The Plight of Black Sistas: The Maternal Health Crisis
In this blog post, I will be discussing the maternal health disparities that disproportionately impact black women, namely black mothers, and their insidious rippling effects on society. I am currently reading "Medical Apartheid" by Harriet A. Washington; it is the first comprehensive, broad overview of African-Americans' non-consensual involvement in various research experiments while at the mercy of White medical care practitioners. The Tuskegee Syphilis Study is the most widely known research experiment. Furthermore, I follow Dr. Kali Hobson, M.D, a board-certified child and adult psychiatrist, on TikTok, and she referenced this book in one of her TikTok videos. I admire her tireless advocacy for social justice and dismantling racism in the mental health field, inspiring me. A final source of inspiration that propelled my interest in the maternal health field is a presentation on the maternal health crisis given by two of my peers in the Social Work field. Another noteworthy point is that doula work is becoming highly popular, and the demand for doula workers is increasingly high, which is excellent!
Photo of Unsplash(Courtesy of João Paulo de Souza Oliveira) An umbilical cord with the connected placenta that is ejected during a woman’s post labor and delivery period.
I want to provide some critical snapshots of statistics that highlight the vast disparities between White and Black women:
Infant mortality rate: Black/African-American mothers had the highest rate out of all the ethnic groups, with a prevalence rate of 10.5 per 1,000 live births in the country, whereas White mothers had an infant mortality rate of only 4.5 per 1,000 live births.
Photo of Unsplash(Courtesy of Annie Spratt): An infant child is placed on its mother’s back as she is working in the field.
Low birthweight: Black/African-American mothers had the highest percentage of low birthweight out of all ethnic groups with a ratio of 14%, whereas White mothers had a low rate of low birth weight of 6.8%.
Preterm births: Black/African-American mothers had the highest percentage of low birthweight out of all ethnic groups with 14%, whereas White mothers had a low rate of preterm births at just 9%.
The overall maternal mortality rate is about 17.4-19.00 per 100,000 live births in the U.S alone, which is already a considerable concern. However, what's even more unsettling is that Black women are dying from pregnancy-related complications at higher rates than White women, which is shameful! Disturbingly, about 700 women die annually from pregnancy-related issues, according to the Centers for Disease Control and Prevention(CDC). Black mothers are more susceptible to maternal mortality and severe maternal morbidity. The World Health Organization(WHO) defines severe maternal morbidity as "the general state of ill health brought about by pregnancy-induced complications that result in short-term and long-term health consequences during pregnancy, labor/delivery, or puerperium." It's a huge pity that the U.S is infamously known for its high maternal mortality rate, given the advanced health care and wide accessibility of resources that the country boasts.
Photo by Ella Jardim on Unsplash. An expecting woman is examining her growing baby bump as she prepares for pregnancy.
In the article, "Structural Racism and Maternal Health Among Black Women," Dr. Jamila K. Taylor incorporates the structural racism framework to highlight the myriad health disparities that significantly impact black mothers. The Aspen Institute defines structural racism as "a system in which public policies, institutional practices, and cultural representations work synergistically to reinforce and perpetuate racial inequity ."The discrediting and dismissal of black women's pain and the deprivation of primary medical care during pregnancy and labor/delivery are a few clear-cut examples of structural racism. WHO defines maternal health as "the overall health of women during pregnancy, childbirth, and in the postpartum period."
The late Dr. Shalon Irving and the late Kira Johnson's tragic deaths demonstrate how the U.S health care system did a complete disservice to both of them by not providing them with the necessary care and dignity. Both of these women died from delivering their babies via cesarean section, or C-section for short, and subsequently died from pregnancy-related complications. Dr. Irving succumbed to complications of pregnancy-induced high blood pressure. At the same time, Kira Johnson suffered from a postpartum hemorrhage in which she lost 3 liters of blood after she delivered her second baby boy. Although both women's cause of death was different, the commonality in both cases was the deliberate negligence and dismissal of their pain from medical providers after delivery. I felt bouts of anger from reading these anecdotes because they did not deserve to die! Pregnancy is a joyous, exciting occasion for mothers and their families and should not be rife with pain, sorrow, disappointment, suffering, grief, or even worse yet, death.
Medicaid is another clear example of structural racism that can negatively impact low-income families, namely those of color. Reducing funds, implementing draconian policies, and changing its eligibility and threshold stipulations are just a few ways of its negative impacts. New mothers in the postpartum stage of pregnancy are no longer granted Medicaid health care coverage 60 days after birth. It is considered a vast lifeline for women of reproductive age, in which around 25 million women are enrollees. Medicaid is a simultaneous federal and state program that offers health care insurance for people with low incomes and presents any form of disability. In a concerted effort to assist more individuals in obtaining health care coverage and accessing healthcare services, the Affordable Care Act played a massive role in facilitating this effort by expanding the range of services and increasing the income threshold. The ACA Medicaid expansion expanded coverage to adults with incomes up to 138% of the Federal Policy Level(FPL), equating to $17,774 for a single individual. Thirty-nine states have adopted and implemented the Medicaid expansion, and vice versa; 12 states have not adopted and implemented the Medicaid expansion. New York is one of the 39 states that have expanded Medicaid coverage, and on the other hand, Alabama comprises one of the 12 states that have not expanded Medicaid coverage.
Photo of Unsplash(Courtesy of Shelley Shell): An expecting woman poses with her expecting baby bump in a maternity-themed photoshoot.
Dr. Jamila Taylor provided some examples of tangible benefits from the expansion in her "Structural Racism and Maternal Health among Black Women" article. One advantage is that states who have expanded Medicaid have witnessed an overall significant decrease in infant mortality rates by 50%. Another successful outcome of Medicaid expansion is the decrease of maternal deaths at 1.6 per 100,000 live births. Finally, expecting mothers and new mothers maintained their regular medical care treatment continuity and integrity.
I want readers to leave with a few key takeaways. To truly create an anti-racist health care system, change on the systemic and policy level needs to occur. For example, continuous professional development on topics such as recognizing one's implicit biases, cultural competency, and lots of ongoing personal self-reflection will be the starting blocks in cultivating culturally competent and well-informed health care professionals. Another avenue of change is that companies should strive to improve their recruitment approaches to attract and retain highly talented, diverse medical practitioners. Black women's social determinants of health do not work in their favor. They do not shield them from receiving poor medical treatment or apathetic health care professionals, as evidenced by Dr. Taylor's mentioning of them in her article. On the surface, Dr. Shalon Irving and Kira Johnson had their lives going for them; they had successful jobs, were highly educated, and came from great homes. But, even these things did not protect these ladies from receiving poor medical treatment.
Photo by Annie Spratt on Unsplash. A mother with her sleeping infant child on her back is working in a cassava farm.
Courtesy of Photo by Camylla Battani on Unsplash. An expecting woman is embracing her growing baby bump during a maternity-themed photoshoot.
Photo of Unsplash( Courtesy of Tony Luginsland): An expecting woman is posing with her baby bump during a maternity photoshoot.
Photo of Unsplash(Courtesy of Omar Lopez): An expecting woman is examining her baby bump during a maternity-themed photoshoot.
