Black maternal mortality in the United States

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Black maternal mortality in the United States refers to the incidence of maternal mortality in the U.S. specifically for those identifying as black or African American. Maternal death is described as the death of a woman either during pregnancy or within 42 days of the end of the pregnancy. This death can be due to how the pregnancy was handled or the pregnancy itself, but is not associated with unintentional or secondary causes.[1] Between 1897 and 2016, the maternal mortality rates in the United States more than doubled, while the maternal mortality rates around the world had seen an overall decrease.

There have been significant differences between the maternal mortality of white women versus black women throughout history. In the U.S., the CDC reported that black women experience maternal mortality at a rate two to three times higher than that of white women. The estimated national maternal mortality rate in the United States is about 17 per 100,000 live births–but is about 43 per 100,000 live births for black women.[2] Furthermore, data from the CDC Pregnancy Surveillance Study that shows these higher rates of black maternal mortality are due to higher fatality rates, not a higher number of cases. This indicates that the higher maternal mortality rates among black women is not due to a larger number of high-risk cases, but because black women are more likely to die during or after giving birth at a disproportionate rate. Since the usual causes of maternal mortality are conditions that occur or are exacerbated during pregnancy, most instances of maternal mortality are preventable deaths.[3] There has been more notice of these statistics recently, as more emphasis is being placed on minimizing these racial/ethnic disparities seen in maternal mortality.[4] Researchers have identified several reasons for the black–white maternal mortality disparity in the U.S., including historical context, access to healthcare, socioeconomic status, incidence of preexisting conditions, medical racism, and abortion access, all of which are social determinants of health in the United States.

Historical context[]

Distrust of health institutions[]

A photograph of a participant of the Tuskegee syphilis study

The historical context of institutionalized racism in the United States has had the effect of black people having to deal with medical and scientific racism, making the black community less likely to trust medical institutions and professionals, due to previous exploitation and abuse.[5] Medicine and healthcare has been plagued with racial injustices for many years.[6] Slavery had caused black bodies to be seen as less then—something that could be used for entertainment or exploitation. An article in the American Journal of Public Health describes that laws making enslavement an inheritable status increased the scrutiny of black women and forced them into bearing children for the economic gain of their enslavers. In addition, many medical and surgical techniques were developed by exploiting the bodies of enslaved black women.

Sarah Baartman was a Hottentot woman who was paraded around in circuses around 1810-1820. She was taken from the Cape to London, presented as the "Hottentot Venus" on account of the fact that her buttocks were considered abnormally large by Europeans.[7] After her death, French scientist George Carvier anatomized her body in order to measure her genitalia along with other body parts. A cast of her body, skeleton, brain, and a wax mold of her genitalia were once on display in a museum.[8]

The Tuskegee Syphilis Study occurred from 1932 until 1972, where 600 economically disadvantaged African American men were unknowingly used by researchers to track the progression of syphilis, resulting in subjects going blind, insane, or experiencing other severe health problems.

A more mild, but equally horrifying example of Black bodies being exploited is Henrietta Lacks, a Black woman who had samples taken of her cancerous cells without her knowledge. This tissue was given to researcher George Gey. It was found that Lacks' cells have a remarkable capability to survive and reproduce. For years after her death, scientists continued to use her cells, released her name, and released medical records to the media without her family's consent.[9] This legacy has persisted into modern times and has made Black women less likely to trust the medical community.[10] The battle of Henrietta's bodily rights is not over yet though. On October 4, 2021, the Lacks' estate announced that they will be suing the biotechnology company named Thermo Fisher Scientific Inc., who says they have the intellectual rights of the HeLa cells. Lawyers for Henrietta's surviving family say the biotechnology company has continued to profit off the cells well after the origins of the HeLa cell line became well known. "The exploitation of Henrietta Lacks represents the unfortunately common struggle experienced by Black people throughout history," the suit says.[11] The blatant disregard of the worth of Black people in healthcare has left Black people more untrusting of medical institutions, and provides more context into why Black mother may be perishing at a higher rate.

Causes[]

Access to maternal care[]

Both prenatal care and postnatal are used to support pregnant women at different stages and monitor potential risk factors in order to make pregnancy and delivery as safe and healthy as possible. The literature shows that increasing access to prenatal care through public health departments caused a subsequent decrease in black maternal mortality rates.[12][13] Furthermore, having fewer than 5 prenatal care visits, not attending prenatal care appointments, and accessing prenatal care later in a pregnancy are associated with maternal mortality. Black women are less likely to initiate prenatal care, with 10% of black women receiving late (third trimester) or no prenatal care, compared with 4% of white women.[14]

"Maternal care deserts" are an important factor when it comes to access to prenatal and postnatal care. A maternal care desert is defined as a county with no hospital offering obstetric care and no OB/GYN or certified nurse midwife providers.[15] Around 15 million women live in these maternity care deserts, with many of these women being minorities. A study done on the relation of maternal care deserts and pregnancy associated mortality found that "the risk of death during pregnancy and up to 1 year postpartum owing to any cause (pregnancy-associated mortality) and in particular death owing to obstetric causes (pregnancy-related mortality) was significantly elevated among women residing in maternity care deserts compared with women in areas with greater access."[15] Other obstacles such as lack of providers accepting public insurance such as Medicaid and transportation requirements to get to prenatal appointments affect black women more than white women in the United States.[12]

Intersection of race, socioeconomic status, and disability[]

Income has been well studied as a social determinant of health, and it has been found that worse health outcomes at all-time points surrounding pregnancy are associated with lower socioeconomic status and income levels. Lack of insurance/using Medicaid and experiencing homelessness are associated with severe morbidity rates, and are all more likely to apply to black women and increase their risk of maternal death.[12]

Systemic racism contributes to the greater likelihood of black women to belong to lower socioeconomic classes. However, it is important to note that Black women across all socioeconomic statuses and education levels experience the same extent of racism both during the birthing process and after, as noted in Black women’s experiences in the Neonatal Intensive Care Unit following birth.[16] A study from the Nature Public Health Collection journal pointed out that the COVID-19 pandemic increases the vulnerability of black women who are more likely to work at jobs that carry greater exposure risks to COVID-19, and more likely to lose income due to unemployment. This is in addition to the pandemic making accessing perinatal care more challenging, and making income disparities even more stark. The researchers who authored this study recommend that the interlocking factors affecting black mothers during the COVID-19 pandemic be specifically addressed in order to see tangible improvements in maternal health outcomes.[17]

More and more women with disabilities are becoming mothers, but few federally-funded programs or support services to women with disabilities.[18] Black mothers with disabilities have increased barriers to accessing maternal services, which increases health and mortality risks for the mother. Women with disabilities also have higher pregnancy complications, preterm deliveries, and low birth infants.[19]

Causes of maternal mortality worldwide

Pre-existing conditions[]

A study conducted by Amy Metcalfe, James Wick, and Paul Ronksley analyzing trends in maternal mortality from 1993 to 2012 showed that the percentage of black women with pre-existing conditions increased from about 10% to about 17%, the highest out of all other racial and ethnic groups in the United States. Black women are more likely to have adverse pregnancy outcome which makes them more susceptible to cardiovascular diseases putting them at a greater risk for material mortality.[20] On top of this, black women are more likely to already have pre-existing cardiovascular disease.[21] They also have a greater odd of developing preeclampsia, along with an increased prevalence of chronic disease and obesity.[22] Black women are more likely to have unplanned pregnancies as well–and are thus more likely to lack prior monitoring and treatment of pre-existing conditions before, during, and after the pregnancy.[23]

A different study by Deirdre Owens and Sharla Fett points out that everyday and institutional racism against black people can affect the health of black women, and increase their risk of high blood pressure, which in turn increases the risk of eclampsia, a major cause of pregnancy-related death.[10][24]

Racial bias[]

See also: Medical racism in the United States

There has been thousands of studies analyzing the racial bias against Black people in the healthcare system.[25] Overall, Blacks are less likely to receive the same quality care as their White counterparts. Clinician bias is one of the largest contributors to this disparity. This bias can be either implicit or explicit, but both are harmful to the well-being of Black patients. Explicit biases have generally been measured with self-reports while implicit biases are measured through "validated tests of unconscious association".[25] A lot of empirical evidence strongly suggests that White physicians hold negative implicit racial biases and negative explicit racial stereotypes, which causes them to be influenced by these biases when it comes to making medical decisions for their patients. In turn, this contributes to the racial inequities prominent in the healthcare system.

In general, Black Americans are under-treated for pain when compared with White Americans.[26] Black patients are less likely to receive pain medication, and when they do, they are more liekly to receive a lower quanitity than their White counterparts. This phenomenon contributes to Black maternal mortality, aiding in the dismissal of Black women's pain by medical professionals.[10] A Harvard School of Public Health publication discussed this phenomenon by collecting numerous examples of medical professionals being dismissive or providing delayed care to Black mothers expressing pain or problematic symptoms.[27] The publication tells the story of Shalon Irving, a Black woman who experienced symptoms such as high blood pressure, blurry vision, and hematoma after childbirth. However, her doctors advised her to not take further action, and Irving died soon after. According to the author, this was just one instance of medical caregivers being less likely to take Black women's concerns seriously, contributing to maternal death.[27]

Demonstrator for abortion rights

Maternal morality is connected to racism, with Black women dying from medical issues that are preventable yet not being listened to when they complain about pain. Although the likelihood of poor Black women are more susceptible to the reality of maternal mortality, the risk still exists for other Black women with better resources. For example, world-renowned tennis athlete Serena Williams almost suffered a fatality postpartum when she got a pulmonary embolism. This was a result of the doctors not listening to her when she expressed her health concerns, and not considering those concerns serious enough to be acted upon urgently.[28] According to a study done by the Robert Johnson Fund, over 22% of Black women report discrimination from medical professionals when they are seeking help.[29]

Abortion access[]

Unsafe abortion is a major contributing factor to maternal mortality and morbidity and Black women, who are more likely to have unplanned pregnancies and be of lower socioeconomic status, are more likely to undergo unsafe abortions. Black women have consistently had higher abortion rates than White women, which means that restrictions to safe abortions will disproportionately affect them. And over the last couple of years, access to safe abortions in the United States has become increasingly restrictive.[30] These restrictions include bans on particular methods of abortion care, Targeted Restriction of Abortion Provider (TRAP) laws, and specifically trigger laws which would ban abortion immediately in some states if Roe v. Wade is ever overturned.[31] The lack of access to safe abortions have been exacerbated within the past decades as states pass strict regulations around abortion especially in southern states with higher proportions of African Americans. The World Health Organization recognizes that in order to help decrease maternal mortality, access to safe abortions must be increased. And while few studies have inquired as to whether there is a direct link between unsafe abortion and maternal mortality, the studies that have been done support this link.

Prevention[]

A large proportion of maternal deaths are thought to be preventable, and thus research has been conducted to identify methods to decrease maternal mortality and reduce these health disparities.

Some researchers looking at hospital quality believe that improving the quality of care can help address the maternal mortality disparity in the United States. The authors of one article from the Seminars in Perinatology journal suggest that higher quality hospitals have administrative and physician advocates, collect and use feedback, and have substantial goals they want to achieve. In addition, the capacity for hospitals to offer maternal health-related services, such as an intensive care unit, 24-hour anesthesia, and OB/GYN specialists contributes to maternal mortality rates by hospital. Prioritizing standardizing care in times of crisis and early risk factors may also directly address issues that lead to maternal mortality in black women, such as hypertension, hemorrhage, and eclampsia.[32] Notably, a 2018 initiative in New York City attempting to address the strikingly high levels of black maternal mortality had  healthcare workers undergo implicit bias training, and included a public health component through community-based organizations.[10]

It is also important to recognize that only 87% of black women have health insurance and most have gaps in coverage at some point in their lives. To improve the health of black women, then policies need to be implemented that focus on the expansion and maintenance of the care and coverage.[29]

A 2018 Lancet study employed a health technology system called “Gabby” to assess health risks and pre-existing conditions in black women before conception. The study found that the use of this system to target preconception health risks increased the number of risks that received the necessary attention and treatment.[33] Addressing conditions prior to conception and prenatal care could be an important part of reducing black maternal mortality, as black women are more likely to have unaddressed pre-existing conditions that endanger their health or their child’s health. These conditions can impact the health of the parent or child even before conception occurs, so the use of this kind of system could be beneficial in reducing adverse outcomes.

In addition, experts in medicine, sociology, and law have said that deliberately addressing racism,  both within and outside of the medical field, is necessary. Some have argued against the conventional classification of race as a risk factor in health, instead calling for the recognition of racism and poverty as the underlying factors contributing to black maternal mortality and other poor health outcomes for black people.[10]

See also[]

References[]

  1. ^ Oribhabor, Geraldine I; Nelson, Maxine L; Buchanan-Peart, Keri-Ann R; Cancarevic, Ivan (2020-07-15). "A Mother's Cry: A Race to Eliminate the Influence of Racial Disparities on Maternal Morbidity and Mortality Rates Among Black Women in America". Cureus. 12 (7): e9207. doi:10.7759/cureus.9207. ISSN 2168-8184. PMC 7366037. PMID 32685330.
  2. ^ "Racial Disparities Persist in Maternal Morbidity, Mortality and Infant Health". AJMC. Retrieved 2020-10-22.
  3. ^ MacDorman, Marian F.; Thoma, Marie; Declcerq, Eugene; Howell, Elizabeth A. (September 2021). "Racial and Ethnic Disparities in Maternal Mortality in the United States Using Enhanced Vital Records, 2016‒2017". American Journal of Public Health. 111 (9): 1673–1681. doi:10.2105/ajph.2021.306375. ISSN 0090-0036. PMC 8563010. PMID 34383557.
  4. ^ Oribhabor, Geraldine I; Nelson, Maxine L; Buchanan-Peart, Keri-Ann R; Cancarevic, Ivan (2020). "A Mother's Cry: A Race to Eliminate the Influence of Racial Disparities on Maternal Morbidity and Mortality Rates Among Black Women in America". Cureus. 12 (7): e9207. doi:10.7759/cureus.9207. ISSN 2168-8184. PMC 7366037. PMID 32685330.
  5. ^ "The Impact of Institutional Racism on Maternal and Child Health". NICHQ - National Institute for Children's Health Quality. Retrieved 2020-10-22.
  6. ^ Nuriddin, Ayah; Mooney, Graham; White, Alexandre I R (October 2020). "Reckoning with histories of medical racism and violence in the USA". The Lancet. 396 (10256): 949–951. doi:10.1016/s0140-6736(20)32032-8. ISSN 0140-6736. PMC 7529391. PMID 33010829.
  7. ^ Jansen, Jonathan; Walters, Cyrill, eds. (2020-04-01). Fault Lines: A primer on race, science and society. doi:10.18820/9781928480495. hdl:10019.1/109577. ISBN 9781928480495. S2CID 229145601.
  8. ^ The gender and science reader. Muriel Lederman, Ingrid Bartsch. London: Routledge. 2001. ISBN 0-415-21357-6. OCLC 44426765.{{cite book}}: CS1 maint: others (link)
  9. ^ "Henrietta Lacks: science must right a historical wrong". Nature. 585 (7823): 7. 2020-09-01. Bibcode:2020Natur.585....7.. doi:10.1038/d41586-020-02494-z. PMID 32873976. S2CID 221466551.
  10. ^ a b c d e Owens, Deirdre Cooper; Fett, Sharla M. (2019-08-15). "Black Maternal and Infant Health: Historical Legacies of Slavery". American Journal of Public Health. 109 (10): 1342–1345. doi:10.2105/AJPH.2019.305243. ISSN 0090-0036. PMC 6727302. PMID 31415204.
  11. ^ Press, The Associated (2021-10-04). "Henrietta Lacks' estate sued a company saying it used her 'stolen' cells for research". NPR. Retrieved 2021-10-19.
  12. ^ a b c Gadson, Alexis; Akpovi, Eloho; Mehta, Pooja K. (2017-08-01). "Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome". Seminars in Perinatology. Strategies to reduce Racial/Ethnic Disparities in Maternal Morbidity and Mortality. 41 (5): 308–317. doi:10.1053/j.semperi.2017.04.008. ISSN 0146-0005. PMID 28625554.
  13. ^ NAM JIN YOUNG; Eun-Cheol Park (May 2018). "The Association between Adequate Prenatal Care and Severe Maternal Morbidity: A Population-based Cohort Study". Journal of the Korean Society of Maternal and Child Health. 22 (2): 112–123. doi:10.21896/jksmch.2018.22.2.112. ISSN 1226-4652.
  14. ^ Gadson, Alexis; Akpovi, Eloho; Mehta, Pooja K. (August 2017). "Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome". Seminars in Perinatology. 41 (5): 308–317. doi:10.1053/j.semperi.2017.04.008. ISSN 0146-0005. PMID 28625554.
  15. ^ a b Wallace, Maeve; Dyer, Lauren; Felker-Kantor, Erica; Benno, Jia; Vilda, Dovile; Harville, Emily; Theall, Katherine (March 2021). "Maternity Care Deserts and Pregnancy-Associated Mortality in Louisiana". Women's Health Issues. 31 (2): 122–129. doi:10.1016/j.whi.2020.09.004. ISSN 1049-3867. PMC 8005403. PMID 33069560.
  16. ^ Davis, Dána-Ain (2019). Reproductive Injustice: Racism, Pregnancy, and Premature Birth. New York: New York University Press.
  17. ^ "PRIME PubMed | Syndemic Perspectives to Guide Black Maternal Health Research and Prevention During the COVID-19 Pandemic". www.unboundmedicine.com. Retrieved 2020-10-09.
  18. ^ Long-Bellil, Linda; Valentine, Anne; Mitra, Monika (2021), Lollar, Donald J.; Horner-Johnson, Willi; Froehlich-Grobe, Katherine (eds.), "Achieving Equity: Including Women with Disabilities in Maternal and Child Health Policies and Programs", Public Health Perspectives on Disability: Science, Social Justice, Ethics, and Beyond, New York, NY: Springer US, pp. 207–224, doi:10.1007/978-1-0716-0888-3_10, ISBN 978-1-0716-0888-3, S2CID 225010310, retrieved 2021-10-09
  19. ^ Mheta, Doreen; Mashamba-Thompson, Tivani P. (2017-05-16). "Barriers and facilitators of access to maternal services for women with disabilities: scoping review protocol". Systematic Reviews. 6 (1): 99. doi:10.1186/s13643-017-0494-7. ISSN 2046-4053. PMC 5432992. PMID 28511666.
  20. ^ Lister, Rolanda L; Drake, Wonder; Scott, Baldwin H; Graves, Cornelia (2019). "Black Maternal Mortality-The Elephant in the Room". World Journal of Gynecology & Women's Health. 3 (1). doi:10.33552/wjgwh.2019.03.000555. ISSN 2641-6247. PMC 7384760. PMID 32719828.
  21. ^ Lister, Rolanda L (2019-11-22). "Black Maternal Mortality-The Elephant in the Room". World Journal of Gynecology & Women's Health. 3 (1). doi:10.33552/wjgwh.2019.03.000555. ISSN 2641-6247. PMC 7384760. PMID 32719828.
  22. ^ Kuriya, Anita; Piedimonte, Sabrina; Spence, Andrea R.; Czuzoj-Shulman, Nicholas; Kezouh, Abbas; Abenhaim, Haim A. (2016-02-18). "Incidence and causes of maternal mortality in the USA". Journal of Obstetrics and Gynaecology Research. 42 (6): 661–668. doi:10.1111/jog.12954. ISSN 1341-8076. PMID 26890471. S2CID 1087698.
  23. ^ Metcalfe, Amy; Wick, James; Ronksley, Paul (2018). "Racial disparities in comorbidity and severe maternal morbidity/mortality in the United States: an analysis of temporal trends". Acta Obstetricia et Gynecologica Scandinavica. 97 (1): 89–96. doi:10.1111/aogs.13245. ISSN 1600-0412. PMID 29030982. S2CID 207028740.
  24. ^ Chandler, Rasheeta. “Sexual and Reproductive Health Knowledge Gaps Identified by Black Women: Considerations for the Nurse Educator.” ABNF Journal, vol. 31, no. 3, Summer 2020, pp. 88–94. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=c9h&AN=147546585&site=eds-live&scope=site.
  25. ^ a b van Ryn, Michelle; Burgess, Diana J.; Dovidio, John F.; Phelan, Sean M.; Saha, Somnath; Malat, Jennifer; Griffin, Joan M.; Fu, Steven S.; Perry, Sylvia (2011-04-01). "The Impact of Racism on Clinician Cognition, Behavior, and Clinical Decision Making". Du Bois Review : Social Science Research on Race. 8 (1): 199–218. doi:10.1017/S1742058X11000191. ISSN 1742-058X. PMC 3993983. PMID 24761152.
  26. ^ FitzGerald, Chloë; Hurst, Samia (2017-03-01). "Implicit bias in healthcare professionals: a systematic review". BMC Medical Ethics. 18 (1): 19. doi:10.1186/s12910-017-0179-8. ISSN 1472-6939. PMC 5333436. PMID 28249596.
  27. ^ a b Boston, 677 Huntington Avenue; Ma 02115 +1495‑1000 (2018-12-18). "America is Failing its Black Mothers". Harvard Public Health Magazine. Retrieved 2020-10-22.
  28. ^ 43 Campbell L. Rev. 243 (2021) Can You Hear Me?: How Implicit Bias Creates a Disparate Impact in Maternal Healthcare for Black Women, Glover, Kenya [ 34 pages, 243 to [vi] ]
  29. ^ a b "Black Women's Maternal Health". www.nationalpartnership.org. Retrieved 2021-10-19.
  30. ^ Verma, Nisha; Shainker, Scott A. (August 2020). "Maternal mortality, abortion access, and optimizing care in an increasingly restrictive United States: A review of the current climate". Seminars in Perinatology. 44 (5): 151269. doi:10.1016/j.semperi.2020.151269. ISSN 1558-075X. PMID 32653091. S2CID 220502603.
  31. ^ Ellmann, Nora. "State Actions Undermining Abortion Rights in 2020". Center for American Progress. Retrieved 2021-04-05.
  32. ^ Howell, Elizabeth A; Zeitlin, Jennifer (August 2017). "Improving Hospital Quality to Reduce Disparities in Severe Maternal Morbidity and Mortality". Seminars in Perinatology. 41 (5): 266–272. doi:10.1053/j.semperi.2017.04.002. ISSN 0146-0005. PMC 5592149. PMID 28735811.
  33. ^ Jack, Brian W.; Bickmore, Timothy; Yinusa-Nyahkoon, Leanne; Reichert, Matthew; Julce, Clevanne; Sidduri, Nireesha; Martin-Howard, Jessica; Zhang, Zhe; Woodhams, Elisabeth; Fernandez, Juan; Loafman, Mark (2020-09-01). "Improving the health of young African American women in the preconception period using health information technology: a randomised controlled trial". The Lancet Digital Health. 2 (9): e475–e485. doi:10.1016/S2589-7500(20)30189-8. ISSN 2589-7500. PMID 33328115.
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