JMIR Publications

ABSTRACT

North America remains the rare region among high-income nations that continues to have devastating maternal health outcomes such as undetected preeclampsia and postpartum depression, for example, among Indigenous and Black populations in the United States. A cross-sectional study on data from 2018-2022 reported, for example, that American Indian and Alaska Native women had the highest age-standardized annual and aggregated rate (ASR) of pregnancy-related mortality at 106.3 deaths per 100,000 live births in the United States, surpassed those of Black women at 76.9. While factors, such as updated facilities and proficient healthcare provider practice can directly affect maternal health, these may appear as not ideal or not being fully translated into practice in these countries. Despite the advancement of maternal medicine, healthcare practices that do not consider a client as a collaborator in their care can become a part of the inequitable care that contributes to poor outcomes. This Viewpoint highlights the Indigenous origin and relevance of cultural safety, importance of establishing a trusting healthcare provider-client relationship, and sustaining a continuous journey of cultural competence with a cultural safety lens in the context of optimizing maternal healthcare for all. Existing evidence points toward efforts to initiate a trusting relationship and cultivate meaningful communication within the provision of care. An important part of that relationship can include amplifying the client’s role in their own care. But current provider-client relationships do not display widespread improvement in maternal health outcomes. This Viewpoint focuses on evidence-based examples and considerations in maternal healthcare practice. For Indigenous women in the United States, a relationship of trust can require cultural considerations as part of their care. However, there are American Indian and Alaska Native women who have admitted to expecting to experience cultural discrimination as part of the package when receiving care, and thus, hesitant to seek care. Healthcare providers may consider the client’s perspective of cultural safety and empower participation in the planning and implementation of their care. This can be done by incorporating intentional cultural practices in the care which can help women receiving care perceive it as safe care. We argue for high-quality continuity of care and a trusted healthcare-client relationship, prior to assessment and intervention development, that can be prioritized as a way to facilitate improved health outcomes. Although modern healthcare overtly states a priority of cultural competence as part of individualized client care, it is not reflected in maternal morbidity and mortality rates. This Viewpoint will highlight considerations of cultural awareness, knowledge, skill, encounter, and desire as necessities and how cultural safety can be a salient informer on establishing healthcare provider-client relationships of trust with meaningful communication which may better position providers regarding maternal outcomes.