"Birthing while Black"
As the CDC provides evidence that COVID-19 is devastating minority communities at higher rates with corresponding poorer outcomes for those infected, we are reminded of how healthcare in America has disproportionately failed communities of color. In August (2020), CNN released an article focused on highlighting that babies of color are three times more likely to die when cared for by White doctors as opposed to Black doctors. Even the most casual of internet searches will produce countless articles devoted to the unequal medical outcomes of minorities within America’s healthcare system, it is, therefore, no surprise that it exists even at the level of our reproduction.
An article published in the American Journal of Obstetrics and Gynecology in 2010 gave shocking data on the mortality of Black women during pregnancy. Overall maternal morbidity has been on the rise across all races since 2005, but it is glaringly worse among Black women. In 2005, the death rates for White women were 11.7 per 100,000 live births, 9.6 for Hispanic women, and 39.2 for non-Hispanic Black women (1). In 2020, those numbers have not improved much, despite all the research and discussion that has been devoted to it over the years. Based on recent data released by the National
Center for Health Statistics in 2018, the maternal death rate for Black women is still more than double that of White women: 37.1 deaths per 100,000 live births compared to 14.7. It was also more than three times the rate for Hispanic women 11.8 (2).
Generally, maternal death can be attributed to pregnancy outcomes such as pre-eclampsia/eclampsia, postpartum hemorrhage, placenta previa, and placental abruption. What is most telling is that although the prevalence of these five conditions was not higher among Black women, they are 2-3 times more likely to die from those conditions. This begs the question: WHY? Many theories have been explored. Is poor access to healthcare, poverty, and pre-existing medical conditions to blame? It certainly may play a role. However, even when Black women of higher socioeconomic status and more education are looked at, which would make one assume better access to medical care and overall improved health status, they still die at higher rates than their White counterparts. Additionally, it is interesting to note that Black women have cesarean sections at higher rates than their White counterparts, specifically 36% compared to 31%. It is well known that women who have cesarean sections have more post-delivery complications than if they were to have had a vaginal birth.
Current efforts aimed to address this maternal healthcare crisis focus on trying to improve the social conditions of minority women. This is why efforts such as the expansion of Medicaid and the elimination of maternity care deserts in underserved communities are coming under scrutiny. However, given that higher education and wealth have not been found to be as protective for Black women as it has been for White women, one is left with racism as the root of the problem. It is the elephant in the room that presents itself over and over again in America’s history. Its branches extend far and wide in every aspect of our culture. No solutions can be properly instituted without addressing and dismantling this monster. Racial bias and discrimination are pervasive in healthcare settings and can lead to increased stress for the woman when she is not treated with dignity during her interactions with healthcare providers. Oftentimes, women, but especially women of color, feel invisible or unheard when asking medical providers for help and when expressing concerns about pain or discomfort during and after the birthing process (3).
To this point, one concludes that minority women will continue to die unnecessarily unless progressive measures are implemented, such as programs to increase the number of minorities in medicine, in addition to other vehicles of advocacy. The most special, joyous, and defining moment in most women’s life should not also be her most dangerous one.
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Written by Rashida McCain-Hall, MD