Mortality Rates of Women of Color in Underserved Communities
By Damola Thomas and Pearl Omo-sowho
The mortality rate of both women of color and their unborn children is an unfortunate statistic that continues to rise. A woman of color is two or three times more likely to die from pregnancy-related complications than a white woman. [2] For the last fifty years, Black women who have given birth in the United States have been approximately four times more likely to die than white women. [3]
The medical racism that women of color in underserved communities face is a driving factor of the increasing mortality rate of both mothers and their unborn children. Women of color often have to deal with injustices such as disbelief when explaining pre-existing conditions, failure to receive the proper care needed, or not being treated with the basic compassion that other patients would receive. The long-standing systemic racism that we see in medicine—in addition to the history of oppressive reproductive policies and ideologies—results in the devaluation of certain lives.
The non-profit organization 4Kira4Moms was founded by Charles Johnson IV when his wife Kira Johnson passed away after the birth of their second son in 2016. Kira was in good health throughout her pregnancy and was ecstatic to give birth at Cedar Sinai Medical Center, a world-renowned hospital. Unfortunately, moments after Kira gave birth, Kira’s husband noticed blood in her catheter. They thought it would be regarded as an immediate concern after bringing it to the nurse’s attention, but it took several hours before an internal exam was conducted. Kira Johnson died less than twelve hours after giving birth. Through this organization, Charles Johnson has created a united voice for women like Kira who have gone through this insufferable experience. There is a community of women and families who have had to endure this pain, and this organization has also worked to bring more awareness to the specific neglect that women of color face during their pregnancies.
“High blood pressure and cardiovascular disease are two of the leading causes of maternal death, according to the Centers for Disease Control and Prevention, and hypertensive disorders in pregnancy, including pre-eclampsia, have been on the rise over the past two decades, increasing 72 percent from 1993 to 2014.” [1]
The complications of pregnancy often begin prior to when a woman is impregnated with a child. There are many women who are uninsured and lack access to primary care, including information about contraceptives and its services. The cost of healthcare makes comprehensive primary care visits nearly impossible for women of color who are uninsured prior to pregnancy. Furthermore, these women are more likely to become pregnant with unmanaged chronic health conditions that heighten risks in pregnancies. Improving the health of women across a life course is a step forward towards ensuring safer health for women of color.
All women deserve to safely go through pregnancy, one of life’s most transformative experiences, with the support of their family and physicians along with their local healthcare system. This means women of color should not have to worry about the quality that their local healthcare system will provide. There will need to be a significant shift in the care they receive present-day. This necessary shift will require initiative and commitment from various systems to address the factors affecting these disparities.
The CDC recommends that hospitals and healthcare systems start with the following to provide safer deliveries for women of color: communities that are disproportionately affected should have protocols for quality improvement initiatives implemented and the implicit biases in the healthcare system should be identified and addressed, which could lead to improvement in patient-provider interactions, health communications, and health outcomes. [2]
One way to reduce mortality rates of these women could be increasing diversity in health care. Patients will feel more understood if there were health care workers who looked like them. These women could have an improved experience on their journey to motherhood if they felt comfortable with the people taking care of them. If there were more clinics and workshops that informed women of color about pregnancy, expecting mothers could be more prepared when meeting with physicians. Women of color in underserved communities could benefit from these workshops and clinics. Creating a more effective plan to grow health outreach, especially regarding access and quality of care, for women is a positive step towards making sure preventative health is more regularly and consistently practiced.
Other approaches to improve women of color’s maternal health include: expanding protection for pregnant workers because pregnancy discrimination has many of serious consequences for women and their families, expand paid family and medical leave because the care of mother and child does not stop right after delivery, and most importantly, providing patient-centered care responsive to the needs of Black women, including non-clinical and social needs.
Initiatives being carried out by Medicaid to improve maternal and child health for women of color include programs such as the Children’s Health Insurance Program (CHIP), which in collaboration with Medicaid, aims to provide nationwide coverage for low-income women pregnant women and children, assisting women of color who have the highest uninsured percentages as well as lack of access to quality health care. There has been interest at the state and federal level in extending the postpartum Medicaid eligibility period to further reduce coverage losses for women at the end of the period. In addition, there are efforts to expand benefits and implement new payment and delivery models. [5] There is a need for more of these initiatives both statewide and federally in order to contribute to the improvements of maternal and child health in communities of color and to work towards reducing racial disparities.
Every day, families with women of color who are pregnant face the fear of their mothers, sisters, or wives not living to see the next day. These women are not able to enjoy the journey leading to motherhood because of the uncertainty they may have with the healthcare they are provided. Hopefully, the day will come where women in underserved communities are confident in knowledge of and compassion from their healthcare system and can start this new journey in their life safely and happily.
Sources
[1] Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis (Linda Villarosa, The New York Times)
[2] Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths (CDC Newsroom)
[3] Maternal mortality in the United States: a human rights failure (Debra Bingham, Contraception Journal)
[4] Foundation Established After Black Mom Dies From Childbirth Complications Because Doctors Ignored Her For 7 Hours (BlackNews)
[5] Medicaid Initiatives to Improve Maternal and Infant Health and Address Racial Disparities (Artiga et al., Kaiser Family Foundation)
Damola Thomas is a third-year Pre-Psychobiology major at UCLA. Pearl Omo-sowho is a fourth-year Human Biology and Society major at UCLA. Damola and Pearl are both THINQ 2020–2021 clinical fellows.
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