Your skin color should not determine the quality of your health care. But at the intersection of being Black and being a mother lies a grim question related to social determinants of health for Black mothers: Why are so many Black women in the U.S. dying from pregnancy-related causes?
The question reverberates across the nation amid calls for serious investigations into finding the answers — and saving lives.
At the core, these discussions bring to the forefront the disproportionate health disparities that exist for Black people and other communities of color. Black mothers are not being heard and, in some cases, their complaints are not being taken seriously. They sometimes don’t have access to quality health care. They can suffer from pre-existing conditions that need to be carefully monitored, especially during and after pregnancy. And they need health care professionals who are committed to their wellness, which demands cultural awareness and the acknowledgment of bias — implicit or not.
Inequities in health care are systemic and long-standing.
The stats weighed heavily on first-time mom Kebina Young-Frazier.
“I was genuinely concerned that I would be mistreated or my needs would be ignored, either through unconscious bias or willful neglect. And this is not to vilify health care professionals — but the statistics are there — the countless stories from Black women that we know are there,” she says.
Concerns are real
ZERO to THREE’s State of Babies Yearbook 2020 recently reported that the national maternal mortality rate — 17 deaths per 100,000 live births nationally — is higher than those found in other industrialized countries. When broken down, maternal mortality among Black women is more than three times higher (40.8%) than among white women (13.2%) — a gap that has not decreased over multiple decades.
“Researchers have explored connections between health disparities and factors such as poverty caused by parents not earning a living wage, unemployment or underemployment; living in under-resourced neighborhoods; or low-educational attainment. Numerous studies reach the same conclusion: Even after considering the influence of these factors, race accounts for huge differences,” the study found.
ZERO to THREE’s mission is to ensure that all babies and toddlers have a strong start in life, and the institute just added maternal mortality as an indicator to its annual study.
Michigan’s pregnant moms face a huge problem, and they now have the governor’s ear. Gov. Gretchen Whitmer announced the Healthy Moms Healthy Babies initiative in her 2020 State of the State address, in part to combat medical bias against women of color and to expand access to evidence-based home visiting programs to increase health outcomes. The $12.6 million initiative is part of her Fiscal Year 2021 budget proposal.
According to the initiative’s fact sheet, Detroit’s maternal death rate is three times higher than the national average, and pregnant Black women are 4.5 times more likely to die than white women. Black women are also three times more likely to die from pregnancy-related causes than white women.
If that is not sobering enough, 44% of those pregnancy-related deaths in Michigan were preventable, the Michigan Maternal Mortality Surveillance Committee said. That means those women did not have to lose their lives, their families did not have to lose a family member and a newborn child did not have to lose a mom.
Ditching the stereotypes
There are faces behind the data that show Black women are more at risk of maternal mortality or near-death experiences. Misconceptions about moms impacted by those risk factors too easily assume they are low-income or are uneducated. In reality, socioeconomic status, education and even having a family support system hasn’t provided protection for Black women against this crisis.
When Detroit’s Young-Frazier was planning her family, there was no question about her desire to develop a team of advocates around her and her unborn baby. “The morbid statistics around Black maternal health outcomes definitely weighed on me while I was pregnant,” Young-Frazier says. “… So, I felt like I had to do everything that I possibly could to protect myself and my child.”
Her health plan included a doula and a midwife. “I advise women to take the time to find the right health care professional for them,” she says. “If a doctor is not meeting your needs or if you feel like you are not being heard, find someone else. There is no reason to stay in a relationship that doesn’t best serve you.”
Young-Frazier is part of a growing number of Black women who empower themselves with information and acknowledge that they have to be their own advocate or need to have someone who is equipped to advocate on their behalf.
Even Black celebrities and higher profile moms aren’t immune.
Serena Williams, a multiple Grand Slam tennis champion, had life-threatening complications shortly after giving birth to her daughter in 2017. Even with a history of developing blood clots that nearly killed her in 2011, her complaints of shortness of breath were not treated with the urgency.
In her case, she advocated for a CT scan and a blood thinner and received an ultrasound on her legs. Her concern was confirmed; she was suffering from a pulmonary embolism.
Dr. Chaniece Wallace, a chief resident at Indiana University School of Medicine Pediatric Hospitalwith Indiana University Health Physicians, died last year after giving birth to her daughter and developing preeclampsia. Erica Garner, an outspoken activist about Black maternal health, suffered a heart attack after giving birth to her second child.
Cynthia Jackson, a certified midwife with the state of Michigan, is all too familiar with the statistics for Black birthing women.
“The downward spiral of the medical system plays a part into why the maternal death rate is so high in Michigan,” Jackson says.
As the founder of Sacred Rose Birthing Services, she provides home-based services that include prenatal care, labor and birth care and postpartum care. Her website describes midwifery care as traditionally respectful and compassionate, a different experience for some Black women who might not be getting what they need elsewhere, she says.
“If you are not getting answers from your provider, you can switch. There are a lot of choices, and choosing the best care provider and not feeling stuck is important,” she says.
A national spotlight
The issue of Black maternal health is finally getting national attention.
North Carolina Congresswoman Alma Adams and Illinois Congresswoman Lauren Underwood co-founded the Black Maternal Health Caucus so that Black mothers like Young-Frazier are not alone in advocating for quality health care.
As co-chairs, they are leading the efforts to ensure health care is equitable by working to eliminate the Black maternal health crisis in the United States through the Black Maternal Health Momnibus Act. The act includes a series of 12 bills, sponsored by caucus members, to save lives and help end racial and ethnic disparities in maternal health outcomes.
Among the efforts, the bills will grow and diversify the perinatal workforce, provide funding to community-based organizations working to improve maternal health outcomes and promote equity, and support moms with maternal mental health conditions.
The legislative efforts to remove barriers to unbiased medical care for Black women are a start, those in the field say.
But medical professionals need to be committed to providing equity in their care and approach, researchers say.
Joel Bervell, a second-year medical student at Washington State University’s Elson S. Floyd College of Medicine and Yale alum, actively looks for disparities in medicine training. In a Feb. 13 Instagram post, he says “that is literally how racism is perpetuated in the field of medicine.”
Something must be done to protect moms and their babies, says Myra Jones-Taylor, chief policy officer at ZERO TO THREE, in a news release.
“This is an unmitigated crisis that impacts babies and families in every single state in our country, and it has long-lasting impacts throughout our lives,” she says. “If we want to truly address the issues plaguing Black and Brown communities in the United States, we need to start by identifying disparities, addressing them with specific policies and budgets, and making the potential of every baby a national priority.”
Detroit’s maternal death rate is 3 times the national average.
In Michigan, pregnant Black women are 4.5 times more likely to die than white women. Black women are more than 3 times more likely to die from pregnancy-related causes than white women.
Michigan’s infant mortality is 38th in the nation.
Black babies are more than twice as likely to die before their first birthday than white babies.
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