The Unfortunate March to Wokeness by March of Dimes

Continuing education modules in medicine may, at times, reveal the ideological goals of the organization hosting them. The March of Dimes (MoD), a nonprofit originally founded to combat polio, and now ostensibly devoted to maternal and infant health, is no exception.

In its course titled “Awareness to Action: Dismantling Bias in Maternal and Infant Healthcare®,” MoD finds a way to include as much wokeness as it possibly can. From the beginning, one of its four goals is to “Explain how structural racism has played a key role in shaping care settings within the U.S. and contributes to implicit biases in patient/provider encounters.”

This trope is all too familiar at this point, but deserves pointing out again: simply saying “structural racism” over and over does not make it real, even though the curriculum writers claim it is. 

Do they make any attempt to prove this assertion?

Within the context of “structural racism,” several slides are shared by MoD focusing on the disparity between black and white maternal mortality, yet their own graphs do not offer the full context, and they do not back up the implied connection between disparities and “structural racism.” 

As Do No Harm reported three years ago, a data set of 800 people out of over 3.5 million births is too small to draw society-wide conclusions, especially when the CDC data and research demonstrates that many of these deaths were not as preventable as is often claimed.

To be clear, even a single death of a pregnant woman is one too many. But the overwhelming majority of women survive motherhood, and highlighting the extremely rare instances of maternal death does not, in itself, indicate an inherent problem with the way society functions.

In other words, simply showing a disparity between racial groups does not prove claims of “structural racism,” especially when such analyses fail to account for medical co-morbidities and other contributing factors in maternal mortality. For example, Do No Harm reported on a detailed study by the CDC showing that 42% of deaths related to pregnancy were not preventable, having to do with conditions such as cardiovascular disease and pulmonary embolism. Other contributing factors, such as hypertension and kidney disease, are often genetic.

These facts are conveniently left out of the presentation shared by MoD.

The course continues with a distinction between equality and equity, stating:

Equality

Treating everyone the same, no matter where they’re starting from or whether outcomes remain unequal. Equality has to do with giving everyone the exact same resources.

Equity

Equity involves distributing resources based on the needs of the recipients.

To that end, MoD pushes learners to “establish a culture of equity” as another one of its educational objectives. This drive for equity – instead of equality – rests on the unproven premise that there is continuing “structural racism” throughout healthcare.  And, consequently some people must be treated more favorably than others based on their identity. 

Another word for this is discrimination.

Offering terms like equality and equity in this way, and defining them as they do, demonstrates a desire to turn medical professionals into social justice warriors rather than improve their skills as healthcare providers. 

Moving on to a section titled “Implication of Bias,” we are told:

Bias can influence behaviors and actions that are discriminatory. When these behaviors and actions are consistently repeated without being interrupted, it can lead to inequitable practices on a systemic and structural level. As you continue with this learning activity, you will learn more about the impact of structural racism in care settings and research.

Structural racism is a key driver of unequal outcomes for people of color in the United States. It has resulted in political and economic setbacks especially among Indigenous and Black populations. It also contributes to health disparities among these groups.

First, it does not follow that ‘structural racism’ is the chief cause of racial disparities because of the false claim that healthcare professionals have unconscious biases that ‘can’ influence their behaviors. But more importantly, the notion that implicit bias predicts real-world behaviors, much less health outcomes, is simply false and has been repeatedly debunked.

In popular terminology, this is called a bait-and-switch. We are told that bias can influence behaviors and actions, but then again assured that “structural racism” is foundational to the way healthcare operates.

Structural racism is the historical, cultural, social, psychological, and legal system of racial bias across society and institutions that disadvantage certain racial groups.

The claim that “structural racism” drives maternal mortality disparities is bold and far-reaching, yet the mechanism behind it is never clearly explained or supported by evidence.

To bolster this, we are given examples of Dr. James Marion Sims operating on women of color (in the mid-1800s, which MoD conveniently leaves out) and Puerto Rican women taking part in high-dose hormonal contraceptives studies (more than half a century ago), as if these stories prove their point. 

How might isolated historical references demonstrate “structural racism”? While we certainly want to appreciate past events for what they are – acknowledging wrongdoings while simultaneously also understanding them in historical context – citing a 19th-century surgeon  and unethical studies from the 1950s is hardly sufficient evidence to label the modern healthcare system as fundamentally racist. To state that their evidence is cherry-picked would be too kind.

From here, the class moves further towards promoting political activism. Section titles such as “Race Forward: Framework for advancing racial equity in the federal government” point directly toward a goal that goes well beyond the scope of maternal care by, once again, attempting to turn medical professionals into social justice warriors. 

If the goal were truly scientific education, then MoD’s class would provide evidence-based information, not ideological rhetoric that shifts focus from patient care to political advocacy.

For those truly focused on improving maternal care a “framework for advancing racial equity in the federal government” is simply unnecessary – unless the goal is to prioritize ideology over the actions that can be taken to mitigate medical co-morbidities and improve access to care.

Yet, this focus on advocacy shouldn’t come as a surprise. Throughout the course MoD can’t even use the term “mothers.” Instead, it opts for phrases like “birthing people” or “people with uteruses,” demonstrating far more concern for being woke than maternal health. 

It’s disheartening to witness a once-respected organization like the March of Dimes shift so drastically toward political advocacy. Sadly, this course – led by so-called professionals in maternal and infant health – offers little more than an attempt at ideological indoctrination. Instead of providing clear, evidence-based medical guidance to support mothers as they bring new life into the world, it delivers confusing, politically charged messaging that undermines its stated purpose.