The importance of cultural competency in our care

On September 1, 2017, superstar tennis athlete Serena Williams gave birth to her daughter Alexis Olympia Ohanian Jr. According to a 2018 Vogue interview detailing her journey to motherhood, Williams had a relatively easy pregnancy. However, Olympia was born by emergency C-section due to her heart rate dropping to a dangerously low level during contractions. The C-section went smoothly. 

The day after delivery, mom Serena began feeling short of breath. Williams—who as a top-performing athlete is quite in tune with her body and health—has a history of blood clots. Because she was off her daily anticoagulant due to the recent surgery, she immediately knew that something wasn’t right. She left her hospital room and told the nurse that she needed a “CT scan with contrast and IV heparin (a blood thinner)” right away.

The nurse assumed that her pain medication was making her confused. It turned out that, indeed, several small blot clots had settled in her lungs. 

Williams faced several other challenges before she was well enough to head home to be with her newborn daughter, but she recovered and is the happy and healthy mother that we see in the media today. 

While it was lucky that Williams was in tune enough with her body to recognize what was going on, unfortunately, many mothers, specifically Black mothers, aren’t so lucky. Williams’s story is just one example of why cultural competency is critical in the care of Black mothers. 

What’s Happening? 

Maternal health is a measure of a country’s overall health and wellbeing. Yet, the United States has the highest maternal mortality rate of all developed countries and Black women in particular experience disproportionately high rates of maternal mortality in this country. According to Monica R. McLemore and Valentina D’Efilippo’s 2019 article on Black maternal health in the Scientific American, “Black women are three to four times more likely to die from pregnancy-related conditions such as cardiac issues and hemorrhage … and bear the brunt of serious complications as well. That risk is equally shared by all black women regardless of income, education or geographical location.”

But why? 

Many factors contribute to this problem. In a recent Journal of Women’s Health article, authors Crear-Perry and colleagues believe it starts with “governance, policy, cultural and societal norms, and values that shape who has access to health-promoting resources and opportunities, and who doesn’t.” 

The article also shares how recent efforts to identify root causes of inequality in care typically focus on individual factors —clinical, behavioral, and even social conditions—versus the historical, systemic, structural, and political forces that created them.

What is Culturally Competent Care

First, it’s essential that we—doctors, media, and the public—stop blaming Black women. It’s become far too common to push high maternal mortality rates off on surface-level issues like “unhealthy behaviors.” 

Instead, McLemore and D’Efilippo believe that we should focus on better understanding the underlying contributing factors. These include; a lack of data; not educating patients about signs and symptoms; not believing Black women when they speak up; errors made by health care providers; and poor communication among different health care teams.

Cultural competency in Black women’s care is an opportunity to move the needle on Black maternal health. While expanded access to healthcare is critical, it’s also important to offer and deliver high-quality maternity care that “acknowledges and respects the cultural experiences and contexts in which women live,” suggests Crear-Perry and colleagues.  

It’s called centering at the margins. 

Centering at the margins is an approach to patient-centered care that focuses on how our healthcare providers are trained. It requires that providers learn about the experiences of different groups of people, and challenges providers to acknowledge the role that society and history have played in influencing both their understanding of their patients and their patient’s understanding of them. 

Scholars believe that by focusing on the structural roots of health inequities in medical education, a path to cross-cultural understanding could become more clear. It’s important for the care and safety of Black women that healthcare providers are able to identify the social and economic forces that contribute to health outcomes.

Finally, we all must continue to support organizations—such as the Black Mamas Matter Alliance, for example—committed to and doing the hard work of fighting for Black women and, more specifically, Black maternal health.

Feel Empowered 

In Williams’ case, her nurse didn’t trust her instincts. Unfortunately, this is a story that we hear far too often. As an expecting mother, it’s essential to trust your instincts even if your care staff isn’t on the same page. Feel empowered to speak up if you don’t understand something or if your body is telling you something that could be critical to your health. 

Remember that the birthing journey can be unpredictable. To find out more about how care advocates like doulas can support you in your journey, visit us at

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