My mother delivered my twin brother and me by an emergency C-section eight weeks premature, two decades ago. At the hospital, doctors told my parents that they needed to take immediate action to save my mother’s life, as well as ours. While our traumatic birth experience was not the one my mother imagined, it is not uncommon for Black women in the United States.
My mother reflects that after a sudden spike in blood pressure at an OB/GYN appointment, she was sent to the hospital for monitoring. There she learned she had both preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). Overnight, her condition worsened, leading doctors to make the life-saving decision to perform the C-section, despite my brother and me not yet having fully-developed lungs.
After an initial wave of relief, my mother’s precarious journey continued. She remained hospitalized after giving birth so doctors could lower her blood pressure and recover from the C-section. She vividly recalls feeling fearful because of the uncertainty surrounding her health and ours – we remained apart from her in a neonatal intensive care unit (NICU). Fortunately, thanks to health insurance and a reliable monitoring device that sent critically important information to nurses about our health, she was able to take paid leave from work and save our lives.
Not everyone is as lucky to have the positive outcome that we had. Even when access to quality healthcare is there, “luck” is a factor when it shouldn’t be. In particular, our system is failing Black mothers, and society must rally to do more to save them.
Maternal Mortality in Black Women on the Rise
Since I was born, technology has advanced, yet the Black maternal mortality crisis has worsened. The CDC’s National Vital Statistics System shows cases of maternal mortality increasing from 754 deaths in 2019 to 861 deaths in 2020. The maternal mortality rate for Black women was nearly three times more than the rate for White women – 55.3 deaths per 100,000 live births. Preeclampsia is 60% more common in Black women than White women and Black women are at higher risk for HELLP syndrome and postpartum hemorrhage. These disparities increase by maternal age and persist across levels of educational attainment. America’s health outcomes for mothers are some of the worst, especially among Black women.
Social determinants of health drive these disparities; a report published by the Kaiser Family Foundation reveals access to care, health insurance coverage, and systemic racism all contribute to big differences in care and health outcomes. Notably, Black women are less likely to receive routine medical care, and when they do, they experience a lower quality of care than White women (controlling for insurance status, income, age, and severity of conditions.)
What cannot be understated is the role that racism and discrimination play in maternal health outcomes. Provider discrimination during pregnancy, delivery, and the postpartum period leads to maternal deaths when providers under-communicate or fail to listen to patients. This alarming trend was highlighted by stories like the one recently shared by Serena Williams, who almost died because healthcare providers ignored her concerns about blood clots.
There’s work to be done
My colleague Tayla Mahmud, EVP of Health Equity and Multicultural Strategy, said it well: “The health system is failing Black mothers in many ways. As Black maternal health statistics move in the wrong direction – the time is now to re-evaluate current efforts. Health entities have a responsibility to reexamine how existing practices and programs are contributing to inequitable care. From policies and community programs to culturally-relevant communications, there’s work to be done at every end of the system to improve access and care throughout the Black mother’s journey.”
Here’s my call-to-action:
Targeted Policies Most pregnancy-related deaths are preventable. We need to expand access to healthcare and healthcare coverage by supporting bills which aim to close gaps in access to quality maternal care. Policies that address systemic racism and comprehensive care free from bias and discrimination will go a long way in improving maternal mortality rates and outcomes.
Addressing social determinants of health The entire healthcare system must address unequal social determinants of health that contribute to racial disparities, including safe housing, adequate nutrition, paid leave, and access to healthcare and insurance coverage, including through Medicaid.
Better training for healthcare providers Racial stereotypes must be debunked to ensure providers are trained to treat all patients equally. A 2018 study found doctors often view men with chronic pain as brave, but women as “emotional” or “hysterical.” Some medical professionals were incorrectly taught that Black people have a higher pain tolerance, leading to disparities in pain management. Medical illustrations in textbooks and at doctor’s offices ought to be more inclusive, featuring people of color. As diversity in the healthcare workforce expands, training should ensure standard care includes addressing social and cultural determinants that impact a mother’s health. As diversity in the healthcare workforce expands, training should ensure standard care includes addressing social and cultural determinants that impact a mother’s health.
Better quality of care Communication between medical professionals and expectant mothers can be improved, ensuring safer pregnancies, deliveries, and postpartum experiences – free from judgment and discrimination. Black women should expect, demand and receive patient-centered, culturally-competent care that focuses on individualized needs to feel safe enough to attend medical appointments throughout their maternal journey. Providers need to focus on the mother and the baby since some 45% of postpartum maternal deaths happen in the weeks following delivery.
While my mother is incredibly grateful for the care we received, stories like hers should not be so common. Let’s work to give Black mothers and their babies the births they deserve.