Spotlight on Black Maternal Health

In the US, women of African descent are affected by a significant number of diseases of the reproductive system – which are often under-diagnosed and under-treated. Furthermore, black women continue to face daunting health challenges in terms of pregnancy and childbirth. Black women are 243 percent more likely to die from pregnancy-related causes than their white counterparts. A report from the CDC states that black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women’s health. In addition, a national study of five medical complications reported higher pregnancy-related mortality among black women from preeclampsia, eclampsia, abruptio placentae, placenta previa, and postpartum hemorrhage is largely attributable to higher case-fatality rates.  A comprehensive joint NPR/ProPublica report explained that for every woman who dies from childbirth, 70 more come close to dying during or after a pregnancy.  Even when factors such as physical health, access to prenatal care, income level, education, and socio-economic status are controlled for, black women are still far more likely to experience maternal mortality than non-Hispanic white women. These alarming statistics are significant, given that Black women represent only 7% of the total U.S. population.

The month of April is recognized in the United States as National Minority Health Month – a month-long initiative to advance health equity across the country on behalf of all racial and ethnic minorities. RSP and the Young Advisory Board is joining dozens of other organizations during this second annual Black Maternal Health Week April 11 – 17, to raise awareness about the burden of maternal mortality and morbidity in the Black community.

In recent years, the media has been saturated with reports of racial inequities in reproductive health outcomes. The truth is, these disparities have persisted for decades and the outcomes we’re seeing now are largely tied to the legacy of racism and sexism that persists in the United States and many other places in the world.  In my opinion, hearing repeat statistics layered with similar justifications is tiresome and feels overwhelming. Honestly, I’m ready for a wave of positivity in media. Why is it so difficult to find influencers and initiatives that are actively working to reverse the adverse trends we’re seeing? I have found peace in contributing to productive efforts for better outcomes and I think others would find comfort knowing that the spike in media coverage is met with concerted effort for change that began long before this work became trendy. 

Fortunately, this pursuit has graced me with the opportunity to cross paths with others that share this sentiment and are committed to long-term change in this space. This includes my colleagues here at the Resilient Sisterhood Project and the Institute for Health Care Improvement and extends to those I’ve met through conferences and events. From a place of the utmost respect and warmth—it feels like I happened upon a group of inspiring mentors and peers that I wasn’t even aware I needed. Their insight on maternal health is sharpened with immense professional experience and reinforced by a passion for the health continuum and respect for life. In my mind, change rooted in this genuine energy is what’s needed for health care delivery to reach a state where’s it is what women need, want, and deserve.

A flagship event of last year was the Black Mama’s Matter Alliance’s (BMMA) first conference in Atlanta, GA. It brought together a mix of academics, birth workers, community partners, and clinicians passionate about birth equity and justice. There was also a diverse group of reproductive health leaders in attendance, some of these names served on their advisory committee like Monica Simpson, Kwajelyn Jackson, Joia Crear-Perry, and many others that led breakout sessions or delivered key notes. To have so many changemakers in the same space was a historic moment for Black maternal health and I can hardly wait for the next BMMA event.

A memorable break out I attended was facilitated by Chinyere Oparah and Sayida Peprah who partnered with others to write Battling Over Birth. Their work weaves together the interviews of 100 black women that capture their experiences while pregnant in California’s San Francisco Bay Area. While this is perceived as one of the most liberal areas of the United States it effortlessly calls out barriers to care delivery such as racism, ageism, and overmedicalization. Many narratives were consistent with the themes covered in storylines in the national spotlight like NPR’s acclaimed Lost Mother’s Series and from famous reproductive health advocates like Serena Williams and Timoria McQueen Saba.  It was also diligent in highlighting the importance of positive factors like trust, respect, and consent and a list of insightful recommendations for a way forward.

 Another break-out session I enjoyed was the Community-Based Participatory Research piece led by Shanon McNab from Columbia’s Mailman School of Public Health. She summarized their findings of Black women’s experiences of care during pregnancy in Atlanta and New York City. The output was a considerable number of instances of disrespectful care noted from the patient and clinician perspective. Measuring disrespect is difficult for a host of reasons but it is necessary to see improvement in the treatment and outcomes of women. I am hopeful for the next steps that build on the work of McNab and her team as well as others in the field that are striving to get us to a place where disrespect in healthcare is what we put energy into monitoring like incidences of hemorrhage or pre-eclampsia.

From my perspective, the field is in a place where healthcare is looking inwards to evaluate and reflect on their models of care but with a finer comb. The high coverage of media connecting reproductive health outcomes explicitly to race and its associated inequities has made it clear that disparate outcomes between black and white women are pervasive across the U.S. and will require alternative solutions. In the past, it has been much easier to support women in taking up practices to decrease the risk of complex pregnancies. These recommendations are in the realm of nutrition courses, exercise programs, providing financial support and/or other incentives to seek care. Of course, these examples can all be supportive approaches, but we cannot continue to rely solely on these solutions to then place women in the hands of health systems or providers that do not reliably offer respectful and compassionate care.

I imagine that using an equitable lens for reflection can produce learning that could have ripple effects to influence the way clinical providers train to relate to their patients and colleagues for the better, raise women’s expectations of care, and improve health outcomes of all women that encounter our health care systems, and more. In the meantime, I’ll keep dreaming of a better tomorrow and remain grateful to contribute to help continue to move us forward one step at a time.

“It’s not the load that breaks you down, it’s the way you carry it.”

Lena Horne