Birthing Cultural Humility: A Transformation of Reproductive Justice in the Military Health System

Background: Rising disparities in maternal–child healthcare are linked explicitly to outcomes based on patients' cultural identities. Those who receive universally available health care in the military are not immune from these disparities. Practicing cultural humility has been proposed as a tool for advancing equity through improved understanding of cultural factors that may impact a patient's healthcare. How cultural humility impacts healthcare remains unexplored from the patient perspective. Methods: To examine the relationship between patient identity and experience within the Military Health System, from their own perspectives, we conducted 31 semi-structured interviews with birthing individuals who delivered a child utilizing military health insurance within the last 5 years. Participants were recruited through physical flyers and social media blasts, with additional purposive sampling. Data was coded, and repeating patterns of experience were identified and interrogated through thematic analysis. Results: Three predominant findings were identified via the interviews. First, participants with minoritized backgrounds described instances of racism, sexism, and homophobia attributed to a lack of cultural humility and ultimately to the delivery of oppressive medical care by providers. Second, this lack of cultural humility was described further through a lack of communication, feeling unheard or dismissed, and exposure to judgment and paternalism. Third, there were described instances of shared decision making as well as autonomy and respect that contributed to culturally humble care provided to a portion of participants, which positively impacted their care. Discussion: Experiences of birthing individuals in the Military Health System qualitatively support prior quantitative studies and offer insight into the lack of cultural humility underlying care provided over the last several years. Ultimately, providers should use this information as a framework for understanding the sources of cultural humility and how they address it in individual patient–provider interactions.