Reducing the Black Maternal Mortality Rate in the US
Medically reviewed by Kasirat Jimoh, R.N.
Maternal health is one of the components of primary health care. This aspect of health care should be fundamental and accessible for every single mother, nurturer, or caregiver. However, sadly, even with increased technology and better facilities, women's health is still at a significant risk globally and in the United States.
What is Maternal Mortality?
The WHO defines maternal mortality as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, excluding those from accidental or incidental causes.
Black Maternal Mortality: The Stats
According to the CDC, up to 700 women die yearly due to pregnancy and childbirth in the United States; in 2020, 861 deaths were reported. When analyzed along racial lines, it became evident that black women are at a higher risk of maternal mortality than white—up to 3 times. This is only a direct comparison between non-Hispanic black women and non-Hispanic white women, it doesn’t include other racial origins.
This ratio is similar when compared to Hispanics; in 2020, the maternal death for Black women was 55.3 for every 100,000 live births, while the figure stands at 18.2 for Hispanic women.
Other financial and emotional costs are being incurred by every family that is affected by black maternal mortality. Frankly speaking, some families never recover from such tragedies.
It should be noted that maternal health outcomes are also an essential factor in infant mortality and morbidity, making these statistics all the more terrifying.
Causes of Maternal Mortality
Maternal mortality rates have been linked to various causes over the years. These factors could be linked to the service provision, health care accessibility, and the health-seeking attitude of the given individual.
Years of research by the Centers for Disease Control and Prevention and other allied bodies and initiatives have shown that hemorrhage is one of the leading causes of pregnancy-related deaths, accounting for more than a quarter of all mortalities. Closely related to this are previous medical conditions of the mother, which become aggravated in pregnancy.
In addition, hypertension in pregnancy, (known as preeclampsia), infective disorders, and complications from abortion have been responsible for a significant loss of lives during childbirth. 52% of the mortalities have been attributed to complications that occur after childbirth, 17% on the day of delivery, and others during pregnancy.
The increased maternal mortality risk after birth is due to the lack of postpartum care in many places in the United States, which makes the country an outlier amongst other developed countries. Also, the absence of paid maternity leave is responsible for the early return of new mothers to their workplace, thus increasing their risk of severe maternal morbidity in the postpartum period.
So, Why is There a Racial Disparity in Maternal Health?
Unlike many other developed countries, the US is an outlier regarding maternal health care and safety through pregnancy and childbirth. The ethnic disparities seem to worsen the matter, given that throughout its existence, race and ethnicity play a role across many of the important sectors of the US.
Reports have shown that, amongst many things, wealth and financial inequality affect access to the necessary care that pregnant women need. Closely associated is the issue of distrust in the healthcare system due to the past experience (such as the Tuskegee experiments), of people of color.
It’s important to be aware of the fact that structural racism of course resulted in the poor proliferation of health delivery systems such as Medicaid services in black communities. There is a reduced number of skilled professionals such as gynecologists, obstetrics, midwives, and doulas who could provide optimum prenatal care and post-natal interventions to women of color.
According to a report by the Center on Budget and Policy Priorities, women of color are more predisposed to co-morbidities and health conditions that could complicate pregnancy, such as pregnancy-related cardiovascular diseases. Difficult access to basic amenities such as fresh food and safe water also affects the health of Black women while Pregnant.
Another risk factor contributing to racial disadvantage is the Lifetime risk of maternal death, which, according to UNICEF, is higher in low-income countries and communities.
It is also important to note that African-American girls reach puberty earlier, resulting in a higher teenage pregnancy rate. Even though teenage pregnancy is manageable, naivety and fear of the unknown may make teenage girls seek out unsafe abortions that put their lives at risk.
What is the Way Forward?
It is clear that black women are at higher risk of pregnancy-related complications than white women in the US, and even still, average maternal mortality in the US is higher than in other developed countries. It is essential to employ policies that will eliminate health disparities, improve care, and promote health equity during the period of pregnancy and one year after delivery.
It is important to adopt a social approach to solve the problem nationwide. By speaking about these structural issues, we admit the problem.
This way, social determinants of health that are often beyond the control of black mothers can be improved, leading to an enhanced attitude towards health, better control of preventable co-morbidity, and an increased quality of care in pregnancy.
The government, the community, and families all have important roles in reducing black women's maternal mortality. We all must come together to make steps towards improving this critical issue.
The States and the Local Community
The Policy makers in States and the local community must have the political will to improve the perinatal health of black women by adopting healthy public policies that are sustainable and equitable. These policies could lead to better access to healthy nutrition, safe water, and essential drugs among black women.
The re-orientation of maternity care and health delivery addresses racial and economic inequities and implicit bias by increasing the insurance coverage for black women to access midwifery care.
Over the years, the CDC launched several programs to reduce the maternal mortality ratio. Many of these are patient-centered, aimed at listening to and providing solutions to the concern of pregnant women, and employing a holistic approach to improve the perinatal care for women while addressing racial inequalities.
The Commonwealth Fund noted that the Affordable Care Act has allowed for expanded Medicaid coverage, which has increased access to essential health benefits, preventive services, and better health insurance for new mothers.
Health Care Provision
Health institutions and health providers should coordinate and strive to reduce the implicit bias that is unfavorable to the black community by training professionals and increasing awareness of diseases and co-morbidities that may compromise the lives of pregnant women.
The quality of health care provided to women, regardless of race and origin, needs to be standardized and improved. Patients should feel that during their prenatal care check ups they are truly being listened to and cared for - educated professionals should be able to recognize symptoms that present early on and could potentially save their lives.
Safe abortion services are also important. Tragically, black women may be more predisposed to post-abortion guilt due to their environment and racial stigma; therefore, it is crucial to provide quality health care and adequate therapeutic and counseling services for women who have chosen to undergo an abortion.
Families and Close Relatives
It is important for black women to ask questions and seek emergency care whenever they experience any sign of danger in pregnancy, as emphasized by the CDC. If able to, speaking regularly with their health care providers and gaining confidence in disclosing their health conditions to them can go a long way - but it’s up to all of us to instill this confidence in black women and work to eradicate structural racism for good.
Black women should foster and strengthen community actions among one another by sharing experiences, creating support groups, and assisting new mothers who may be afraid or inexperienced. We all have a role to play.
Black maternal mortality is a problem of public health concern in the United States. It is an issue of national importance that requires a multisectoral and collaborative approach that focuses majorly on policies that improve the reproductive health of black women.
Reducing the Black maternal mortality ratio will improve black maternal health and reduce the national average of pregnancy-related mortality, changing the way we think about maternal mortality for good.
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Kasirat Jimoh is a veteran freelance writer, beginning early in her University days.