The Importance of Addressing Black Maternal Health

If you are Black, you are statistically likely to die at a significantly younger age than your White neighbor. For example, while African Americans comprise only 13% of the total U.S. population they make up 30% of the COVID-19 cases. If you are Black, you are twice as likely to die from diabetes, 30% more likely to die from heart disease, and 50% more likely to die from a stroke.

 And, if you are a Black woman, you are 3-4 times more likely to die in childbirth. It is widely believed that we have solved the maternal mortality problem in America – expectant mothers dying while giving birth. We have not, particularly among Black women.

 This week marks Black Maternal Health Week. The moment offers us a chance to consider how we can truly do more to address the systemic inequities in our communities and across our health care system – and reduce maternal mortality and poor infant health outcomes in our communities of color.

 In 2021, many Black women still face real barriers to accessing quality care. These may include logistical barriers such as a lack of transportation or childcare; or social barriers, such as systemic racial bias. The term systemic racism applies to stressors that are baked into the system – through policy decisions over many years and decades that disfavor Black people, and particularly Black women.

 In an August 2020 article for Vox.com, Anna North writes that, according to experts on maternal health, “…the COVID-19 crisis is only exacerbating the discrimination that Black patients and other patients of color already face from providers — one of the main drivers behind their higher rates of maternal mortality.”

 There are reasons people avoid or have lost faith the healthcare system – resulting in delays in seeking help until it’s too late, or a lack of confidence that their problems will be sufficiently identified and addressed. Data shows that providers do not listen to women in general, and to Black women less often. Consider Serena Williams following the birth of her daughter in 2018. She had a history of life-threatening pulmonary embolisms. One day after her daughter’s birth, she alerted a nurse to shortness of breath. Recognizing the potential serious issue, Williams requested a CT scan and blood thinner. But her requests were ignored and an ultrasound was performed instead, finding nothing. A follow-up CT scan showed a small blood clot in her lungs. If Williams had not advocated for herself, the blood clot could have been deadly. Providers may lack cultural competence and are shown to ignore input from Black women and their children about their levels of pain, among other things, and to dismiss their claims. Perception and reality combine to keep people out of the health system. This is a cost our entire society bears, and a situation that must be addressed.

 Some statistics to consider:

• Thirteen out of 100,000 White women die from pregnancy-related complications compared with 41 out of 100,000 Black women.
• Black infants are twice as likely to die compared with their white counterparts.
• At a time when mental health is a critical issue facing so many in our nation, our Black mothers are struggling at higher rates. Mental health is one of the most common complications of pregnancy and childbirth, affecting 1 in 5 women during pregnancy or in the first year after pregnancy. Black mothers are more likely to experience these mental health conditions and are far less likely to seek treatment.
• While the health benefits of breast feeding are clear, fewer Black babies are breastfed compared with White babies – 66% vs. 82%.

 These numbers tell an important story about the health of minorities in our country, particularly Black women.

 We must improve the health of Black women by addressing several factors that impact their health. Specifically, there are opportunities to:

•  Address Equity: This starts by training our providers – doctors, nurses and others –to provide culturally competent care that gives Black women a voice in their care that focuses on serving their physical, mental and social needs.
• Address Access: Find ways to remove barriers - from transportation to child care to language – in order to enable Black women to more easily access the health care they need. And, ensure that Black women can access mental and physical care before, during and after pregnancy.
• Address Implicit Bias in Health Care: Bias in health care, sometimes unintended or implicit, prevents Black and Brown patients from accessing the best care, being referred to a specialist or receiving pain medication when they need it or request it. We must address this bias and train our providers to listen and provide equitable care to their patients.
• Address Education: Help Black mothers and mothers-to-be overcome stigmas around health care and respect when they advocate for themselves. Additionally, we must provide appropriate education to help them navigate care options and advocate for their choices as mothers. We must help them navigate the system and hold us accountable for providing them the highest level of care.

 We can all play a role in making sure our health care system is meeting the needs of all patients, including Black women. We must learn to listen and truly hear these patients and then partner to ensure equitable care that meets their needs.