PPN 301 Class 1: Promoting the Health of Childbearing Individuals and Populations

What are the current global trends and statistics related to maternal, infant, and child mortality?

• Maternal–child health is a global marker of societal health; inequities persist and require justice-oriented health promotion across pregnancy, birth, and postpartum.

• Maternal: High rates of maternal deaths occur in low and lower-middle-income countries. Young adolescents (ages 10-14) face a higher risk of complications and death as a result of pregnancy than other women.

• Infants: Preterm birth complications are the leading cause of death among children under 5 years of age.

Question: What are the maternal and infant mortality rates in Canada, and how do these differ for Indigenous populations?

• Access and outcomes vary by geography and social conditions; Indigenous communities face compromised access due to a lack of culturally safe care and the effects of colonialism/racism. 

• Infant mortality rates are twice as high for each Indigenous group, compared with the non-Indigenous population.

• The risk of preterm birth is 8.9% higher compared to their White counterparts

Why are Black women in the U.S. more likely to die from pregnancy and childbirth-related complications compared to White women?

• Inequities in perinatal outcomes reflect structural factors.

• Black women/ African American are 3-4 times more likely dies from Pregnancy and Childbirth related complication.

What are health inequities, and how do they arise according to the WHO?

• Definition: Health inequities are differences in health status or distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age.

• WHO: They arise from the social conditions in which people are born, grow, live, work, and age. These inequities are unfair but can be reduced with the right mix of government policies.

• Social location (e.g., race, class, Indigenous status) shapes access to resources and care, producing unequal perinatal outcomes—an equity issue, not just individual choice.

What does social justice focus on in relation to maternal, infant, and child health inequities?

• Social justice focuses on the advantage that some groups or individuals have relative to others; the need to understand root causes of inequities; and the need to take responsible action to eliminate inequities.

• For community health nurses, this means advocating for policies, programs, and culturally safe supports that reduce barriers and promote equity in perinatal care

Which UN Sustainable Development Goals (UN SDGs) focus on maternal, infant, and child health promotion?

Goal 3: Good health and well-being; ensuring healthy lives and promoting well-being for all ages is essential to sustainable development. Target 3.1: Reduce maternal mortality. Target 3.2: End all preventable death under 5 years of age. Target 3.7: Universal access to sexual and reproductive care, family planning and education.

How are reproductive rights defined according to the International Conference on Population and Development (ICPD)?

Reproductive Rights: “a) basic rights of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, b) the right to attain the highest standard of sexual and reproductive health. c) It also includes the right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents”

How is reproductive justice defined, and how does it expand on the idea?

• Definition: the complete physical, mental, spiritual, political, economic, and social well-being of women and girls.

• Will be achieved when women and girls have the economic, social and political power and resources to make healthy decisions about our bodies, sexuality and reproduction for ourselves, our families and our communities in all areas of our lives. (Asian Communities of Reproductive Justice)

• The textbook (chapter 16) notes that Indigenous and low-income women face barriers like colonialism, racism, and poverty that limit their reproductive freedom.

 How does critical social theory explain maternal and child health inequities?

• Critical social theory explains maternal and child health inequities as being historical and socio-politically situated, shaped by relationships of power and underlying social structures.

• It emphasizes asking “why” at the micro, meso, and macro levels to understand root causes, and challenges social inequities and injustices that impact population health.

• This perspective seeks transformation through work with individuals, families, and multisector collaboration to influence policy and address structural determinants of health, with an explicit commitment to social justice.

•  Perinatal inequities are historically and socio-politically situated; CHNs should address structural determinants and collaborate across sectors to change conditions.

How does critical race theory help explain racial disparities in health outcomes?

• Social Determinants of Health: income, employment and working conditions, housing, education, food security, social inclusion and the environment.

• Rooted in the understanding that race is a social construct, and that racism is a central feature of society embedded within systems and institutions.

• Challenges race as a biological construct in the understanding of health disparities. c) Analyzes the historical and sociopolitical structures contributing to differential health outcomes between races and for certain groups.

• Reframe health disparities away from pathologizing marginalized communities.

• Colonialism and racism shape access and outcomes; improving Indigenous perinatal health requires Indigenous participation in health program governance and policy.

What examples demonstrate the MCN (Maternal Child Nursing) understanding of critical social theory and reproductive rights?

• Critical social theory includes recognizing that maternal and child health disparities are shaped by social conditions, not just individual lifestyles or efforts.

• Reproductive rights include: 1. Working with women to advocate for safe abortion services. 2. Attending training programs on promoting reproductive rights. 3. Working with a school principal to provide young girls with contraceptives. 4. Creating supportive environments to support trans couples

•  Justice-aligned practice includes ensuring access to reproductive health services/education and advocating policies that reduce structural barriers to care.

How does intersectionality explain the overlapping effects of racism, classism, sexism, and other forms of discrimination in perinatal health?

• Intersectionality considers how systems such as racism, classism, sexism, homophobia and other forms of discrimination overlap and interact with one another to advantage some and disadvantage others at an individual and social-structural level.

• Perinatal risks increase where poverty, immigration stress, or isolation intersect with gender and race—e.g., higher postpartum depression among asylum seekers with precarious status and low support.

What are systems under forms of discrimination and oppression? As well as forms of social systems and structures? And what impacts social status and identity?

• Discrimination and oppression: a) colonisation. b) homophobia. c) ageism. d) racism. e) ableism. f) religion discrimination. g) classism. h) sexism.

• Social systems and structures: a) social assistance. b) economics. c) education. d) labour. e) legal. f) health.

• Social status and identity: a) indigeneity. b) ethnicity. c) parent/care status. d) sexuality. e) gender identity. f) [Dis]ability. g) religion. h) age. i) race. j) cultural background. k) migration & refugee status. l) socio-economic status. j) sex.

What policies and practices have harmed Indigenous birthing experiences in Canada (obstetric racism)?

• Indigenous birthing experiences in Canada have been harmed by the colonization and dominance of the biomedical model, which has limited culturally appropriate perinatal care.

• Harmful policies and practices include:

  • Forced evacuation: Pregnant people from isolated communities were required to travel to deliver their babies, often far from home and communities, stripping them of cultural practices and family support.

  • Lack of support: Before 2017, Indigenous women were forced to deliver alone without family or community support, since escorts were not considered medically necessary.

  • Loss of cultural practices: Traditional ceremonies and practices around birth and newborn care were excluded.

  • Feelings of loneliness and isolation: Being separated from communities and families during childbirth led to emotional harm.

• Biomedical dominance removed births from communities; many Indigenous women travel alone to urban centres for delivery, disrupting cultural practices and support.

What adverse perinatal outcomes are more common among Black women in Canada?

• Differences in perinatal outcomes shows Black women had higher rates of: a) Stillbirths. b) Preterm births. c) Caesarean sections.

• Higher risk of: a) gestational diabetes. b) preeclampsia. c) placental abruption. d) low birth weight. e) small for gestational age.

How does the weathering hypothesis explain the impact of chronic stress and racism on Black maternal health?

• The weathering hypothesis explains that:

  • repeated exposure to socioeconomic adversity, political marginalization, racism, and ongoing discrimination creates chronic stress that harms health.

  • This leads to an increased allostatic load—the physiological toll of constant stress—

  • which raises levels of cortisol, norepinephrine, and epinephrine.

  • Over time, this results in higher blood pressure, cholesterol, HbA1c, and waist-to-hip ratios, causing accelerated biological aging and poorer maternal health outcomes for Black women.

•  Repeated adversity (poverty, racism, isolation) harms perinatal mental health—immigrant/refugee women show higher postpartum depression linked to insecurity and lack of support.

What is obstetric racism, and how does it affect Black women in medical institutions?

• Obstetric racism highlights the forms of violence and abuse that medical personnel - and potentially any personnel within medical institutions—routinely perpetrate against Black women.” (Scott & Davis, 2021,p. 682) There is a high maternal mortality rate in Black women: stillbirths, preterm birth, and cesarean sections.

•  Systemic structures and medicalization have marginalized traditional midwifery and cultural practices, contributing to inequitable experiences and outcomes.

What unique considerations do lesbian, gay, and transgender clients face in pregnancy and perinatal care?

• Many lesbian, gay, and transgender couples become parents but face stigma and discrimination.

• Intersecting barriers (race + sexual identity) such as: identities of sexual orientation, gender identity, and race intensify health inequities.

• They deserve respectful care during the childbearing experience as well as during health screening and wellness care.

• Have the same range of reproductive rights and interests as cis people, and many are at childbearing age at the time of transition; emphasizing that reproductive justice demands freedom from discrimination and coercion, ensuring inclusive access to reproductive services.

• Masculinizing and feminizing hormone therapy can have temporary and long-term impacts on fertility.

• HCPs need to discuss both birth control and fertility preservation prior to the initiation of hormone therapy (affects fertility).