As the infection and death counts roll in on my newsfeed, an ever-increasing clamor demands the American public confront the fact that in this pandemic, racial minorities are hospitalized at 4-5 times the rate of white America.
Are you surprised? You shouldn’t be. This story repeats itself across a multitude of public health issues in the United States, and in particular, maternal mortality rates.
On July 13, 2020, the New York Times published an article, “What’s Missing in the Effort to Stop Maternal Deaths,” by Austin Frakt, enumerating the extreme disparities in health outcomes women of color face when giving life to a new generation in the land of the free.
Frakt begins by sharing the most recent CDC data. Here are the highlights:
- In 2018 in the U.S. there were 17.4 maternal deaths for every 100,000 live births. However, this may even be a severe underestimation of the actual rate due to the exclusion of drug overdoses and suicides.
- Broken down by race, maternal mortality disproportionately impacts Black women at 37.1 deaths per 100,000 live births, compared to 14.7 deaths per 100,000 for white women and 11.8 per 100,000 live births for Hispanic women.
- Although Black women make up about 13% of the U.S. female population, they account for over 40% of maternal mortality in the states.
Why is it that Black women are forced to literally gamble with their own lives to bring children into the world?
First, they live in a web of racist systems.
Frakt states in his article “The racial differences seen in both maternal and infant mortality are driven by the same forces. Relative to white people, Black Americans have less access to the health system and receive poorer care, with worse outcomes. This has been documented both broadly and specifically for birth outcomes. Racism, including in its institutional and implicit forms, underlies all these factors.”
He continues, quoting Rachel Hardeman, a University of Minnesota School of Public Health assistant professor: “People of color experience the cumulative effects of disadvantages throughout their lives. The constant stress of racism may lead to premature biological aging and poor health outcomes for African- Americans. This means they might enter into pregnancy less healthy.”
Second, Black women may be fiscally more vulnerable and have fewer resources to help them develop and maintain good maternal health. Frakt reports:
“One-third of pregnancy-related mortality occurs after delivery. Lack of insurance can impose a crucial financial barrier to post-delivery care. In all states, low-income pregnant women…are eligible for Medicaid, which finances over 40 percent of births nationally. But a couple of months after delivery, new mothers can lose coverage…Women of color are more likely than white women to be covered by Medicaid, so are more likely to be affected by postpartum eligibility changes.”
In the fight for the equality of women across the world, we talk a lot about the unpaid labor of women, evoking images of caregiving, cooking, or cleaning. What about the literal labor of birthing children? We overwork and underpay women, and then overcharge them for fulfilling their expected role of perpetuating the human race, nay, the next generation of tax-paying citizens. After tackling all these hurdles, we must not turn a blind eye as women die in the very act for which society insists they exist.
To reduce the overall maternal mortality rate in the United States, we should consider a variety of strategies specifically designed to reduce the disparity, and therefore overall rate, between white women and women of color dying pregnancy related deaths. The CDC leans heavily on the work of state and local Maternal Mortality Review Committees (MMRC) for research and strategies to combat maternal mortality. “A recent report with data from 13 state MMRCs determined that each pregnancy-related death was associated with several contributing factors, including access to appropriate and high-quality care, missed or delayed diagnoses, and lack of knowledge among patients and providers around warning signs. MMRC data suggest the majority of deaths – 60% or more – could have been prevented by addressing these factors at multiple levels.” If 60% or more deaths are preventable, what will it take to prevent them?
- Better Healthcare
A recent report from a group of nine MMRCs includes a long list of suggested strategies to lower the number of preventable maternal deaths, including procedural trainings for medical providers. These trainings focus on medical processes, like how to perform a cardiac exam and processes dealing with patient-provider interactions, like teaching providers how to follow up with patients.
- Empowered and Informed Patients
“Early initiation of prenatal care by pregnant women, and continuous monitoring of pregnancy by health providers, are key to helping to prevent and treat severe pregnancy-related complications.” In order to curb the steady loss of women due to complications associated with pregnancy, well-trained and diligent medical providers must work in tandem with a community of well-informed women. Gone must be the days of medical gaslighting, a phenomenon in which doctors act upon women’s bodies with little heed to the women’s intimate knowledge of their own corporal state. A new book by UC Berkeley professor Tina Sacks, Invisible Visits: Black Middle-Class Women in the American Healthcare System, dives into this trend, exposing the inequities more forcefully imposed upon Black women due to medical gaslighting. Public health efforts to a) educate doctors about their bias and b) empower women to advocate for their reproductive health are crucial to curbing the alarming death rate among Black women.
- Black Doctors and Other Birth Workers
NPR’s July 6 Shortwave episode “The Importance of Black Doctors” highlights the power of representation in healthcare. While 13% of the U.S. population is made up of Black Americans, only 5% of physicians are Black. In this episode, they explore a clinical, double blind study of whether “the race of the doctor mattered in successfully encouraging Black patients to take advantage of preventative healthcare services,” services the CDC claims to be “key to helping to prevent and treat severe pregnancy-related complications.” Spoiler alert, it does! Considering the high rate of maternal mortality among Black women, it is essential to the health of Black women to accelerate efforts to train and certify Black birth workers, from doctors to doulas.
In short, there are many straightforward strategies poised to reverse this horrific trend. Prioritizing access to quality healthcare, better representation of the Black community in the healthcare system, and educating women on their own health are among the few. Black women will save their own lives if given half a chance.