Attacking America’s Black Maternal Health Crisis
Jasmine Clemons, NLC Capital District NY
It seems as if each week, another media story is released detailing another tragic moment in the ongoing Black maternal health epidemic. Many of these stories advocate for the expansion of pre- and post-natal Medicaid services to improve conditions of lower-income Black mothers, an act that would indeed improve many outcomes. But, a 2016 study found that in NYC hospitals, Black, college-educated mothers still had higher rates of severe maternal morbidity than women of all other ethnicities who never graduated high school.[1]Additionally, most of us are very familiar with Serena Williams’ near death experience delivering her Grand Slam winning daughter, Alexis Olympia. Both anecdotes are grim reminders to myself and women like me, that just like other areas of our Black lives, our privileges still won’t protect us.
Most of these write ups avoid calling out the real issue: racism. Racism and bias are responsible for America’s shameful Black maternal mortality rate, both in systemic, historical practice and through individual actors. Our gynecological history was built on foundation of racism, as Dr. J. Marion Sims, the field’s “founder”, surgically experimented on enslaved Black women without anesthesia because he believed them to have a higher pain tolerance than the white women he would later hone his techniques upon.[2]Over one hundred and thirty years after his death, white medical students and residents are found to still hold false beliefs in Black pain perception and thresholds.[3]These kinds of false perceptions keep providers from taking Black women seriously when they complain of pregnancy or labor related complications, which can have tragic results.
Our country’s history of redlining and segregation has also produced disparate delivery of healthcare, especially in hospital services. Most women look to give birth near their homes and for expectant Black women, where you live and give birth can play a huge factor in your delivery outcomes. Seventy-four percent of Black women deliver at predominantly Black population serving hospitals and this concentrated group of hospitals has high rates of poor maternal outcomes.[4]Compared to their non-Black counterparts, these Black-serving hospitals perform worse on 12 out of 15 birth outcomes, which include trauma, non-elective cesarean birth, and maternal mortality.[5]Clearly, hospitals are not delivering the same quality of care across populations and Black women, whose options can be limited due to accessibility, pay a dire cost for this disparity.
Lastly, we must acknowledge societal racism and its direct effects of Black women. Linda Villarosa of the New York Timesrecently wrote extensively on the myriad of ways that the lived experience of being both Black and a woman is affecting our maternal health outcomes. She points to numerous studies that detail the variety of ways that the stress of racism impacts Black women; from the presences of higher measures of stress-related body chemicals than other demographics, to growing evidence that social maternal stress as a cause of lower birth weights and preterm births of babies born to Black mothers.[6]Villarosa is one of the few major journalists to directly identify racism as the source of the disparity, but more voices are needed.
As with all manifestations of racism in America, the only way to solve the Black maternal health crisis is by being intentional with our reformative actions. The health, safety and well-being of Black women has traditionally been an afterthought in our society, but it is imperative that our state and Federal governments prioritize creating an equitable health care system while we dismantle societal pillars of racist and sexist oppression.
1) Standard practice of care: Development and implementation of standard protocols for handling most common obstetric emergencies has been proven to reduce severe maternal incidents and thus decrease mortality rates. California, for instance, has halved its overall maternal mortality rate through several measures but most noticeably through distribution of a hemorrhage toolkit, which includes evidence-based best practices, protocols, and tools hospital obstetrics wards should have on hand and readily accessible. These standard protocols also can help mitigate the impact of provider implicit biases, as they are following an evidence-based checklist rather than assumptions based on the patient’s appearance.
However, even with the overall maternal mortality decrease, California Black mothers are over five times more likely to die than Latina women and over three times more likely than white women, showing a continued disparity.[7]This calls for a continued standard review of the causes of maternal death, something not done federally at this time and only in some states.
2) Medicaid penalty: The NYC Health Department determined that severe maternal complications cost the city more than $17 million a year,[8]and hemorrhage complications alone costs California’s Medicaid system over $100 million a year.[9]When one considers that almost half of American births are paid for by Medicaid, there is a financial impact to our current negligence. Similar to how the federal government monitors and publicly reports organ transplant centers and patient outcomes, Medicaid should publicize hospital mortality rates and penalize facilities that do not improve their maternal mortality outcomes. Medicare already links quality of services to payment for several health programs, clear evidence that the federal government has the capacity to incentivize providers. If not just the morally correct thing to do. This tactic is fiscally imperative in an era of climbing health care costs.
The American College of Obstetricians and Gynecologists issued a statement in 2015 prioritizing the reduction of racial and ethnic health care disparities. Among the suggestions made included a call for Ob-Gyns to understand the role that practitioner bias can play in health outcomes and encouraged the adoption of federal standards for collection of race and ethnicity data to better identify disparities.[10]By acknowledging the roles individual health providers and the federal government both play in this health crisis, we can continue to identify tools to break down both the systemic and unconscious barriers to equitable maternal healthcare.
Jasmine is an analyst with the federal government in Washington, D.C. A 2016 Capital District NY fellow, she now serves as the Selections Chair on the NLC DC board.
[1]New York City Department of Health and Mental Hygiene, 2016, “Severe Maternal Morbidity in New York City, 2008–2012,” Report, New York, https://www1.nyc.gov/assets/doh/downloads/pdf/data/maternal-morbidity-report-08-12.pdf
[2]L. L. Wall, “The Medical Ethics of Dr J Marion Sims: A Fresh Look at the Historical Record,” Journal of Medical Ethics 32, no. 6 (2006): , doi:10.1136/jme.2005.012559.
[3]Kelly M. Hoffman et al., “Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs about Biological Differences between Blacks and Whites,” Proceedings of the National Academy of Sciences 113, no. 16 (2016): , accessed June 18, 2018, doi:10.1073/pnas.1516047113.
[4]Elizabeth A. Howell et al., “Black-white Differences in Severe Maternal Morbidity and Site of Care,” American Journal of Obstetrics and Gynecology 214, no. 1 (2016): , doi:10.1016/j.ajog.2015.08.019.
[5]Andreea A. Creanga et al., “Performance of Racial and Ethnic Minority-serving Hospitals on Delivery-related Indicators,” American Journal of Obstetrics and Gynecology 211, no. 6 (2014): , doi:10.1016/j.ajog.2014.06.006.
[6]Linda Villarosa, 2018. “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis,” The New York Times, April 11, https://www.nytimes.com/2018/04/11/magazine/black-mothers-babies-death-maternal-mortality.html
[7]Joy Joynt, 2016 Maternity Care in California: Delivering the Data. Almanac, California health Care Foundation https://www.chcf.org/wp-content/uploads/2017/12/PDF-MaternityCareCalifornia2016.pdf.
[8]New York City Department of Health and Mental Hygiene, 2016, “Severe Maternal Morbidity in New York City, 2008–2012.”
[9]Pourat N, Martinez AE, McCullough, JC, Gregory KD, Korst L, Kominski GF. Costs of Maternal Hemorrhage in California. Los Angeles (CA): UCLA Center for Health Policy Research; 2013.
[10]Racial and ethnic disparities in obstetrics and gynecology. Committee Opinion №649. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;126:e130–4.
