U.S. maternal mortality ratios are the highest in the developed world and are rising, in contrast to global trends. The national rate, however, hides an even more troubling fact: black women in the U.S. die at three to four times the rate of white women during pregnancy or within one year of pregnancy. Black expectant and new mothers in the U.S. now die at about the same rate as women in countries like Mexico and Uzbekistan. In Texas, while black women make up only 11% of live births in the state, they account for 29% of its maternal deaths.
So, why do black women in the U.S. face a significantly higher risk of maternal mortality?
The answer is complicated. Some studies have concluded that racial disparities in other health outcomes (e.g. obesity, hypertension, etc.), which are risk factors for pregnancy complications, are to blame. Other studies have pointed to differences in socioeconomic status, access to quality health care, education, insurance coverage, housing and levels of stress between black and white women.
But what about the experiences of tennis star Serena Williams and CDC epidemiologist Shalon Irving? Despite being well-off, highly-educated, insured, etc., they nevertheless failed to receive adequate care for life-threatening complications following childbirth. Shalon’s story, according to close friend Raegan McDonald-Mosley, “[t]ells you that you can’t educate your way out of this problem. You can’t health care-access your way out of this problem. There’s something inherently wrong with the system that’s not valuing the lives of black women equally to white women.”
In a report published in the American Journal of Public Health, John Hopkins University School of Medicine researchers found that physicians who hold unconscious racial biases tend to dominate conversations with black patients and pay less attention to their personal and psychosocial needs. Those patients, as a result, feel less involved in making decisions about their health.
A report from the Institute of Medicine found that, for almost every disease studied, black Americans received less effective care than their white counterparts. These disparities persisted, despite matching for socioeconomic and insurance status. Moreover, in a survey conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, 32% of black women reported being personally discriminated against because of their race when going to a doctor or health clinic. Overall, black expectant and new mothers often feel that doctors and nurses do not take their pain seriously.
Black women in this country will continue to face a significantly higher risk of maternal mortality unless we begin to address these challenges, at both individual and institutional levels. As Shafia Monroe, President of the International Center for Traditional Childbirth, explained to Amnesty International, “[b]lack women will be more likely to die until we are treated equally.”