Disproportionately High Rates of Maternal Complications and Mortality Among Black Women in the United States

From UBC Wiki
A black mother and child, Chicago. - NARA - 556145.jpg

Overview

Racial disparities are significantly prevalent in maternal complications and mortality in the United States. Statistics show there are disproportionately high rates of maternal complications and mortality among Black women in the United States.[1] Black women are three to four times more likely to die from maternal complications compared to white women. [2]These disparities are present before, during, and after pregnancy. Individual bias in healthcare workers and structural racism are the main contributors to these disparities. [3]Recently, multiple organizations have contributed financial support and resources to abolish the racial disparities within maternal mortality and complications.

Maternal Complications and Mortality

Understanding Pregnancy Complications and Deaths

Pregnant women can die as a result of complications during childbirth. The majority of these complications develop during pregnancy but are treatable. Other conditions may be pre-existing but worsened during pregnancy.[4] The majority of the complications that cause maternal death are high blood pressure throughout pregnancy (eclampsia and pre-eclampsia), delivery complications, infections after childbirth, and severe bleeding after childbirth[5].  

Disparities at Each Stage of Pregnancy

It is crucial to understand that these racial disparities exist before, during, and after pregnancy. Dr. Lisa Hollier, former president of the American College of Obstetricians and Gynecologists, stated “[w]e are missing opportunities to identify risk factors prior to pregnancy, and there are often delays in recognizing symptoms during pregnancy and postpartum, particularly for Black women”[6].

Preconception Care

As Black women suffer higher rates of chronic illnesses, preconception care is essential to treat these ailments and to target maternal disparities. [3]Unintended pregnancies have been linked to higher rates of maternal complications and deaths. For example, an unintended pregnancy in someone with a chronic illness could be detrimental to their health. Black women have twice the rate of unintended pregnancies in comparison to white women. [3]

Prenatal Concerns

Early and sufficient prenatal care is necessary to have a healthy pregnancy and birth[7]. Fewer prenatal care visits are associated with increased infant and maternal mortality and complications.[3] Black women in the United States are four times more likely to have fewer prenatal care visits in comparison to white women[3]. Often the delay of prenatal care has been associated with racism. It is not uncommon for Black women to experience issues of racism during pregnancy, up to and including birth hospitalization. [3]

Postpartum Disparities

Health issues of pregnancy do not stop when the baby is delivered. [6]The changes within the body from pregnancy can worsen existing illnesses or cause new illnesses. For example, women with gestational diabetes are at an increased risk of developing cardiovascular disease[8]. Studies have also found there were higher rates of death among Black women in comparison to white women in the postpartum period as well (seven weeks to a year after delivery). [3]

Statistics

  • The United States has higher rates of poor maternal health and maternal death among Black women in comparison to other developed countries. [9]
  • 42.8 Black women will die for every 100,000 live birth, yet only 13 white women will die for every 100,00 live birth. [9]
  • An estimated 60% of these deaths were preventable. [5]
  • Black women in the United States not only have higher rates of maternal fatality, but they are more likely to experiences pregnancy complications, such as hypertensive disorders of pregnancy, cardiomyopathy, hemorrhages, and thrombotic pulmonary embolism. [3]
  • These complications also contribute to more pregnancy-related deaths for Black women than white women. [3]
  • These racial disparities continue to persist, as they have not changed significantly from 2007-2016. [4]

Reasons Behind Maternal Racial Disparities in the United States

Multiple Factors

These racial disparities between Black and white women concerning maternal health and mortality have continued over time, therefore it is difficult to distinguish the exact cause. It is complex and there are multiple factors that contribute to these disparities.

Socioeconomic Status

Some believe socioeconomic status and poor quality of care are among the leading causes of these disparities[10], yet research has shown that these disparities still exist with wealthy or middle-class black women with higher levels of education[3]. Therefore, sociodemographic does not independently cause these disparities[2].

Structural Racism and Personal Bias

Black women have increased risk of maternal complications and fatality because of higher rates of obesity, diabetes, and hypertension.[3] However, reports have found that the higher rates of complex health conditions among black women were not what caused this racial disparity within maternal deaths[3]. Experts believe and research shows it is caused by personal bias and structural racism[2]. Black women are often not monitored as carefully during pregnancy and delivery and their symptoms are often trivialized or dismissed[2]. One study found that half of the medical trainees surveyed believed black people were not as sensitive to pain in comparison to white people, and those who believed this were less likely to treat black people’s pain appropriately.[11] Unconscious bias can be especially prevalent in medical care and can alter the quality of care being given. As obstetrician-gynecologist Neel Shah states “there is a very fine line between clinical intuition and unconscious bias”[9].

Resolutions to Eliminate the Disparities

Planned Parenthood’s Response

The Chief medical director for Planned Parenthood Raegan McDonald-Mosley claims “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"[9].

The Centers for Disease Control's Support

The CDC awarded over $45 million to assist and support the Maternal Mortality Review Committees and the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality Program.[4] The CDC is also providing hospitals and healthcare systems information on what they can do to address these disparities, which includes implementing and improving standardized protocols and addressing and identifying implicit healthcare bias to improve health outcomes. [4]

Resources for Hospitals

The Council on Patient Safety in Women’s Health Care and the Alliance for Innovation in Maternal Health published the “Reduction of Peripartum Racial/Ethnic Disparities Patient Safety Bundle”. This bundle provides institutions and healthcare workers with specific steps on how to recognize unconscious bias and ultimately aid in the fight against racial disparities in terms of maternal complications and mortality[3].

The American College of Obstetrics and Gynecology in 2015 released a report with recommendations on combatting these maternal disparities[12]. These recommendations include raising awareness among medical professionals, understanding implicit bias and how it can affect health outcomes and care, promoting research that addresses these disparities and supporting and assisting in the employment of more racial minorities in the field of obstetrics and gynecology.

See Also

Black Feminism

Race and Health in the United States

Health Disparities Centres

Health Care in the United States

African Americans and Birth Control

References

  1. Howell, Elizabeth (January 2016). "Black-White Differences in Severe Maternal Morbidity and Site of Care". American Journal of Obstetrics and Gynecology. 214: 122–127.
  2. 2.0 2.1 2.2 2.3 American Heart Association News (February 2019). "Why Are Black Women at Such High Risk of Dying from Pregnancy Complications?". American Heart Association. Retrieved 27 July 2020.
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 Elizabeth, Howell (2019). "Reducing Disparities in Severe Maternal Morbidity and Mortality". Clinical Obstetrics and Gynecology. 61: 387–399.
  4. 4.0 4.1 4.2 4.3 CDC (September 2019). "Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths". Centers for Disease Control and Prevention. Retrieved 27 July 2020.
  5. 5.0 5.1 World Health Organization (September 2019). "Maternal Mortality". World Health Organization. Retrieved 27 July 2020.
  6. 6.0 6.1 Rabin, Rony (May 2019). "Huge Racial Disparities Found in Deaths Linked to Pregnancy". The New York Times. Retrieved 27 July 2020.
  7. Cabacungan, Erwin (November 2011). "Racial/Ethnic Disparities in Maternal Morbidities: A Statewide Study of Labor and Delivery Hospitalizations in Wisconsin". Maternal and Child Health Journal. 16: 1455–1467.
  8. James-Todd, Tamarra (December 2013). "Race/Ethnicity, Educational Attainment, and Pregnancy Complications in New York City Women with Pre-Existing Diabetes". Paediatric and Perinatal Epidemiology. 28: 157–165.
  9. 9.0 9.1 9.2 9.3 Roeder, Amy (June 2020). "America Is Failing Its Black Mothers". Harvard Public Health Magazine. Retrieved 27 July 2020.
  10. Obstetrics & Gynecology (December 2015). "Obstetrics & Gynecology". Obstetrics & Gynecology. 126: 130–134.
  11. Sabin, Janice (January 2020). "How We Fail Black Patients in Pain". AAMC. Retrieved 27 July 2020.
  12. The American College of Obstetrics and Gynecologists (2018). "Racial and Ethnic Disparities in Obstetrics and Gynecology". ACOG. Retrieved 27 July 2020.

External Links

Maternal Complications and Mortality

Eclampsia

Pre-Eclampsia

Hypertensive Disorders of Pregnancy

Cardiomyopathy

Hemorrhages

Thrombotic Pulmonary Embolism

Unconscious bias

Planned Parenthood

The Enhancing Reviews and Surveillance to Eliminate Maternal Mortality Program

The American College of Obstetrics and Gynecology