Why is Childbirth a Public Health Crisis for Black Women in the U.S.?
By: Laurén Doamekpor
For most women around the world, pregnancy is an exciting, joyful, albeit anxiety-ridden time. But for too many Black women in the U.S., pregnancy and childbirth is a matter of life and death, with hundreds of Black women dying from pregnancy-related complications every year.
In the past few months there have been several high profile news articles (See the Vox article here and the NY Times here) about the maternal mortality crisis in the U.S., specifically highlighting the disproportionate toll pregnancy and childbirth has on Black women.
In the few weeks after the stories hit the news cycles and made their way around social media, I fielded several questions from friends and acquaintances about what in the world was going on. At the heart of all these conversations was a sense of fear, and the realization that any one of the stories, could be ours, our family members’ and friends’. What was most shocking to most was the fact that death during or after childbirth was particularly common among highly educated Black women with successful careers.
To better explain to my friends and family what was going on with this public health issue and what could be driving it, I broke down what I knew about the current research on the topic from my experience doing research in Maternal and Child Health. Below are the most common questions that came up during these candid conversations with answers which I think will be helpful to anyone who is interested in knowing more about the alarming statistics.
What should we know about maternal death in the U.S. and why has this issue garnered so much attention recently?
Maternal mortality is seen as a sign of the quality of healthcare in a country. In the U.S. recently, pregnancy and childbirth has become more and more dangerous. Moms in America are more likely to die during or shortly after childbirth compared to mothers in any other developed countries. American women are more than 3 times as likely as Canadian women to die during this time period and 6 times as likely to die as women in Europe.
This issue is such a big deal for a few reasons. First, globally, maternal death rates have been improving- essentially decreasing over time— but in the US, maternal death increased from 2000 to 2014 about 27%. In a nutshell we’re going against the grain and in the opposite direction of the rest of the world. Another reason this topic is so important is because of the staggeringly stark disparity along racial/ethnic lines in maternal death.
What does research tell us about what is going on for Black mothers in particular?
When we drill down on maternal death statistics in the U.S. – it becomes clear that it’s largely Black women who are dying. Between 2011 and 2013 Black moms across US were 3.5 times more likely to die in childbirth compared to their White counterparts. If we put this in context and compare this disparity to other diseases, it’s just shocking how wide the gap is. Black women are 22% more likely to die from heart disease than a White woman, 70% percent more likely to die from cervical cancer, but 243% more likely to die from pregnancy- or childbirth-related causes.
What are the reasons behind this stark disparity? What is the research in this area pointing to, to explain what’s going on?
Researchers often point to the social determinants of health and the fact that Black women tend to be low income and uninsured. There are also underlying health differences in Black versus White populations: heart disease, high blood pressure, and diabetes are more common among Black individuals, and they can all contribute to pregnancy-related complications. But that can’t explain the whole story because research is showing that more highly educated, high income Black women are dying. A 2016 analysis of five years of data found that Black, college-educated mothers who gave birth in local NY hospitals were more likely to suffer severe complications of pregnancy or childbirth than White women who never graduated from high school. And that high maternal death among Black women is irrespective of income, health insurance.
The research points to a couple reasons why Black mothers are more likely to die.
Stress from race- and gender-based discrimination – the double whammy of being Black and a woman – the discrimination that Black women experience in their everyday lives may be the most significant factor in poor maternal outcomes. High levels of stress can exacerbate high blood pressure and heart disease, which can lead to deadly health complications during pregnancy.
Bias in the medical system - Pregnant Black women get different — and often worse — care than their White counterparts in hospitals, and that may be more likely to lead to pregnancy-related complications. There are so many reports of Black women experiencing the feeling of being devalued and disrespected by medical providers -- medical providers who equated being African-American with being poor, uneducated, noncompliant and unworthy.
How can the everyday woman or pregnant woman connect these statistics to her everyday life?
I think these stats can be scary. I know I’m scared when I read these stats. There are so many things that are out of our control especially during pregnancy. This means that for Black women, the risks for pregnancy start at an earlier age than many clinicians — and women— realize, and the effects on their bodies may be much greater than for White women. What we can do is do the best you can, stay as healthy as we can - our minds, bodies, and spirits. And of course find ways to manage stress.
Dr. Doamekpor is a public health scholar trained in maternal and child health and quantitative research methods. Her research focuses on understanding the underlying reasons behind racial and ethnic health disparities and has centered on women’s health, immigrant health, and minority inclusion in clinical trials. Her other research interests include the social and cultural determinants of health and the impact of chronic stress on health.