The US is becoming increasingly diverse. Although predominantly white middle-class women seek out-of-hospital birthing services, midwives provide care to increasingly diverse populations, on reservations, in rural, urban, suburban, inner city, and migrant camp settings, serving clients from other countries, undocumented immigrants, and alternative lifestyles. We are challenged to increase sensitivity and skills to serve many populations. As educators we are called upon to not only prepare our students to provide excellent care to a wide variety of families, but also to recruit a diverse student population and to implement support systems that increase retention and graduation rates. And, ultimately, to recruit midwives representing the diversity reflective of our populations to leadership positions within our national midwifery organizations.

A diverse student body enables student midwives to share their cultural backgrounds with classmates. Cultural differences may include ways of learning, body language, nutritional practices, the meaning of time, reliance on the spoken or written word, relationship to nature, valuing competition and independence vs. cooperation and team work, who is "family" and roles of family members, where to seek advice, beliefs about health, traditional healers and modalities. Creating an environment that welcomes all students and solicits input from various cultural perspectives helps students feel comfortable to share.

The two hardest things for a white girl like me during my six-month, required cultural competency and anti-racism training were 1) grasping that racism was real and ever-present in my modern-day life and society, and 2) figuring out what I was supposed to do about it, especially in the midst of all the guilt and helplessness I felt.

The answers, in the end, were simple-as the seeds of most immensely powerful things are-but they took time, patience, and effort to reach. I know that I never would, or could, have reached the important and life-changing, work-enabling realizations that I did without the help of my anti-racism teacher, combined with the immersion in these issues that was provided by this training.

As we leave Birthwise today and head into the world as new midwives, we are tasked with the sweet privilege and honor of attending and facilitating the birth of families. We are also inheriting some incredible challenges and responsibilities. According to new data from the United Nations, women are more likely to die from pregnancy and birth-related complications in the US than in 50 other countries and its getting worse.

I have a hard time getting beyond those numbers. 50th place for maternal mortality. I cannot wrap my brain around the fact that we are in country where we spend more money (by a long shot) on medicine than any other country in the world and yet our maternal mortality numbers look like that. But then it just gets worse. In the US, black and Native American women and their babies die at rates disproportionate to their white counterparts. Black infants are 2.4 times more likely to die in the first year of life than white babies. Black women are 4 times more likely to die from pregnancy-related causes than white women. Frankly, these statistics are unconscionable. They are horrendous and abhorrent. And we HAVE to do something about it.