Welcome to Nat’s Civic Issues blog! This semester, I will be focusing on health equity, domestically and internationally. In the field of medicine and healthcare, there are glaring disparities connected to racial, gender, or sexual orientation, and I plan to investigate these throughout this semester. As my first Civic Issues blog post, I’d like to talk about the maternal mortality rates and the influence of race on pregnancy-related deaths, specifically focusing on the US. This issue is frequently overlooked in public health and advocacy, but the statistics paint a dark picture of racial bias and negligence, especially for black mothers. Let’s dig in.

 

To start, let’s define some important terms in this issue. First, I will be referring to the pregnancy-related mortality ratio, or PRMR, in my statistics. This refers to the mortality rate for pregnant mothers per 100,000 live births. This is often the statistic that organizations like the CDC use to classify mortality rates. The CDC in particular compiles all pregnancy-related mortality concerns in their Pregnancy-Related Mortality Surveillance System (PMSS), which defines a pregnancy related death as:

“The death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication; a chain of events initiated by pregnancy; or the aggravation of an unrelated condition by the physiologic effects of pregnancy” (CDC).

In the United States, according to an observational study published in 2016, the PRMR increased by 26.6%, from 18.8 deaths per 100,000 births in 2000 to 23.8 deaths per 100,000 births in 2014 (MacDorman). This statistic is interesting, especially considering that the international maternal mortality rate decreased globally in the same time frame. However, in the US, this PRMR doesn’t show the full story, as the mortality rate differs greatly for different racial groups. For instance, Black, American Indian, and Alaska Native (AI/AN) mothers are 2-3 times as likely to die in childbirth than white mothers (CDC). In this blog post, we will examine some potential causes and start to explore potential solutions.

(Maternal Mortality Graph)

 

Since the late 1980’s, the US maternal mortality rate has been steadily climbing, which had many statisticians and physicians puzzled. Surely, one of the world’s most wealthy and developed countries would have a solid healthcare system that is built to save lives, but the rate rose from roughly 7 deaths per 100,000 births in 1987 to over 17 deaths per 100,000 births. For Black women specifically, these rates grow astronomically. For instance, Black mothers over 30 years old are 4-5 times as likely to die in childbirth, and highly educated Black women (with at least a college degree) are 5.2 times as likely to die in childbirth than white mothers (CDC). Infant mortality shows a similar trend across different racial minorities as well, and we can even see this in deaths related to diagnostic errors, since much of health research has excluded Black biology.

 

There are several prominent theories as to the cause of this issue. It’s important to note that issues like these are rooted in systemic racism and implicit bias, and no one aspect of these will explain the whole issue. Maternal mortality is an incredibly nuanced topic, so we cannot hope to fix the mortality gap by simply changing one aspect of society. For instance, one common theory is that doctors are less likely to believe a Black mother’s pain given inherent racial biases that plague our country even now. We know that there is a severe lack of trust between the Black community and the healthcare system, since it has routinely left them out of the medical dialogue. Also, most of gynecological research until this century has only included white mothers, and there are some biological and genetic factors in Black mothers that we do not understand. The most shocking fact of all: nothing is improving. These disparities are still just as prevalent today as they were decades ago. So, what is the solution?

 

With the prevalence of this issue highlighted through recent movements against racial injustice, hospitals all over the country have been taking steps to diminish the effects of this issue and help save lives that should not have been at risk to begin with. Most of these measures include reevaluating the systemic policies or practices that have allowed racism to fester in the shadows throughout the healthcare system, as well as restructuring the support provided to Black mothers throughout their pregnancy.

 

Part of the issue in medical racism stems from the training residents receive, dating all the way back to medical school. Textbooks commonly used in medical school have been found to cater to diagnosing white people and often follow extremely outdated beliefs, such as the idea that Black people feel less pain than white people, which dates back to the time of slavery. With hospitals being more aware of the implicit bias that has been created in so many people in the medical field, many have taken action by implementing programs to provide more anti-racist training and education to their staff as well as doing their part in creating a more diverse and equitable workforce.

 

To address the root cause of maternal mortality, which is that Black mothers face disproportionately higher risks throughout their birthing journey, hospitals and health care systems are taking steps to improve their structures. One proposed step is creating committees to evaluate the maternal procedures in hospitals and their standardization. The goal of these committees is producing one procedure to follow that allows the best possible success rate for mothers and their children regardless of their race. While all medicine can not be standardized, finding a procedure for standard testing and treatment could prevent maternal deaths related to heart conditions, which are the leading causes of maternal mortality in Black mothers.

 

In summary, maternal mortality rates across the United States have been increasing at a concerningly high level across the decades, but the disproportionate rates at which Black women specifically face during their pregnancies is unacceptable. As hospitals take steps to attempt to remedy the implicit racism that has been festering throughout the teachings of doctors for centuries, it is of utmost importance to give Black women the care and respect they have deserved the entire time. The right to basic human care should not be dependent on your race or gender, and I hope to further enforce this idea throughout future blogs.

 

Sources:

https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Fmaternalinfanthealth%2Fpregnancy-mortality-surveillance-system.htm

https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001799/

https://www.nih.gov/news-events/news-releases/nih-funded-study-highlights-stark-racial-disparities-maternal-deaths

https://www.nami.org/Blogs/NAMI-Blog/July-2021/Addressing-the-Increased-Risk-of-Postpartum-Depression-for-Black-Women#:~:text=PPD%20affects%20one%20in%20eight,less%20likely%20to%20receive%20help.

https://www.nami.org/Blogs/NAMI-Blog/July-2021/Addressing-the-Increased-Risk-of-Postpartum-Depression-for-Black-Women#:~:text=PPD%20affects%20one%20in%20eight,less%20likely%20to%20receive%20help.