The United States has poorer health and decreased longevity compared to other nations in the world. This chapter addresses clinical care from the framework of social determinants and proposes strategies grounded in the literature of healthcare, public health, and the social sciences. Disrupting undermining social determinants needs to be the paradigm of care. This paradigm is presented from four vantage points: embracing equity; safeguarding respectful birth and physiologic care; reducing cesarean birth; and preventing and managing risk. The chapter describes how maternal health in the United States can be enhanced by providing an environment of social justice and equity and discusses priority areas of clinical care essential to addressing the social determinants of the maternal health crisis in the United States. It describes selected evidence-based initiatives to promote equity and standardization of care in the prevention of maternal mortality and the management of severe maternal morbidity in the United States.

The idea of cultural sensitivity focuses on the basic awareness and willingness to learn about cultural differences. Cultural safety emphasizes patient-centered and community-centered care that takes into consideration the intersecting and ongoing processes of oppression that impact Lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual or allied (LGBTQIA+) people every day – especially people of color. The chapter enables the reader to list three ways that cultural safety differs from cultural competence and clinical care modifications supporting the cultural safety for LGBTQIA+ patients. It helps the reader to self-reflect on personal biases which prevent provision of culturally safe care. Keeping cultural safety at the forefront of clinical practice guides clinicians in culturally informed, conscious and mindful care that acknowledges a patient’s narrative and history of oppression. Maintaining a mindful clinical practice brings LGBTQIA+ patients one step closer to health equity and justice.