It is well known that minority women and children experience disparities in labor and delivery methods, prenatal technology use, infant mortality rates, birth weights, prenatal care, education related to pregnancy, medications, and pediatric services. In my opinion, disparities may be perpetuated through nursing attitudes during maternal and child healthcare. Why does this happen? It occurs for multiple reasons: (1) Nurses are influenced by societal views, biases, and prejudices (whether conscious or unconscious), having a direct impact on the care they deliver during the perinatal period (van Ryn & Fu, 2003). (2) Nurses' behaviors can directly influence how patients utilize available services because negative clinical encounters can lead to lack of follow-up and less-than-optimal outcomes in pregnancy. (3) Minorities are underrepresented in nursing. (4) Nurses lack comprehensive cultural competence education.

Minorities have documented concerns in trusting healthcare providers because of previous historical events (such as slavery and the Tuskegee research). Nurse providers "are powerful gatekeepers and may influence health disparities via such mechanisms as differential access to treatments or services" (van Ryn & Fu, 2003, p. 249). Nurses play a critical role in creating equitable care for minority populations in maternal and child health, but to do so they must first work on eliminating their own biases, facing the stereotypes they (along with the rest of society) have internalized, and working on improving communication with patients from different ethnic/racial groups than their own, because language barriers create obstacles for effective treatment and access to healthcare. In my opinion, these steps would go a long way toward reducing disparities, especially in maternal and child health, when health promotion education is accessible on an ongoing basis through prenatal care visits.

Nursing behaviors can influence access to care issues because nurses are in a position to establish rapport with minority women who attend healthcare visits, either in the emergency department or in an office. When patients feel welcomed and not judged, they are more likely to continue with care. Nurses can also be vigilant about seeing that all women receive the same comprehensive care regardless of their ethnic, racial, or socioeconomic background. When nurses exhibit behaviors that insist on equal care for all women, they can help to ensure that disparities in care do not exist.

An additional area in which nursing perpetuates disparities is the lack of minority representation in the nursing profession. Only 12.2% of RNs are of minority backgrounds and are employed in hospital settings (Department of Health and Human Services, 2006). When so few professionals who manage the care of women and children share the ethnicity/race of their patients, this imbalance can complicate care provision, and disparities can increase due to lack of "race-and language-concordant healthcare visits" (Ho et al., 2008, p. 187). It is also possible that smaller numbers of minority nurses in clinics and maternal/child offices contribute to disparities because patients utilize services less when they cannot be understood.

Education about cultural competence is said to be included in schools of nursing, but in my experience, it is general cultural knowledge that is taught rather than a comprehensive approach to culture across the curriculum. Overviews about culture taught in school may even cultivate stereotypes, thus enhancing racial/ethnic disparities. Cultural competence would imply that each individual be approached as an individual and not as someone who represents the culture, but this approach is neither the norm nor how cultural competence seems to be practiced.

Nurses might be perpetuating disparities by their actions and education in maternal/child healthcare, and it is time that this be examined and changed.

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