Efforts to achieve health equity goals in the United States require the recruitment, retention, and graduation of an increasingly diverse student body of aspiring health professionals. Improving access to health care providers who are culturally congruent with the populations served is a related ethical priority that has the potential to improve the health inequities faced by communities of color and others in the United States. Midwifery education program administrators and faculty have responded to this need by acknowledging that creation of a more representative midwifery workforce starts with midwifery education. The Equity Agenda Guideline, related conceptual model, and website resources were developed for the purpose of supporting health professions educators and institutions who recognize a need for change and are seeking answers about how to train and graduate more health care providers from communities that are currently underrepresented. Using a systems approach to outline the transformative multilevel changes required, these resources offer a roadmap for how to address the underlying problems of racism and other differentisms that have limited the growth and diversification of the health and helping professions. This article addresses how health education programs interested in making an impact on this complex and persistent problem can adopt or adapt the Equity Agenda Guideline, originally developed for midwifery education programs in the United States.
Limited access to medications and devices relevant to the care of low‐risk childbearing families acts as a barrier to the successful integration of high‐quality midwifery care into health care systems. Families who live in clinically underserved areas, whether urban or rural, are particularly in need of perinatal professionals who can provide comprehensive care. This article reviews existing US laws that impact whether families who choose community‐based care with direct entry midwives have access, through their chosen provider, to the medications and devices relevant to their normal perinatal and postpartum care. Scope of practice and practice authority are considered as they relate to access to medications and devices primarily for certified professional midwives and state‐licensed midwives. These professionals are the primary health care providers offering community‐based care and birth at home and in freestanding birth centers. Washington state laws are compared and contrasted with laws from other states and jurisdictions, with the aim of identifying ways to improve service delivery for families who choose community‐based midwifery care. Recent and historical efforts to expand Washington state's midwifery drugs and devices formulary are described. This discussion outlines the Washington context for direct entry community midwifery practice, highlights relevant legal examples, and describes current and future efforts around quality improvement. Information from a midwifery clinic serving some of Washington's most vulnerable pregnant and postpartum families allows for an exploration of the role that access to essential medications and devices might play in supporting midwives to address health inequities. Ideal statutory and regulatory language, lessons learned from an analysis of Washington's experience, and strategies to overcome barriers are described to aid and inspire midwifery advocates in other jurisdictions who want to increase access and enhance their ability to offer current evidence‐based care. Policy makers can improve health, health equity, consumer choice, and access to evidence‐based care by using ideal legal language for midwifery practice authority.
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