Researchers found that, in fact, Apgar scores were able to predict whether preterm infants would die within 28 days of delivery.

Using data from the Swedish Medical Birth Register, researchers identified 113,300 preterm infants who had a gestational age of 22 weeks 0 days, to 36 weeks and 6 days. All were born from 1992 to 2016.

Researchers analyzed Apgar scores at 5 and 10 minutes, also monitoring the change in score between that timeframe.

For more information on this study and its findings, visit 

Articles

A new study in the New England Journal of Medicine investigated the joint effect of gestational age and Apgar scores on the risks of neonatal death. 

Apgar scores and gestational age as predictors for neonatal death 

In women with breast cancer, a history of taking menopausal hormone therapy (MHT) before diagnosis was associated with a 23% to 43% reduction in risk of all-cause mortality and mortality from breast cancer and cardiovascular disease (CVD), according to results from the Long Island Breast Cancer Study Project (LIBCSP).

 found a 17% risk reduction in the age-matched comparison group from the same source population: women without breast cancer but who also had a history of MHT use.

“MHT increases the risk of developing breast cancer through the mechanisms of promoting breast cell proliferation and division. 

These mechanisms are also believed to influence prognosis for breast cancer,” said first author Tengteng Wang, PhD, a research fellow in epidemiology at Harvard University and Brigham and Women’s Hospital in Boston. 

“However, most observational epidemiologic studies conducted among women with breast cancer have reported that prediagnosis MHT is associated with a reduced risk of mortality. Such conflicting results inspired me to further clarify the association between MHT and mortality outcomes, especially among breast cancer survivors.”

The investigators interviewed 1,508 women from LIBSCP who had been newly diagnosed with first primary breast cancer between 1996 and 1997, along with 1,556 age-matched women without breast cancer from LIBSCP. Both groups were asked about MHT usage.

The National Death Index (NDI) provided vital status after a median follow-up of 16 years, during which time there were 915 overall deaths in the two groups combined.

Women with breast cancer who had taken MHT prior to diagnosis were 23% less likely to die overall, 31% less likely to die from breast cancer specifically, and 43% less likely to die from CVD compared with MHT never users.

Differences in breast cancer-specific mortality according to hormone receptor (HR) status were also observed: 56% less risk for negative tumors and 4% less risk for positive tumors in ever vs. never users.

“I was surprised that except for breast cancer mortality, prediagnosis MHT was associated with a strong risk reduction of CVD-specific mortality, because previous studies that investigated the association between prediagnosis MHT and mortality among women with breast cancer did not report CVD mortality as a major outcome,” Dr. Wang told 

“I also found unexpected a more pronounced mortality reduction for breast cancer with hormone receptor-negative tumors than for positive tumors, because prior studies mostly report similar associations of MHT-breast cancer mortality by hormone receptor status.”

The study underscores that for patients with breast cancer who used MHT before diagnosis, MHT may be part of the cause of the breast cancer, but that these patients need not worry that such exposure history may increase their likelihood of dying from breast cancer. 

“This is an important message that directly helps clinicians in counseling women about MHT,” Dr. Wang said.

Although usage of MHT has declined dramatically in recent years, “most older American women currently diagnosed with breast cancer have used MHT at some point in their lifetime,” Dr. Wang said.

Besides women needing to understand the broad health risks and benefits of taking MHT, “the therapy should be given according to Food and Drug Administration (FDA) recommendations, which is at the lowest effective dose and for the shortest duration that is consistent with treatment goals and risks for individual,” Dr. Wang said.

To further clarify the effect of MHT on breast cancer mortality, Dr. Wang advocates future studies that examine the link between MHT and mortality by tumor molecular subtypes, as well as other tumor characteristics of aggressiveness.

Dr. Wang reports no relevant financial disclosures.

Wang T, Bradshaw PT, Moorman PG, et al. Menopausal hormone therapy use and long-term all-cause and cause-specific mortality in the Long Island Breast Cancer Study Project. 

. Published online June 25, 2020. doi:10.1002/ijc.33174

A study from the Long Island Breast Cancer Study Project (LIBCSP) investigated the association between menopausal hormone therapy (MHT) and mortality outcomes among breast cancer survivors.

Menopausal hormone therapy and mortality in breast cancer survivors

Cancer-related fatigue (CF) can significantly impact breast cancer survivors and limit their ability to return to a normal life. Although research proves that physical activity and psychosocial interventions are successful in alleviating CF, many breast cancer survivors struggle to adhere to them.

A new study from the European Society for Medical Oncology (ESMO) analyzed the real-world uptake of physical activity and supportive care recommendations among early breast cancer survivors. 

The findings, presented at the ESMO Breast Cancer Virtual Meeting, highlighted a need for more personalized recommendations tailored to unique needs of the patient. They also found that the use of supportive care seemed to be overshadowed by an emphasis on physical activity as the primary recommendation.

Using data from a CANTO study that analyzed long-term toxicities in early breast cancer patients from 26 French cancer centers for at least 5 years from the time of diagnosis, researchers investigated data from more than 7,000 patients, all of whom had completed primary treatment and were free of disease.

Patients reported the use of the recommended fatigue treatment strategies—physical activity and supportive care—once at baseline and 12 months thereafter. While 64% of patients compied with physical activity recommendations during that year, 36% reported severe fatigue at 3 to 6 months after treatment.

Patients who reported severe levels of fatigue immediately after completing treatment were less likely than those with non-severe symptoms to adhere to physical activity recommendations (59% versus 67%) in the year after treatment.

According to researchers, only one out of 10 women consulted a psychologist; one out of 12 saw an acupuncturist; and one of 14 sought treatment from a homeopath.1 Researchers note that cost may have had an impact, but it requires further research.

“The fact that the strategies patients adopt to manage side-effects are strongly correlated to the type of fatigue they are suffering from is particularly interesting,” Prof. Gabriella Pravettoni, Director of the Psycho-Oncology Division at the Eurpean Institute of Oncology (IEO) said in a recent press release. “Patients experiencing significant physical fatigue, for example, may actually benefit substantially from seeing a psychologist.”

Patients with severe physical fatigue, according to the study, were less likely to adhere to physical activity recommendations, at 59% compared to 67% of those with non-severe physical fatigue. The study also found that women with severe overall fatigue were only 1.3 times more likely to seek help from a psychologist than patients with non-severe fatigue.

This study highlights the need for more emphasis on supportive care to improve patients’ motivation and resilience, and that CF relief recommendations should be personalized.

Abstract 183O ‘Use of physical activity (PA) and supportive care (SC) among patients (pts) with early breast cancer (BC) reporting cancer-related fatigue (CRF)‘ will be presented by Antonio Di Meglio during the Proffered Paper session 1 on Saturday, 23 May, 12:45 to 14:15 (CET) on Channel 1. 

UNICANCER: French prospective cohort study of treatment-related chronic toxicity in women with localised breast cancer (CANTO) 

e000562. doi: 10.1136/esmoopen-2019-000562

“Supportive Care to Relieve Cancer-Related Fatigue Is Largely Underutilized by Breast Cancer Survivors.” 

, ESMO, 22 May 2020, www.esmo.org/newsroom/press-office/esmo-congress-breast-2020-breast-supportive-care-fatigue-dimeglio.

New research shows that, when seeking treatment for cancer-related fatigue, breast cancer survivors underutilize recommendations. 

Supportive care underutilized by breast cancer survivors

, Dr. Washington Hill of Sarasota, FL discussed the existence and impact of 

 in healthcare. Multiple studies have illustrated these outcomes.

investigated whether black children were likely to have more complications and greater mortality following surgery than white peers.

Although researchers discussed some of the study’s limitations, they did find that black children were linked to a higher risk of complications and mortality following an operation, even in children who are apparently healthy. The findings, noted the authors, do not represent causality between race and post-surgery complications, but that the association is strong.

A new report in Pediatrics investigated whether black children were likely to have more complications and greater mortality following surgery than their white peers. 

Racial disparities in healthcare impact post-surgery outcomes

, is a Maternal-Fetal Medicine Specialist with CenterPlace Health and Sarasota Memorial Hospital and has been an ob/gyn for 55 years, almost 30 in Sarasota, Fla., within the Sarasota Memorial Health Care System.

Watch the full video recording of this interview 

What is the ob/gyn's role in promoting racial equity?

Podcasts

This episode of Pap Talk by Contemporary OB/GYN features an interview with Dr. Washington Hill, Maternal-Fetal Medicine Specialist in Sarasota, Fla.

Pap Talk S2E1: Dr. Washington Hill: racial justice and health equity in ob/gyn

The potential vaccine is still awaiting approval by the U.S. Food and Drug Administration (FDA). The deal includes payment of $1.95 billion by the U.S. government.

According to Pfizer, the U.S. can also acquire an additional 500 million doses of the vaccine under the current agreement. The candidate, named BNT162, is the latest in a portfolio of vaccines receiving investments from the Biomedical Advanced Research and Development Authority (BARDA).

The deal is part of the government’s “Operation Warp Speed” initiative. Get the full story from our sister publication 

The U.S. government had entered into an agreement with Pfizer and BioNTech to acquire the first 100 million doses of a potential COVID-19 vaccine. 

US Government acquires first 100 million doses of Pfizer, BioNTech COVID-19 vaccine candidate

Watch the full interview with Dr. Hill on racial justice and health equity 

Videos

Maternal-Fetal Medicine Specialist Dr. Washington Hill shares his perspective with Senior Editor Angie DeRosa on the existence and impact of structural racism in America's healthcare system.

Structural racism and health disparities in America

 to prevent pregnancy in teenagers, they have also proved to be useful in treating HMB and AUB. Recent studies have also shown that LARC can be used to treat 

Similarly, LARC may even lower symptoms of 

The American Academy of Pediatrics (AACP) has recently issued a clinical report to provide pertinent information about improving access to LARC in teens. 

The report includes several crucial topics, such as taking time to discuss expected side effects, changes to bleeding patterns and reminding patients that condoms are still needed to protect patients against STIs.

For the full list of recommendations, read additional coverage from our sister publication 

The American Academy of Pediatrics has released new information to improve long-acting reversible contraception (LARC) access for teenagers. 

New information to improve LARC access in teens

Vaccine developments to prevent SARS-CoV-2 are well underway as many candidates are entering phase 3 trials and major government investments for the first 100 million doses are starting to pour in. Case counts continue to climb, making this one of the most important public health challenges this country has ever faced.

, join us for a 1-hour live webinar as experts in infectious disease, virology, and vaccinology break down the top vaccine candidates, key findings from the latest clinical trials, and discuss ways to overcome the logistical hurdles of a vaccine rollout amidst a global pandemic.

 for and learn more about the top minds you will hear from in this groundbreaking virtual event 

will publish an article detailing the vaccinations and their impact on pregnant women, women who are breastfeeding, and more as it pertains to ob/gyns.

 to let us know what you are interested in learning more about as it pertains to the vaccinations and your obstetric and gynecologic practice.

This Thursday, July 30, 2020 at 6 p.m. EDT, join us for a 1-hour live webinar as experts in infectious disease, virology, and vaccinology break down the top vaccine candidates, key findings from the latest clinical trials, and discuss ways to overcome the logistical hurdles of a vaccine rollout amid a global pandemic. 

Live Webinar: Race for a COVID-19 vaccine

The study was conducted to determine whether an association existed between sleep duration and diabetes. 

Data was based on self-reported information without the use of objective measurements and lacked the use of factors. For more information on this study and its findings, read the full article from our sister publication, 

A new study from Diabetologia found that adults with type 2 diabetes with extreme sleep duration may be at a higher risk of death than adults without type 2 diabetes. 

Individuals with type 2 diabetes with extreme sleep duration may be at higher risk of death

suggests that, among others, insulin resistance is a contributing factor in the association between race and poor prognosis in US women with breast cancer.

Although mortality rates have declined in some ethnic populations, the overall cancer incidence among African American and Hispanic populations continue to grow.

 The lack of data on the possible connection between race and breast cancer prognosis is what led a group of Mount Sinai researchers to conduct this new multicenter, cross-sectional study.

They used data from 10 hospitals across the country and patients included self-identified black women and white women with newly diagnosed invasive breast cancer. According to the authors, metabolic syndrome disproportionately affects more black women than white women.

The primary goal of the study was to determine if insulin resistance, determined by the homeostatic model assessment of insulin resistance (HOMA-IR), mediated the effect of race on prognosis. Researchers also included demographic data, anthropometric measurements, and fasting blood.

In total, 515 women participated (83% white, 17% black). Researchers ultimately found that MetS was more prevalent in black women than in white women (40% vs. 20%, 

The study also found that the mediation model, when adjusted for age, revealed that HOMA-IR was higher in black women than in white women (1.9± 1.2 vs. 1.3 ± 1.2, 

1. Gallagher EJ, Fei K, Feldman, SM, et al

 Insulin resistance contributes to racial disparities in breast cancer prognosis in US women. 

https://doi.org/10.1186/s13058-020-01281-y

2. Yedjou CG, Sims JN, Miele L, et al. Health and racial disparity in breast cancer. 

. 2019;1152:31‐49. doi:10.1007/978-3-030-20301-6_3

The lack of data on the possible connection between race and breast cancer prognosis is what led a group of Mount Sinai researchers to conduct this new multicenter, cross-sectional study. 

Insulin resistance contributes to racial disparities in breast cancer prognosis in US women

Dr. Spong is Chief of the Pregnancy and Perinatology Branch at the National Institute of Child Health and Human Development (NICHD), and Program Scientist for the Maternal-Fetal Medicine Unit Network. A Maternal-Fetal Medicine Specialist with INOVA Alexan

Women’s health research continues to be marginalized. To address and reverse this trend requires committed, accountable leadership, inclusion of diversity of thought and critical social science issues, in addition to the more well-funded basic traditional and clinical research.

There are several areas that contribute to this marginalization, first, with respect to pregnant women. Optimizing pregnancy outcome would significantly improve world health, as babies, if born early – and often thus small – have higher risks of heart disease, diabetes, and asthma. 

Therefore, a baby born without complications, at the right time and weight, has the potential for a healthier life. Similarly, optimizing a woman’s health – both for a healthier pregnancy and outcome and for her long-erm health – also has the potential to improve world health. A woman’s health is known to impact her family, including both younger and older generations, thus strategies to address women’s health are essential.

Funding for women’s health research is limited. The National Institutes of Health (NIH) categorizes research funding to provide consistent and transparent information on the categories of disease, conditions, and research areas. 

The categorization uses sophisticated text data mining based on scientific experts to define a research category. Incredibly, 

2019 was the first year that federal funding for women’s health research was classified based on scientific relevance

, rather than based on the percentage of female subjects included in the studies.

The rationale for using the percentage of females enrolled in a study to count as “women’s health research” is unclear, and unfounded, as women certainly are enrolled in studies that are not focused on women’s health.In 2019, the NIH funded $4,749M in women’s health research, with the largest percent (26%) by the National Cancer Institute (Figure 1). 

As examples, the genetics, neurosciences, biotechnology, brain disorders, pediatrics, and aging research categories all had more NIH funding in 2019 than women’s health. 

Although COVID-19 has impacted research across the board, its negative impact on women’s research cannot be underestimated. 

To prevent transmission of the virus, all non-essential visits and encounters have been appropriately stopped, thus all ongoing clinical research has effectively ceased aside from that impacting clinical care. As I mentioned in my editorial in April, when there were only 51 studies

 - pregnant and breastfeeding women are yet again excluded from research, notably from participating in COVID-19 clinical trials during this pandemic. 

This is a major missed opportunity as results with therapies studied in men and nonpregnant women may not be generalizable. Furthermore, therapies are potentially not being offered to women, or if they are offered, are not being systematically studied in this population to provide needed data with which to guide therapy. 

The impact of COVID-19 on women’s health research highlights the long-standing inequities in including this population in research. Only in the last few decades were women required to be included in clinical research. 

Only in 1993, with the passage of the National Institutes of Health Revitalization Act, were women mandated to be included in NIH-funded research. 

Yet even with this mandate, subsets of women remain excluded.

Despite mandated inclusion of women in research, women’s health research remains marginalized, as are women researchers and physician-scientists. Although data suggest that women submitting NIH research project grant (RO1) applications for the first time have the same grant success rate as men

, they are half as likely to apply for those grants

, despite the fact that just as many women as men are receiving advanced degrees. 

A natural history experiment using the investigator-initiated Canadian Institutes of Health Research Grant Programmes demonstrated that gender gaps in funding were due to female principal investigators being evaluated less favorably than male principal investigators - and not related to the quality of their research proposals.

This marginalization of women researchers is rampant. As reported in numerous studies, women are less likely to be promoted, achieve tenure, or be selected for leadership roles (Supplemental figure). 

Similarly, women with equal stature are less likely to be selected to participate in “think tanks” than men. As an example, a recent article outlining a research strategy for women’s health with 17 authors included only 4 (24%) women.

Furthermore, of the nine physician authors, only one is an ob/gyn and four are pediatricians. The themes from the “think tank” neglect critical areas of research, focusing on traditional sciences and emphasize genetics, overlooking the role of racial disparities and health inequities.

As noted by the 2018 NIH Gender Inequality Task Force Report, “Sustainable change in representation of women, and of all individuals from underrepresented groups, requires committed, accountable leadership along with effective tools to accomplish this important goal.”

 It is troubling that gender diversity in leadership positions is lacking nationally. 

Using 2019 data, only 19% of department chairs (both interim and permanent) are held by women. Extrapolating the trend lines suggests another 50 years are needed to attain parity of department chairs and medical school deans by gender (Figure 2). 

This diversity is not due to a lack of qualified women, as since 2002, women have earned the majority of all doctorates

 and in 2019, women comprise the majority of enrolled US medical students.

Underrepresentation creates a culture that perpetuates inequalities. For our patients, for ourselves, for our families, we must correct this course. This is not easy, and will require a change of culture led by a committed, accountable, proactive leadership. 

Equally important will be the inclusion of diversity and broadening of the research agenda to include critical social science issues, health disparities, and social determinants of health.

One ray of hope to address these pressing issues is the formation of the Womxn’s Health Collaborative, a group determined to identify and initiate actionable steps. 

If you are interested in participating, I encourage you to contact Dr. Michal Elovitz at 

, editor in chief, is Professor and Vice Chair in the Department of Obstetrics and Gynecology and Chief of the Division of Maternal-Fetal Medicine at UT Southwestern Medical Center in Dallas. She holds the Gillette Professorship of Obstetrics and Gynecology.

https://report.nih.gov/categorical_spending.aspx

https://www.contemporaryobgyn.net/view/heralding-new-era-timely-topics-and-guidance

Constantine MM et al. Obstetrics & Gynecology: 

Pohlhaus JR et al. Acad Med. 2011; 86(6):759-67.

https://report.nih.gov/nihdatabook/report/132?showm=Y&chartId=176&catId=

Witteman HO et al. Lancet 2019; 393:10171:531-540

Sadovsky Y et al. AJOG 2020. PMID: 32565236

https://diversity.nih.gov/sites/coswd/files/images/2018-05/Gender%20Inequality%20Task%20Force%20final%20AD%20may%2030%202018.pdf

https://ncses.nsf.gov/pubs/nsf20301/report/u-s-doctorate-awards#sex

https://www.aamc.org/news-insights/press-releases/majority-us-medical-students-are-women-new-data-show

In this month's issue, Contemporary OB/GYN Editor-in-Chief Dr. Catherine Y. Spong talks about the ways in which women's health research has and continues to be marginalized. Addressing these inequalities, Dr. Spong says, demands a change of culture led by committed and accountable leadership.

Addressing inequalities in women's health research

The double impact of the pandemic and protests have placed a spotlight on what could otherwise be ignored corners and crevices. 

Starting on page 6, Editor-in-Chief Catherine Y. Spong, MD, tackles the topic of the inequities in women’s health research and has a call to action.

As is pointed out by Dr. Spong, correcting inequities demands a change of culture that requires committed and accountable leadership.

And so it goes that we must demand more from ourselves and organizations. Dr. Washington Clark Hill, who has been a practicing ob/gyn for 55 years, provides a wake-up call in his 

He addresses the difference between equity and equality. Watch our 

 that supplements his written piece. Sharing the cover story space with Dr. Hill are Vanessa Rogers, MD, and Shawna Nesbitt, MD, MS.

Dr. Rogers, a practicing ob/gyn, interviews Dr. Nesbitt, who is renowned for her work in diagnosing hypertensive disorders and also serves as Associate Dean of Student Diversity and Inclusion at the University of Texas Southwestern Medical Center in Dallas. 

We want your thoughts on other groups that could be covered in similar ways. Please email Senior Editor Angie DeRosa at 

This month’s issue takes on the pervasive problem of implicit bias and systemic racism in health care. 

Chairman's message: Implicit bias and racism

Dr. Hill is a Maternal-Fetal Medicine specialist with CenterPlace Health and Sarasota Memorial Hospital and has been an obstetrician-gynecologist for 55 years, almost 30 in Sarasota, Fla., within the Sarasota Memorial Health Care System.

We are in a cultural moment of awareness and change because of moral outrage by people of all colors. As was said at George Floyd’s eulogy, “What happened to Mr. Floyd happens every day in this country, in education, in health services, and in every area of American life, it’s time for us to stand up in Mr. Floyd’s name and say 

In obstetrics and gynecology, it’s way past the time to provide better and improved health care for all, not just for the haves but for the vulnerable in our communities as well.

Systematic and institutional racism result in many if not all of the 

 (SDoH) our patients face. The SDoH play a major role in numerous health disparities in our specialty and poorer outcomes that we see, whether in the death of pregnant mothers or infants or rates of cancer, heart disease, or worse outcomes in black and brown individuals with COVID-19. 

This is as a result of long-standing racism that is interpersonal, systemic, institutional, structural, and exemplary of racial bias and which adversely affects healthcare.

Physicians and healthcare workers (us) see this every day. We know racial bias and racism when we encounter it and that over the years, it leads to poorer health status and outcomes. 

The COVID-19 pandemic disproportionately affects and targets black and brown people more than whites because of racism. 

. The coronavirus has placed a bright spotlight on the long-existing poor health in black and brown people and the worse outcomes when they get COVID-19.

Clearly, there are demonstrated disparities in outcomes based solely on implicit bias and racism. A midwife said to me on rounds that there is no reason for a black or brown pregnant woman to die or be very sick more so than her white counterpart other than long-standing and present racism. Think about that. She is right. There is no genetic or biological reason for this tragedy! 

We can eliminate racial disparity by eliminating racial inequity.

Racism is an insidious cultural disease with many manifestations. Privilege is one and has to be admitted. Access to healthcare and healthcare injustice are others. Not getting a deserved promotion is another. Being assigned an insurance plan that does not provide for needed services is another. And so on. You know them.

Around the country, medical students, physicians, nurses, and their families have recently knelt in remembrance of George Floyd’s death to say “yes” we know there is racism in the provision of healthcare services and “yes” we admit it and “yes” now let’s use our platforms and do something about it. 

This is a great start but that alone is not enough! Letters and events of support are meaningful, but the systemic racism continues. 

All of us providing healthcare services have a role and must speak out. What should empower you to speak out? Better outcomes for your patients.

Dr. Hill is a Maternal-Fetal Medicine specialist with CenterPlace Health and Sarasota Memorial Hospital and has been an obstetrician-gynecologist for 55 years, almost 30 in Sarasota, Fla., within the Sarasota Memorial Health Care System. He can be reached at 

Steps to advance and address racial justice and healthy equity in ob/gyn

So where do we go from here? What can you as a clinician or administrator do?

 within your organization diversity and inclusion among your learners, faculty, staff, and most importantly the leadership within your organization. Change starts from the top. Is your “med exec” group truly diverse and reflective of your medical staff or group?

Have those difficult and sometimes uncomfortable, real, open conversations about racism and racial equity at your institution and their effects locally and within policies and practices in your organization.

and teach the importance of SDoH and structural racism in health services as part of the curriculum for trainees.

 for more diversity of staff, employees, management, faculty, and leadership. These people need your help. Use your platform and speak out wherever and whenever you can.

 health equity knowledge and advocacy where you work. Remember that equality is not equity. The service may be available to all; i.e., “equality,” but are all really able to access it, i.e., “equity?”

 Examine your own group, clinic or office. Is it really diverse? Who is at the front desk and who is doing the procedures? Any blacks or Latinos?

your meetings, mouth, ears, devices, and contacts to advocate and speak out for a more accountable, diverse and inclusive “healthcare system.” Compliment when you see something done well and hold those accountable when it needs to improve.

 your leadership, staff, and employees to use their influence and push forward with diversity and inclusion initiatives. Encourage them to partner with community organizations, suppliers, businesses, and diverse communities, not just those that look like them.

questions like, “How diverse is our workforce and management?” “What do the data show?” Look at the metrics over time. You know the importance of data. Eenie, Meenie, Minie, Mo...What Do the Data Really Show?

 your own institution. Does it appear that your hospital is welcoming to all forms of promoting diversity? What more can be done? Speak up if you see an injustice committed. Your organizations should encourage and support their staff to confront overt racism and implement efforts to address the implicit biases of coworkers and senior staff members.

 We can no longer remain silent and not speak up. That’s complicity. Your voice has power!

For those of you who choose to do it, this is not easy work. There will be lots of resistance and lots of words. It will take a lot of energy, but do not become dismayed or give up. It can be very frustrating. 

We have come a ways in including diversity, inclusion, and equity in our healthcare organizations but we still have a very long way to go in really being diverse. Healthcare organizations cannot rest on their laurels. 

Your hospital should be just as proud of being one of the top diverse hospitals in your area or country as it is about being a top cardiovascular center putting in valves. Use your platform to get there.

In the past 55 years since I became a physician, progress has been made but we still have so much more to do and a long way to go. Those gatherings in front of medical schools, hospitals, and clinics kneeling to remember George Floyd in support of the Black Lives Matter movement will make sure of that. 

They are not going away nor is the community. 

 wire story, dated March 26, 1966, contains the first known published reference to Dr. Martin Luther King’s famous quotation regarding injustice in health care, “Of all the forms of inequality, injustice in health care is the most shocking and inhuman.” 

Dr. King’s remarks were made at a Chicago press conference held the day before in connection with the annual meeting of the Medical Committee for Human Rights. These words still ring true today.

I graduated from medical school in 1965 and remember marching the next summer for racial equity. It is now the summer of 2020 and people of color are still marching for racial equity. There is something wrong with that picture and many of you have pointed that out. 

—has changed. We must all do, expect, and demand better of ourselves and those in power who provide healthcare services and teach about it.

We have a lot of work and a long way to go to get the knee up and improve healthcare services for all of our patients, but we can do it if we really want to. 

A change has to come! I hope that this commentary rings clear as a clarion call touse our platforms, work together, stronger and better to eliminate racial inequity in our specialty and all of healthcare.

Racial and ethnic disparities in obstetrics and gynecology

. Committee Opinion No. 649. American College of Obstetricians and Gynecologists Obstet Gynecol 2015;126:e130–4.

Importance of social determinants of health and cultural awareness in the delivery of reproductive health care

. ACOG Committee Opinion No. 729. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e43–8.

The Joint Commission Stands for Racial Justice and Equity

SMFM Issues a Statement to its Membership on 

Reduction of Peripartum Racial/Ethnic Disparities

“In the past 55 years since I became a physician, progress has been made but we still have so much more to do and a long way to go.”