Ebony J. Ford
Black Maternal Health Week 2021
The month of April is recognized in the United States as National Minority Health Month – a month-long initiative to advance health equity across the country on behalf of all racial and ethnic minorities. April 11 –17 is recognized as
Black Maternal Health Week (BMHW). BMHW was founded and led by the Black Mamas Matter Alliance. It was created to be a week of awareness, activism, and community building intended to:
Deepen the national conversation about Black maternal health in the US;
Amplify community-driven policy, research, and care solutions;
Center the voices of Black Mamas, women, families, and stakeholders;
Provide a national platform for Black-led entities and efforts on maternal health, birth and reproductive justice; and
Enhance community organizing on Black maternal health.
According to the CDC, approximately 700 women die each year in the United States as a result of pregnancy or delivery complications. Even more alarming are the racial and ethnic disparities that exist in pregnancy-related deaths. Overall pregnancy related mortality in the United States occurs at an average rate of 17.2 deaths per 100,000 live births. However, that number jumps to 43.5/100,000 for non-Hispanic Black women and decreases to 12.7/100,000 for non-Hispanic white women and 11/100,000 for Hispanic women. This means that Black women are three to four times more likely to experience a pregnancy-related death than white women and hispanic women.
For every maternal death there are 70 cases considered “near misses.”
I WAS A NEAR MISS!! The rate of maternal mortality for black women living in right here in the nation's capitol is 59.7 deaths per 100,000 live births. How, in the place where decisions are made concerning third world countries like Syria, do we have a worse mortality rate than them? And that’s just the LIVE BIRTHS!! All of these statistics are LIVE births! What about the women who experience stillbirth or those who die along with their babies? THEY AREN'T INCLUDED!! Why don't we know those statistics? Why aren't they readily available?
SO WHY ARE BLACK WOMEN MORE LIKELY TO DIE?
Black women in the United States experience unacceptably poor maternal health outcomes, including disproportionately high rates of death related to pregnancy or childbirth. Both societal and health system factors contribute to high rates of poor health outcomes and maternal mortality for Black women, who are more likely to experience barriers to obtaining quality care and often face racial discrimination throughout their lives.
REASON 1: Due to racism, sexism and other systemic barriers that have contributed to income inequality, Black women are typically paid just 63 cents for every dollar paid to white, non-Hispanic men. Median wages for Black women in the United States are $36,227 per year, which is $21,698 less than the median wages for white, non-Hispanic men. These lost wages mean Black women and their families 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, face greater financial barriers to care when they need it and are less likely to access prenatal care. Black women experience higher rates of many preventable diseases and chronic health conditions including diabetes, hypertension and cardiovascular disease. When, or if, Black women choose to become pregnant, these health conditions influence both maternal and infant health outcomes.
REASON 2: Black women experience more maternal health complications than white women. Black women are more likely to experience complications throughout the course of their pregnancies than white women. For example, Black women are three times more likely to have fibroids (benign tumors that grow in the uterus and can cause postpartum hemorrhaging) than white women, and the fibroids occur at younger ages and grow more quickly for Black women. Black women also display signs of preeclampsia earlier in pregnancy than white women. This condition, which involves high blood pressure during pregnancy, can lead to severe complications including death if improperly treated. And lastly, Black women experience physical “weathering,” meaning their bodies age faster than white women’s due to exposure to chronic stress linked to socioeconomic disadvantage and discrimination over the life course, thus making pregnancy riskier at an earlier age.
REASON 3: Black-serving hospitals provide lower quality maternity care. 75% of Black women give birth at hospitals that serve predominantly Black populations. Some because of lack of transportation and others because of they feel safest there. I've personally seen this within my hometown. But Black-serving hospitals have higher rates of maternal complications than other hospitals. They also perform worse on 12 of 15 birth outcomes, including elective deliveries, non-elective cesarean births and maternal mortality. The highest ranking hospitals in this area are the most difficult to get to. When I first moved here I was seen at a different University Hospital and the care was especially poor. But I didn’t realize it until I switched care for my pregnancy with Reign (and we know EXACTLY how that turned out).
REASON 4: Many Black women have a difficult time accessing the reproductive health care that meets their needs. Access to reproductive health care, which helps women plan their families, improves health outcomes for women and children. Black women experience higher rates of unintended pregnancies than all other racial groups, in part because of disparities in access to quality contraceptive care and counseling. Many Black women lack access to quality contraceptive care and counseling. For example, in a recent analysis of California women enrolled in Medicaid, Black women were less likely than white or Latina women to receive postpartum contraception, and when they did receive it, they were less likely to receive a highly effective method. Lastly, Black women’s access to abortion is limited, and they may be more likely to experience the ill effects of abortion restrictions — such as delayed care, increased costs or lack of access to care.
So now that we know the issues, HOW DO WE FIX IT?
To improve Black women’s maternal health, we need a multi-faceted approach that addresses Black women’s health across the lifespan, improves access to quality care, addresses social determinants of health and provides greater economic security.
Expand and maintain access to health coverage.
Only 87 percent of Black women of reproductive age have health insurance, and many more experience gaps in coverage during their lives. To improve Black women’s health outcomes, policies should focus on expanding and maintaining access to care and coverage. Women need health coverage throughout their lifespan including access to preventive health care, such as birth control, to maintain their health and to choose when and whether to become a parent. For women who choose to become a parent or expand their families, good prenatal and maternity care are critically important for healthy pregnancies and healthy children. Pregnant women who lack insurance coverage often delay or forgo prenatal care in the first trimester, and inadequate prenatal care is associated with higher rates of maternal mortality. Black women are more likely to live in the South, where women generally experience poorer health outcomes and where many states have chosen not to expand Medicaid coverage, which leaves many Black women in the “coverage gap.” Women fall into the coverage gap because they earn too much to qualify for traditional Medicaid, but not enough to purchase insurance on the Affordable Care Act (ACA) marketplace; as a result, they lack access to health coverage. Expanding Medicaid coverage would improve maternal outcomes for Black women by providing better access to care and reducing financial instability.
2. Provide patient-centered care that's responsive to the needs of
Black women should receive health care that is respectful, culturally competent, safe and of the highest quality. Unfortunately, research shows that Black women receive a lower quality of care than white women. Much too often, Black women are subject to discrimination in the health care field — 22 percent report discrimination when going to the doctor or clinic. Public policies and medical practice should incentivize providing patient-centered care that focuses on Black women’s individualized needs, including non-clinical, social needs. Moreover, policies should endeavor to eradicate cultural biases and discrimination in medical practice and medical education, increase provider diversity in maternity care and hold individual providers and hospital systems accountable if they fail to provide unbiased, high-quality, evidence-based care.
3. Address the social determinants of health.
Social determinants of health are the conditions under which people live, work and play. Social determinants have consequential and varying effects on health outcomes across race and ethnicities. For Black women who are affected by structural inequality and discrimination, the chronic stress of poverty and racism has been shown to have a deleterious effect on health outcomes and is linked to their persistent maternal health disparities. To improve Black maternal health outcomes, social determinants of health must be addressed through policies that raise incomes and build wealth; provide access to clean, safe and affordable housing; improve the quality of education; prioritize reliable public transportation and transport for medical appointments; and increase the availability of healthy, affordable food.
I know that after reading this you may be thinking that there's nothing you can do. After all politicians are the ones who make the decisions. But did you know that with the click of a mouse, you can write to all of your local officials? Click HERE to access March of Dimes Advocacy Toolkit that has links to sample scripts when calling your local officials as well as the standard letter to send to your representative and senator. I hope that after reading this, you're inspired to advocate for Black moms and babies. Through my work with March of Dimes, I've been able to advocate or health equity ensuring just that.
To help us further our work, please click HERE to donate to our March For Babies campaign.