The death of a woman during pregnancy or after delivery is indeed a tragedy for a family. Unfortunately, more and more pregnant women in the United States die each year due to pregnancy or delivery complications, and black women are more likely to be a victim than white women. The United States, in general, has a high maternal death rate and the numbers have doubled since the 1990s. For a developed country like the USA, it seems troubling that it has one of the highest rates of maternal death in the world.
According to the CDC, around 50,000 women suffer from pregnancy complications and black women are 3 to 4 times more likely to die than white women. There were no particular reasons for the problem, the researchers say. But factors like poverty, inadequate healthcare, and higher risk factors such as high blood pressure, obesity, and diabetes are just some causes that impact black women more.
Dr. Elizabeth Howell, the director of the Women’s Health Research Institute at Mount Sinai Hospital, believes that the yet existing racial and ethnic disparities could be the reason for the poor ratings. She says, “I think they’ve been long-standing disparities in maternal health and they’re becoming larger today in certain cities and it’s very concerning.”
Racial disparity across incomes
In recent years, as high rates of maternal mortality in the U.S. have alarmed researchers, one statistic has been especially concerning. According to the CDC, black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women’s health. Put another way, a black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 243 percent more likely to die from pregnancy- or childbirth-related causes. In a national study of five medical complications that are common causes of maternal death and injury, black women were two to three times more likely to die than white women who had the same condition.
That imbalance has persisted for decades, and in some places, it continues to grow. In New York City, for example, black mothers are 12 times more likely to die than white mothers, according to the most recent data; in 2001-2005, their risk of death was seven times higher. Researchers say that widening gap reflects a dramatic improvement for white women but not for blacks.
The disproportionate toll on African-Americans is the main reason 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 countries such as Mexico and Uzbekistan, the World Health Organization estimates.
For much of American history, these types of disparities were largely blamed on blacks’ supposed susceptibility to illness — their “mass of imperfections,” as one doctor wrote in 1903 — and their own behavior. But now many social scientists and medical researchers agree, the problem isn’t race but racism.
The systemic problems start with the type of social inequities — differing access to healthy food and safe drinking water, safe neighborhoods and good schools, decent jobs and reliable transportation.
Black women are more likely to be uninsured outside of pregnancy, when Medicaid kicks in, and thus more likely to start prenatal care later and to lose coverage in the postpartum period. They are more likely to have chronic conditions such as obesity, diabetes and hypertension that make having a baby more dangerous. The hospitals where they give birth are often the products of historical segregation, lower in quality than those where white mothers deliver, with significantly higher rates of life-threatening complications.
Those problems are amplified by unconscious biases that are embedded in the medical system, affecting quality of care in stark and subtle ways. In the more than 200 stories of African-American mothers that ProPublica and NPR have collected over the past year, the feeling of being devalued and disrespected by medical providers was a constant theme.
There was the new mother in Nebraska with a history of hypertension who couldn’t get her doctors to believe she was having a heart attack until she had another one. The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair. The Chicago-area businesswoman with a high-risk pregnancy who was so upset at her doctor’s attitude that she changed OB/GYNs in her seventh month, only to suffer a fatal postpartum stroke.
Over and over, black women told of medical providers who equated being African-American with being poor, uneducated, noncompliant and unworthy. “Sometimes you just know in your bones when someone feels contempt for you based on your race,” said one Brooklyn, N.Y., woman who took to bringing her white husband or in-laws to every prenatal visit. Hakima Payne, a mother of nine in Kansas City, Mo., who used to be a labor and delivery nurse and still attends births as a midwife-doula, has seen this cultural divide as both patient and caregiver. “The nursing culture is white, middle-class and female, so is largely built around that identity. Anything that doesn’t fit that identity is suspect,” she said. Payne, who lectures on unconscious bias for professional organizations, recalled “the conversations that took place behind the nurse’s station that just made assumptions; a lot of victim-blaming — ‘If those people would only do blah, blah, blah, things would be different.’ “
In a survey conducted this year by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, 33 percent of black women said that they personally had been discriminated against because of their race when going to a doctor or health clinic, and 21 percent said they have avoided going to a doctor or seeking health care out of concern they would be racially discriminated against.
Black expectant and new mothers frequently said that doctors and nurses didn’t take their pain seriously — a phenomenon borne out by numerous studies that show pain is often undertreated in black patients for conditions from appendicitis to cancer. When Patrisse Cullors, a co-founder of the Black Lives Matter movement who has become an activist to improve black maternal care, had an emergency C-section in Los Angeles in March 2016, the surgeon “never explained what he was doing to me,” she said. The pain medication didn’t work: “My mother basically had to scream at the doctors to give me the proper pain meds.”
But it’s the discrimination that black women experience in the rest of their lives — the double whammy of race and gender — that may ultimately be the most significant factor in poor maternal outcomes.
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