The shocking death of 23-year-old expectant mother, Amber Isaac, earlier this year put a spotlight on the struggles Black women when attempting to seek the medical attention they need. Amber died on April 20th, 2020, from a perfectly treatable condition called HELLP. Even after attempting to share her concerns with her doctors, she encountered the dismissive attitude many women of color face daily when confronting medical staff and physicians. She was assured there was no issue with her pregnancy in the face of repeated attempts to alert them to her sense that there was something wrong. Had her concerns been taken seriously, Amber would be alive today to care for her infant son.
Unfortunately, Amber’s tragic story is one that is played out in hospitals and clinics daily. Sadly, if Amber were white, it is likely she would have received better care and her chances for survival would have improved significantly.
The evidence for racial bias in the care for Black women is startling. A recent report by the CDC confirms the huge racial disparity in maternal mortality rates. “Black, American Indian, and Alaska Native (AI/AN) women are two to three times more likely to die from pregnancy-related causes than white women – and this disparity increases with age,” according to a press release from the CDC on September 5, 2019. Many of these deaths are preventable.
“These disparities are devastating for families and communities and we must work to eliminate them. There is an urgent need to identify and evaluate the complex factors contributing to these disparities and to design interventions that will reduce preventable pregnancy-related deaths.” — Emily Petersen, M.D., medical officer at CDC’s Division of Reproductive Health
This report’s finding are backed by the previously published CDC Review of Pregnancy-Related Deaths, where non-Hispanic Black women make up 39.2% of the total number of deaths between the years of 2008 and 2017. Note that black women comprise only 17% of the female population of the US.
In the 2019 report, nearly 60% of pregnancy-related deaths were determined to be preventable. Perhaps surprisingly, this rate did not differ between races. The report went on to suggest imbalances in quality of care, lack of access to care and frequency of chronic diseases may be largely to blame.
Doctors Not Listening
Proper care during pregnancy relies on the dialogue between patient and doctor. However, a woman who senses “something is wrong” only to have her physician belittle her knowledge of her own body can become frustrated and angry. It is common for these women to avoid hostilities with someone she must depend upon for the duration of her pregnancy.
Racism in health care is rampant and “disproportionately affects the quality of care mothers receive during childbirth,” according to MiQuel Davies, Georgetown Women’s Law and Public Policy Fellow, noting that Black patients’ complaints are taken less seriously and less time is spent in caring for them. She cites the story of Serena Williams having to outright demand life-saving care from her doctors after giving birth as an example. If the affluent and famous tennis star is put in this position, imagine how often Black women without her clout face this same discrimination.
Considering most pregnancies are endangered by blood and heart conditions, obstetrical staff should be more concerned, not less, about their Black patients since they suffer more frequently from the ailments.
Primary Causes of Maternal Mortality
Leading causes of death among Black women in the earlier report were identified as cardiomyopathy and cardiovascular conditions. The higher rate of heart disease and diabetes-related high blood pressure among Black women have been noted as increased risk factors. Monitoring blood pressure and cholesterol is significantly more important to expectant Black mothers than any other risk group. Establishing healthy eating habits and a prenatal exercise routine can be instrumental in reducing the effects of high blood pressure on pregnancy.
Sepsis & Hemorrhage
Sepsis, a potentially life-threatening condition caused by the body’s response to an infection, and postpartum hemorrhage, excessive bleeding after birth, together accounted for 22% of birth-related deaths. Sepsis in birthing mothers occurs as a result of streptococcal infection which can occur any time in the pregnancy and postpartum periods. Most frequently, infections occur during the first 6 days after delivery.
Black women are more likely to receive Cesarean sections (on average 5% more than their white counterparts). Cesareans have been linked to a higher mortality rate among pregnant women. This sometimes needless procedure increases the chance for post-surgery infection and puts undue strain on a mother’s body. Episiotomies can also increase the likelihood of serious urinary and intrauterine infections.
Quality of Prenatal Care
“Women receiving no prenatal care are five times more likely to have a pregnancy-related death than women who receive prenatal care,” according to the Maternal Health Task Force. However, lack of access to care before, during and after pregnancy is largely driven by socio-economic factors. Black people still represent the largest population of uninsured citizens in the US and are more likely than whites to be among our nation’s poor.
Studies also reveal the medical attention Black mothers receive is grievously substandard. Drs. Elizabeth A. Howell, MD, MPP, Natalia Egorova, PhD, MPH, and Paul L. Hebert, PhD summed up the situation in their 2016 article in American Journal of Obstetrics and Gynecology, “Site of care has received attention as a mechanism explaining disparities in other areas of medicine. Data indicate that blacks receive care in a concentrated set of hospitals and these hospitals appear to provide lower quality of care.”
What can be done?
Solutions to these problems are unfortunately far-reaching in scope. In order to improve conditions some or all of the following would need to happen:
- Increased base-line medical facilities nation-wide, including better qualified staff
- Reduction in unnecessary procedures
- Availability of alternative and supplemental prenatal/antenatal care options
- Improved care for the uninsured and underinsured
More Black Women in Obstetrics Needed
Of the medical fields, there is a woeful underrepresentation of Black women in the field of Obstetrics. Although 87% of OB/Gyns are now female, currently Black women make up less than 11% of professionals in any of the medical fields. Without doctors who empathize with their needs, Black mothers are at a disadvantage to receive the care and attention they so desperately require to ensure their safety during pregnancy and birth.
Any one of these improvements to the system of care available to pregnant mothers would require the coordination of health care providers and governments at all levels. Change will likely be slow in coming and probably won’t be comprehensive. Ultimately, until a sweeping overhaul of the country’s medical care system has occurred, Black mothers will have to do as they have always done and care for themselves and each other the best they can.
This includes staying informed, demanding attention from their health care providers and minimizing unnecessary risks to themselves and their babies by:
- Seeking prenatal care
- Eating healthy foods
- Taking recommended vitamins
- Getting appropriate exercise
- Monitoring blood pressure
- Minimizing risks for heart disease
- Avoiding environmental hazards such as smoking, alcohol and dangerous medications
Here is a list of resources for expectant mothers seeking information about preventative care for the highest risks (in order from greatest to smallest) during pregnancy:
- Other cardiovascular conditions, 15.7%
- Infection or sepsis, 12.5%.
- Cardiomyopathy, 11.0%
- Hemorrhage, 11.0%
- Thrombotic pulmonary or other embolism, 9.0%
- Cerebrovascular accidents, 7.7%
- Hypertensive disorders of pregnancy, 6.9%. (e.g., Eclampsia & Preeclampsia, High Blood Pressure)
- Amniotic fluid embolism, 5.6%. (Risk factors: Placenta Previa, Eclampsia & Preeclampsia, Placental Abruption)
Always coordinate your preventative care with your doctor.