in health outcomes for women and infants in the United States.

J.D. May 2022, Cleveland-Marshall College of Law.

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