This disproportionate burden on Black women is one of the main reasons the U.S. maternal mortality rate is so much higher than that of other affluent countries. Black expectant and new mothers in the U.S. die at about the same rate as women in lower-income countries. Despite these alarming statistics, discussions around the maternal health crisis in the U.S. often overlook the conditions that disproportionately affect Black women.
With the growing momentum around addressing racial and gender discrimination in this country, now is the time to have these discussions. We must include maternal health in the conversation.
BLACK MATERNAL HEALTH DISPARITIES
The CDC’s January report was the first time in more than a decade the government has released new data on the maternal mortality rate, but these racial and ethnic disparities in pregnancy-related deaths have long been documented and continue to persist. Black moms are up to three times more likely to die from pregnancy-related causes than white moms and are twice as likely to suffer from severe complications during pregnancy and birth.
In the report, researchers found that of the 658 women who died of maternal causes in 2018, Black women fared the worst, dying 2½ times more often than white women (37.1 vs 14.7 deaths per 100,000 live births). Controlling for education, socioeconomic status, and health conditions, Black women remain at higher risk for maternal and infant mortality. It’s imperative that these maternal disparities be further investigated and that they take into full consideration the scope of factors and policies that influence the Black American experience.
UNDERSTANDING THE ROOT OF THE PROBLEM IN ORDER TO FIX IT
According to the WHO, the most common complications worldwide that kill women during and after childbirth include severe bleeding, infections, high blood pressure during pregnancy, complications from delivery, and unsafe abortions. But why is it that Black women are more likely to face these challenges?
In order to eradicate these staggering and fatal differences in maternal care, it’s important to critically analyze the known and suspected drivers of Black maternal mortality and morbidity.
The harmful effects of racism and implicit bias in the U.S. healthcare system must be examined to adequately address racial disparities in infant and maternal health.
In 2017, NPR conducted a survey on discrimination in America in which thirty-two percent of African Americans felt they’d been discriminated against when going to a doctor or health clinic. This is not a surprising figure when you consider that Black patients often report facing microaggressions by healthcare providers and poor doctor-patient communication due to the color of their skin. Equally troubling is the prevalence of misinformation surrounding race and pain across the medical field. Black patients’ pain and discomfort is often dismissed due to false notions on pain tolerance— including myths such as Black people have thicker skin or less sensitive nerve endings than white people.
The U.S. healthcare system operates within foundations that inherently undervalue Black lives. For most Black patients, that means being exposed to multiple forms of discrimination and institutional barriers to quality care. An expanding field of research shows that the stress induced by this discrimination can take a significant physical toll on Black women during pregnancy and childbirth. It is systematic racial bias—not race itself—that compromises the health of Black women and infants.
Higher poverty rates are associated with higher rates of maternal mortality for all women, but Black women are more than twice as likely to live in poverty as white women. According to the National Partnership for Women & Families, Black women in the United States who work full time, year-round are typically paid just 62 cents for every dollar paid to white, non-Hispanic men. These lost wages mean Black women have less money to support themselves and their families and may have to choose between essential resources like housing, child care, food, and health care. These trade-offs are evident in Black women’s health outcomes and use of medical care. Compared to white women, Black women are more likely to be uninsured and to face greater financial barriers to care when they need it, and are less likely to have access to quality prenatal care.
INCREASED SUSCEPTIBILITY TO CERTAIN HEALTH CONDITIONS
A critical step towards reducing maternal deaths is addressing the societal conditions that affect Black women’s health throughout their lives. Black women experience higher rates of many preventable diseases and chronic health conditions such as obesity, diabetes, cardiovascular disease, and hypertension–all of which can cause complications during pregnancy. Many of the health disparities faced by African Americans are caused by the stresses of their environment.
African Americans undergo early health deterioration as a consequence of the cumulative impact of repeated social or economic adversity and political marginalization—a concept coined as “weathering” by research professor Arline Geronimus. In a 2010 study, Geronimus found that telomeres—chromosomal markers of aging—of middle-aged Black women were on average seven and a half years older than those of white women. In other words, the chronic stress of being a Black woman in America has a physical toll and makes Black women more susceptible to health complications at younger ages.
POLICYMAKERS, HEALTH CARE PROFESSIONALS AND COMMUNITIES CAN IMPROVE BLACK WOMEN’S MATERNAL HEALTH
Black women deserve to have safe and healthy pregnancies and childbirth. To meaningfully improve Black maternal health outcomes, we need systemic change that starts with improving the healthcare system and advocating for policy initiatives that make access to care more accessible.
Last year, two female members of the U.S. House of Representatives launched the first-ever Black Maternal Health Caucus to address the U.S. epidemic of Black women’s pregnancy-related deaths. This was a significant step toward progress but there is still plenty of work to be done. Here are some of the ways we can do better to ensure quality maternal care for all women:
- Training doctors in implicit bias
- Supporting Black birth workers (doulas, midwives, lactation consultants, etc.)
- Conducting more research into health care discrimination
- Raising awareness within Congress to establish Black maternal health as a national priority
- Recruiting racial minorities to become OB-GYNs
- Exploring and advocating for effective, culturally-competent policies for health outcomes for Black mothers
- Supporting organizations and networks dedicated to raising awareness about Black maternal health and working to end racial disparities. Such as: Black Mamas Matter Alliance, MomsRising’s Maternal Justice Program, National Association to Advance Black Birth, and Sista Midwife Productions.