Search Results (788)

The United States faces a worsening maternal mortality crisis that starkly contrasts with trends in other high-income nations. Maternal mortality rates (MMRs) have more than doubled over the past two decades, rising from 9.65 deaths per 100,000 live births in 1999–2002 to 23.6 in 2018–2021, with approximately 700 deaths annually. Black and American Indian/Alaska Native women experience maternal mortality rates two to three times higher than their White counterparts, reflecting persistent structural inequities rather than biological differences. This narrative review synthesizes current evidence on the underlying drivers of racial inequities in maternal mortality and evaluates evidence-based interventions and policy strategies to address these disparities. A comprehensive literature review between 2000 and 2025 was conducted using databases including PubMed, Scopus, Web of Science, and Google Scholar, focusing on studies examining clinical, social, and structural determinants of maternal health outcomes, as well as evidence-based interventions and maternal health policy. Targeted searches of policy reports and grey literature were also performed to identify relevant policy initiatives and system-level interventions. Key contributors to disparities include underlying health conditions, postpartum mental health inequities, provider shortages, and limited access to postpartum care, with pregnancy-associated breast cancer (PABC) representing a less common but clinically significant risk factor that warrants further investigation in the context of racial inequities. Structural racism and socioeconomic disparities further exacerbate inequities through differential access to care, treatment bias, and barriers to healthcare utilization. System-level challenges, including workforce shortages, maternity care deserts, and the absence of federally mandated paid maternity leave, disproportionately impact marginalized populations. Although policy initiatives such as Medicaid postpartum coverage extensions, the Maternal Health Momnibus Act, and Maternal Mortality Review Committees represent important progress, they remain insufficient without broader structural reform. Evidence-based interventions, including midwife- and doula-led care, community-based peer support, and culturally tailored mental health programs, demonstrate measurable improvements in maternal outcomes. Outcomes of this review highlight the need for a comprehensive, equity-centered approach to reducing maternal mortality disparities, emphasizing structural reform, expanded access to care, strengthened data systems, and community-driven solutions. Full article

Black children and youth in Canada often hold high educational aspirations; however, systemic biases, deficit-based perceptions, and structural barriers limit their opportunities. These challenges, linked to anti-Black racism, migration-related disruptions, and socioeconomic inequities, contribute to lower engagement, underrepresentation, and reduced access to equitable educational resources. This scoping review examines these intersecting factors to inform equity-focused policy and practice. Following the Arksey and O’Malley framework and reported according to PRISMA-ScR guidelines, this review analyzed 96 studies published from database inception to May 2024, including 55 qualitative, 37 quantitative, and 4 mixed-methods studies. Bibliometric analysis was used to summarize study characteristics, while a thematic synthesis guided by intersectionality identified patterns in barriers, experiences, and interventions. Findings indicate that Black children and youth face persistent barriers, including systemic racism, disproportionate disciplinary practices, and Eurocentric curricula, with inequities further shaped by intersections of race, immigration status, and socioeconomic position. At the same time, mentorship, sponsorship, and community networks support academic resilience. Reported interventions include anti-racism training for educators and school stakeholders, culturally responsive curricula, mentorship initiatives, mental health supports, and financial aid. Advancing equity for Black children and youth in Canada requires systemic reform, culturally responsive pedagogy, and intersectionality-informed policies. Future research should prioritize participatory and longitudinal designs to generate evidence on effective and scalable strategies that foster educational opportunity and well-being. Full article

The Australian University Departments of Rural Health (UDRHs) promote the health and wellbeing of people in rural and remote Australia through health education, research, and advocacy. This narrative review evaluated the extent to which Indigenous health intervention research conducted by UDRHs over a 12-year period (2010–2021) aligned with the Principles and Priorities of the National Aboriginal and Torres Strait Islander Health Plan 2021–2031. The purpose was to reflect on past UDRH research contributions to identify existing strengths and areas for improvement in line with current policy. Thirty-three relevant UDRH publications were identified from a broader database of UDRH research outputs. Each paper was independently coded by at least two authors as demonstrating “yes”, “partial”, or “not evident” alignment with the twelve priorities of the Health Plan. UDRH intervention research demonstrated strengths in genuine shared decision making and partnerships with Indigenous communities, workforce development, health promotion, and identifying and addressing racism. However, gaps were evident in research addressing social and emotional wellbeing, mental health and suicide prevention, promotion of healthy environments, sustainability and preparedness, and transparency regarding shared access to data and information. UDRHs play a key role in building research capacity among staff and communities in rural settings and often maintain long-standing, respectful relationships with local Indigenous communities. While UDRH research aligns with many domains of the national Health Plan, future efforts should prioritise social and emotional wellbeing and mental health. Improved reporting of shared data access represents an immediate opportunity for enhancement. Full article

Black women in the United States experience inequities in perinatal and neonatal mortality, contributing to psychological stress during and after perinatal loss. This analysis drew on a subset of interviews from a larger qualitative dataset and explored the experiences of 22 Black women who experienced perinatal loss and were pregnant or had given birth after a loss, focusing on feeling unheard by healthcare providers. Semi-structured interviews were conducted, and data were analyzed using descriptive coding and inductive thematic analysis. Three themes emerged: unheard and dismissed concerns, biased and stratified care, and perinatal loss follow-up gaps driving self-advocacy. Women described how systemic racism intensified psychological distress, expressed as heightened anxiety and uncertainty in subsequent pregnancies after perinatal loss. Findings underscore the need for maternity settings to confront racial bias and strengthen cultural safety. Care environments that validate Black women’s concerns and act on them may help rebuild trust and improve maternal and newborn outcomes. The study calls for changes in maternity and mental healthcare aimed at addressing systemic racism and strengthening culturally responsive, equitable care. These findings have implications for perinatal public health practice and policy, including surveillance, prevention, and community-responsive approaches to maternity care during and after perinatal loss. Full article

This systematic review synthesises the qualitative literature on Māori leadership to examine how leadership is conceptualised, enacted, and constrained, and what this implies for Aotearoa New Zealand’s health system. Across included studies, Māori leadership is grounded in whakapapa-based legitimacy, tikanga and mātauranga Māori, and collective responsibility for relational, cultural, and intergenerational wellbeing; these foundations persist across “traditional” and “contemporary” settings, with differences reflecting institutional conditions rather than shifts in core values. Interpreting the literature through a Māori cultural lens, the review shows that leadership is often exercised within Crown-dominated organisations where Māori authority is not the default, requiring leaders to navigate multiple accountabilities to iwi and communities, organisational mandates, and statutory obligations. Hybridity emerges as a structurally produced feature of practice, integrating Māori relational ethics with bureaucratic, professional, and governance requirements and ongoing translation work to make Māori priorities legible within institutional systems. Health-sector evidence illustrates how commissioning, funding, and accountability arrangements can limit Māori decision-making, increase leadership burden, and constrain sustainability and leadership pipelines. The review concludes that strengthening Māori leadership in health requires organisational and system change—such as clearer Māori decision rights, resourced Māori-led priority setting, and accountability mechanisms that operationalise equity and anti-racism—alongside targeted research on governance, commissioning, and system design. Full article

Culturally unsafe mental health services contribute to persistent inequities for Aboriginal and Torres Strait Islander peoples, yet existing cultural safety frameworks lack clear, prioritised, community-endorsed implementation guidance. This study aimed to establish Aboriginal consensus on cultural safety principles, implementation priorities and practical actions for culturally safe mental health services. A three-round modified Delphi study was conducted with 37 Aboriginal participants from Western Australia with expertise in mental health, social and emotional wellbeing and lived experience. In Round 1, participants completed an online survey rating the importance of cultural safety principles and identifying those requiring urgent action. In Rounds 2 and 3, facilitated yarning sessions reviewed findings, refined principles, grouped them into implementation domains, and identified priority actions. Aboriginal Participatory Action Research ensured Aboriginal leadership and governance throughout. All principles achieved strong consensus for importance. The most urgent priorities were trustworthiness, Aboriginal governance, trauma-informed care, addressing racism and strengthening the Aboriginal workforce. Participants organised the refined principles into six implementation domains, with Leadership and Governance identified as foundational to reform. Trustworthiness was reframed as an aspirational outcome requiring structural change. This study provides a community-endorsed, prioritised framework for translating cultural safety principles into mental health service practice and policy. Full article

Perinatal mood disorders (PMDs) affect approximately 15% of birthing persons during the pregnancy or postpartum (up to one year after birth) time period. People who recently gave birth and are of diverse backgrounds and identities, especially those who are oppressed, are disproportionately affected by PMDs and may experience these conditions differently. One such group is low-income birthing persons living in urban areas. This article will summarize PMDs, including their prevalence rates and how they are disproportionately experienced among low-income birthing persons living in urban areas. The factors to be reviewed include racism, cultural stigma, community stressors, issues with access to services, lack of resources, socioeconomic concerns, and healthcare system problems. Additionally, how PMDs among low-income birthing persons living in urban areas can be prevented, identified, and treated will be discussed. Strategies include practicing cultural humility and promoting anti-oppressive practice, building positive relationships with birthing persons, utilizing formal and informal social supports, promoting community engagement, sharing resources and tangible supports, following universal screening recommendations, addressing barriers to care, and advocating for effective policies. Full article

With the recent ban on Diversity, Equity and Inclusion (DEI) efforts, this study seeks to address an under-researched area—the lived experience of workplace training participation (WTP)/non-participation of Black administrative employees at Canadian universities. While research in academia has focused on faculty and students, there is a lack of research on administrative employee participation within university settings in Canada. This gap is especially significant as this group composes a significant ratio of the entire workforce in Canadian universities. It is also important to understand the implications of WTP/non-participation for employees who identify as Black. This study used Stephen Billett’s conceptualization of affordance and access as a starting point to identify gaps in the workplace training (WT) literature, specifically as it pertains to Black employees. Data was collected from 26 Black administrative employees who discussed their lived experience with WTP in these settings. A qualitative approach from a phenomenological perspective was used to better understand the participants’ lived experiences with WTP. The results revealed a lack of transparency in the WT approval process, experiences of time pressure, managers’ discretion and racism as factors that influence WTP. Full article

In this article I interrogate how the film The Reluctant Fundamentalist aligns with as well as problematizes racial capitalism. The optic of racial capitalism enables me to trace the film’s articulation of race relations within the US and the power of white supremacy internationally, particularly as they manifest in the geopolitics of the US empire. The optic of racial capitalism foregrounds the inextricability of what Cedric Robinson termed racialism and the historical development of capitalism(s). The film demonstrates how racial capitalism is naturalized through the creation of aspirations for the symbolic markers of upward mobility and the acquisition of wealth, which is to say, cultural as much as financial capital. The film also illustrates that racial capitalism is a work in progress; it is neither singular nor homogeneous in its effect as it mutates across the world; it derives its power from the construction of racial infrastructures, political–economic institutions, states and, as I will argue in this essay, through regimes of racial affect. Full article

Background: Maternity care for vulnerable pregnant women presents a particular challenge within midwifery practice. In Germany, maternity services lack standardized frameworks to adequately address the specific needs of individuals who have experienced, among other factors, sexualized violence, poverty, female genital mutilation/cutting (FGM/C), or discrimination. Limited access to healthcare among these populations contributes to increased maternal and neonatal morbidity and mortality. Emerging evidence indicates that comprehensive medical and psychosocial support provided by midwives can substantially improve obstetric outcomes for marginalized pregnant women. Methods: An elective course, Antenatal Care for Vulnerable Women, was offered in the sixth semester of the Bachelor’s program in Midwifery Science at the University of Tübingen in 2025. The course provided insights into the psychosocial challenges faced by vulnerable pregnant women and prepared students for these specific aspects of midwifery practice. The curriculum incorporated foundational lectures and innovative teaching formats aimed at cultivating constructivist approaches to problem-solving. All sixth-semester midwifery students were asked to assess their knowledge and skills across five vulnerability categories: asylum-seeking, FGM/C, intimate partner violence, trauma, and racism. A pilot pre–posttest analysis using a 6-point Likert scale (1 = very good, 6 = poor) was conducted as hypothesis-generating and curriculum-guiding. The pretest included 38 respondents. The posttest included 11 respondents who attended the course. Results: Students who attended the course demonstrated observable gains in knowledge and skills across all categories, with the greatest improvements in asylum-seeking, median of 5 (IQR 4–5) vs. 2 (2–3); FGM/C, 5 (4–5) vs. 2 (2–3); and racism, 5 (3–5) vs. 2 (2–3). Conclusions: Innovative teaching methods may contribute to preparing midwifery students for targeted care of vulnerable pregnant women. Findings from the pre- and posttests provide preliminary insight into the potential value of experiential learning and may inform the further development of practice-oriented teaching methods. Full article

Mental health inequities affecting migrant populations stem from structural determinants that hierarchize access to resources, recognition, and social protection. Among these determinants, structural racism plays a central role in the experiences of racialised Brazilian immigrant women in Portugal, producing vulnerabilities at the intersection of race, gender, nationality, and migration status. Grounded in intersectional feminist and decolonial epistemology, this study analyses how structural racism operates as a health determinant through specific mechanisms traversing material conditions of life, distress trajectories, and experiences of psychological care, and it examines how these women navigate the limitations of mental health services, identifying conditions for a practice committed to racial equity. Fifteen semi-structured interviews were conducted with racialised Brazilian immigrant women and analyzed through Reflexive Thematic Analysis. The findings indicate that racism is manifested through professional devaluation, labour precarity, documentation instability, and linguistic racialisation, impacting access to rights and the production of psychological distress. Mental health inequities are not limited to barriers to access, as institutional and clinical dynamics tend to individualize distress and disregard its historical and social bases, operating as epistemic violence. The community-based strategies mobilized by participants challenge models centred on individual intervention. This study underscores the need for structurally competent approaches and for institutional reforms oriented toward equity and racial justice within mental health systems. Full article

While the association between food insecurity and adolescent obesity is well-established, the mechanisms through which these co-occurring public health crises are linked remain inadequately understood. Using the Social Ecological Model as a theoretical framework, this study examines how individual (physical activity), interpersonal (household food security), community (poverty level, residence), and societal (race/ethnicity) factors interact to influence adolescent weight outcomes. Cross-sectional data from 37,425 adolescents aged 12–17 years in the 2022–2023 National Survey of Children’s Health using weighted multinomial logistic regression with interaction terms were used. Adolescents experiencing nutrition insecurity (adequate quantity but poor-quality food) had 41% higher odds of obesity (adjusted odds ratio (aOR) = 1.41; 95% CI: 1.20–1.65), while those with food insecurity (insufficient quantity) had 48% higher odds (aOR = 1.48; 95% CI: 1.08–2.02) compared to food-secure peers. Significant effect modification emerged across ecological levels: poverty below the 200% federal poverty level (FPL) significantly amplified the food insecurity–obesity relationship (interaction p < 0.001), Hispanic and Black adolescents demonstrated 49% and 78% higher obesity odds, respectively, independent of household food and nutrition security status, and physical activity showed protective effects that varied by food security context (interaction p = 0.003). These findings underscore the necessity of multi-level interventions addressing structural inequities alongside individual behaviors to combat adolescent obesity in food-insecure populations effectively. Full article

Background: Black transgender women experience disproportionately high rates of violent victimization rooted in intersecting systems of oppression, including cisgenderism and anti-Black racism. Although victimization is linked to psychological distress, the mental health impacts of intersectional violence, which targets overlapping marginalized identities, remain understudied. Objectives: To examine the associations between anticipated and experienced intersectional victimization and psychological distress among Black transgender women. Methods: Online survey data from 151 Black transgender women (age ≥ 18) in the United States (US) between October 2021 and February 2024 were analyzed using t-tests and multivariate linear regressions. Results: In models controlling for age, employment, and US region, experienced sexual, physical, and threats of intersectional violence, as well as anticipated intersectional violence, were associated with increased post-traumatic stress disorder (PTSD) symptom severity, in separate models. Conversely, only experienced sexual intersectional violence and anticipated intersectional violence were associated with greater depressive symptom severity. When all violence variables were included simultaneously, experienced intersectional sexual violence and anticipated violence remained significantly associated with PTSD and depressive symptoms in separate models. Conclusions: Service providers who work with Black transgender women should routinely assess for anticipated and experienced intersectional victimization to guide person-centered interventions. Further research is needed to distinguish the effects of intersectional victimization from opportunistic victimization and to inform the adaptation of targeted mental health interventions. Full article

This article argues that racism did not originate with the modern invention of race but crystallized out of a much older imperial grammar that had already learned how to naturalize domination through embodied difference. Long before race emerged as a named category, ancient and medieval empires developed durable ways of converting historically produced hierarchies into features of nature, the cosmos, and divine order. Through a comparative genealogy spanning early Mesopotamian epic, Near Eastern imperial inscriptions, Egyptian visual regimes, Greek philosophy and historiography, biblical scripture, South Asian metaphysics, late antique encyclopedism, and medieval Marian devotion, the article shows how inequality was repeatedly anchored in the body, in genealogy, in geography, and in moral psychology. Across these traditions, political authority is consistently masculinized, while subordination is feminized, animalized, or rendered reproductively vulnerable. Patriarchy and racialization thus emerge as co-constitutive imperial technologies rather than as separate or sequential phenomena. Modern racism did not invent hierarchy; it rendered an ancient logic portable, inheritable, and globally scalable by fastening domination to visible human difference. By situating race within a longue durée history of empire and male domination, the article reframes contemporary debates on racism as questions of imperial continuity rather than modern deviation. Full article

A growing body of research characterizes contemporary global neoliberal hegemony through the lens of racial capitalism—a framework that traces the connections between colonial exploitation, slavery, and the foundations of economic growth, linking these histories to the expanding migrant precariat across Western societies today. Largely unexplored is how gender influences job conditions, alternatives, and forms of collective organization among migrant workers at the bottom strata of the labor market. Using the case of Spain, a country whose immigration history is closely linked to the expansion of precarious labor markets, we conducted our research in Barcelona, a hub in terms of migrant labor, collective agency and migrants’ rights struggles. We apply an intersectional lens to compare job conditions and collective action strategies of female and male migrant workers in two sectors: domestic and construction work, respectively. Both are strongly gendered, ethnically stratified, and highly informal. Many of the workers live in a daily reality marked by racism and exploitation, and we find that while there are important gender-related differences shaping the workers’ alternatives and forms of collective agency, their shared condition as racialized, poor migrants entails more commonalities than differences in terms of the role they fill in a late capitalist economy and the alternatives they have for change. Full article