Emma Kikerkov RR2 : Villarosa and Structural Competencey

Structural competency is defined by Metzl and Hansen as the “trained ability to discern how a host of issues defined clinically as symptoms, attitudes or diseases… also represent the downstream implications of a number of upstream decisions…”,  or in other words, how a patient’s disease may be a result of social determinants such as race, gender, etc. (128)

One issue that illustrates the need for structural competency is the high maternal mortality rate in black women, as seen in Linda Villarosa’s article.

The way that Villarosa’s article is written effectively demonstrates the need for structural competency because both facts/figures and personal narratives reveal different aspects of the black women maternal mortality crisis.

The facts and figures demonstrate that there is undeniable proof that black women are disproportionally die in childbirth through research that indicates “an inescapable atmosphere of societal and systemic racism can create a kind of toxic, physiological stress… that lead directly to a higher rate of infant and maternal death.” (Villarosa)These statistics also indicates how little progress is made by the states in terms of maternal mortality because there are no maternal mortality review boards, none of these deaths are being properly investigated. (Villarosa)

Something that facts and figures fail to do, however, is show how healthcare providers facilitate this phenomenon. Villarosa’s and Simone Landrum’s personal experiences as pregnant black women show how black women are given lower quality care, whether is intentional or not. This discrimination can be seen when Villarosa was accused by her perinatologist of drinking and doing drugs, and again when Landrum was dismissed by her patient when asking why she was given an incorrect dose of anesthesia. (Villarosa)

With the use of personal narratives in this article, this matter is made more tangible and statistics provide evidence for the maternal mortality crisis in black women; with both of these components, Villarosa effectively provides an example of an issue where structural competency is needed.



Jonathan M. Metzl, and Helena Hansen. Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality. 2014, pp. 126–33.

Linda Villarosa. Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis. Apr. 2018, https://www.nytimes.com/2018/04/11/magazine/black-mothers-babies-death-maternal-mortality.html.