May 9, 2018
On Mother’s Day we pay tribute to the women to whom we owe our lives. While it’s a heartwarming celebration, the chances to enjoy pregnancy, childbirth and motherhood differ vastly, with African-American women at a distinct disadvantage.
Many African-American women will never celebrate Mother’s Day, as they are three to four times more likely to die from pregnancy or childbirth-related causes than white women. Their chances of surviving pregnancy are the same as if they lived in Uzbekistan, according to the World Health Organization.
African-American women are also 49% more likely to deliver prematurely, which can have long-term effects for their babies, including intellectual and developmental disabilities, lung and breathing problems, and neurological disorders.
The cause is not poverty. The New York Department of Public Health and Mental Hygiene found that African-American women in the wealthiest neighborhoods have more complications in maternal and child health than white, Hispanic and Asian mothers in the poorest ones. In Oakland, Calif., where Alameda Health System is based, African-American babies account for 21% of all births, but 45% of all infant deaths.
The common denominator is race. Arline Geronimus, a professor at the University of Michigan’s School of Public Health, has coined the term “weathering,” the physical result of an African-American woman’s body consistently, and sometimes unknowingly, battling overt and covert racism. This leads to greater overall health issues, but especially complications in pregnancy, birth and postpartum health for African-American women and their infants.
These statistics and issues represent the cruelest examples of health inequity and disparities in health outcomes and portend limited prospects for wellness, educational attainment and prosperity even before babies are born.
As healthcare providers, we must do more. We can start with how we listen and respond.
The East Bay Express in Oakland, Calif., in January wrote about a pregnant African-American woman who complained of back pain and trouble breathing. Her provider recommended Tylenol for what was deemed gas; in fact, her lung collapsed. Then there’s Serena Williams’ postpartum story about having to argue with medical staff for blood thinners after childbirth. Her records clearly stated she was prone to clotting, yet no one checked. Potentially dangerous blood clots were eventually found in her lungs.
Many black women report they feel their concerns are not heard or respected by their providers and that the healthcare system itself is a cause of stress. If these women don’t feel respected, and their fears, questions or symptoms are ignored, they may not return for prenatal and postpartum checkups, or they might not feel comfortable enough to advocate for themselves.
Alameda Health System is working to improve health outcomes and relationships between expectant women and healthcare providers through CenteringPregnancy. Centering gathers pregnant women with similar due dates for group prenatal visits with certified nurse midwives, who monitor blood pressure and weight, provide comprehensive prenatal care, and discuss topics including breastfeeding, infant care, nutrition, physical activity and stress reduction.
A Maternal and Child Health Journal study in South Carolina stated that CenteringPregnancy reduced the risk of premature birth by 36%, and that every premature birth prevented there represented an average savings of $22,667. Our program is showing similar rates of improvement.
There are other ways to better address this trend—using more midwives and doulas; increasing diversity of staff and providers; and insisting on more culturally competent care.
What may be most important is to acknowledge that these dismal outcomes for African-American women and their babies are intolerable. In the U.S., African-American babies die at more than two times the rate of white babies. The infant mortality rate for the U.S. ranks 20th among wealthy countries at 5.9 deaths per 1,000 births, nearly three times the rate in Japan. We must dedicate ourselves to decreasing maternal harm and mortality during childbirth, and increasing the number of babies who get off to healthier starts and on paths to achieving their full potential.
Around the table during Mother’s Day celebrations, there are too many women who lost their babies and chairs left vacant by women who died during pregnancy and childbirth. We must do better.
Edited on June 15, 2018.