Disparity in access to medical care with regard to POC - focus on pregnancy/maternal mortality

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Culture

Why are Black mothers dying at high rates, in the United States?

Systemic inequality and racism are a huge factor

by Fatu Forna, MD, Guest Writer Reviewed by Kate Wahl, Science writer for Clue
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Worldwide, mothers most commonly die before or after childbirth, as a result of hemorrhaging (the experience of heavy bleeding during or after childbirth); high blood pressure disorders; infections; complications from labor and delivery; ectopic pregnancy, miscarriage, unsafe abortion; and embolism (the development of blood clots that cause blockages inside blood vessels) (1).

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It’s also important to consider that socioeconomic factors like poverty and access to care can be just as detrimental to maternal mortality outcomes as the medical conditions listed above. Successful pregnancies and childbirth depend on a mother’s ability to receive care and assistance from trained doctors, midwives, and nurses. Globally, more than 90% of births, in high-income and upper middle-income countries are assisted by skilled health personnel, compared with fewer than 50% of births, in some low-income and lower-middle income countries (2). Additionally, suicide and homicide linked to intimate partner violence have recently become recognized as significant causes of maternal deaths worldwide (3,4).

Maternal mortality rates have fallen internationally as quality medical care and healthcare information becomes increasingly accessible (5). Yet, in the United States, the proportion of Black mothers who die during or after pregnancy is 3 times that of white mothers (6). Here, we’ll explore the reasons for this alarming discrepancy. 

Why are Black mothers dying at higher rates in the United States?

There is consensus among health organizations that racism impacts healthcare and health outcomes (7), including maternal mortality rates. Researchers see significant disparities in birth outcomes between Black and white mothers, even when they control for factors like education and socio-economic background (8). Institutionalized racism and other forms of discrimination are contributors to the difference between the health of Black and white mothers, even when factors like income are taken into account (8,10). Unlike white mothers, Black mothers continue to experience some poor outcomes—like having a low-birthweight baby—despite improvements in their financial status (11). Studies also show that pregnant Black American women experience race and gender-related stress, which is linked to worse pregnancy outcomes (9). 

Additionally, centuries of systemic inequality experienced by Black Americans manifest in injustices that include, but are not limited to, intergenerational poverty, limited access to education and jobs, police violence against BIPOC, and mass incarceration. The effects of these discriminatory experiences create barriers to care (8). Poverty, for instance, can prevent a mother from being able to afford quality medical care, transportation, food, and housing. Mothers who do not have access to transportation or who do not live near a health facility may have difficulty receiving care. And, mothers who have limited access to information may have difficulty seeking and receiving timely medical care (2).

Racism may also continue to affect the well-being of Black mothers who are able to receive care. Research shows that compared to white women, Black women in the United States are less likely to receive medical advice or effective treatments during pregnancy and childbirth than white women (12,13). One study, for instance, found that Black mothers of very low birthweight infants were less likely to receive antenatal steroids, which help prevent breathing difficulties and other bad outcomes in babies (13).

Lastly, high morbidity and mortality rates for mothers can impact outcomes in children, since complications of pregnancy are associated with premature births (14). In 2007, for example, 18% of babies born to Black mothers were preterm, compared with the 12% of preterm babies born to white women. And, preterm-related causes of death led to a higher overall risk of death for babies who were born to Black mothers (15). 

Toward a brighter future

Raising awareness around the public health crisis of Black maternal mortality rates in the United States can help to build a safer and more equitable future for all mothers. We must acknowledge that Black mothers are disproportionately affected by maternal mortality, understand the factors causing disproportionate mortality rates, and work to create systemic solutions.

Many organizations are working toward systemic change around this issue. The National Medical Association promotes the collective wellness of physicians and patients of African descent. And the National Birth Equity Collaborative is working to improve Black maternal and infant health through training and policy. 

Lastly, there are many resources that support mothers who are seeking information and care. I’ve written a helpful guide that offers advice for mothers to have a safe pregnancy. And, tracking your pregnancy in the Clue App can help you advocate for yourself and become aware of issues to raise with your healthcare provider.

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