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. A few sources of inspiration led me to learn and write about this topic. 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 to make is that doula work is becoming highly popular, and the demand for doula workers is increasingly high, which is excellent!

A placenta and an umbilical cord is in the shape of a heart.

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.

• 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 a ratio of 14%, whereas White mothers had a low rate of preterm births at just 9%.

A pregnant woman is at her maternity photoshoot and is staring at her baby bump.

The overall maternal mortality rate is about 17.4-19.00 per 100,000 live births, 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 at a greater susceptible risk of maternal mortality and severe maternal morbidity. The World Health Organization(WHO) defines severe maternal morbidity as "the general state of ill health that is brought about by any type of 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.

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 postpartum."

Dr. Shalon Irving and Kira Johnson's tragic deaths are a perfect example of how Readers can understand how the healthcare system failed these ladies and their families. 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 stories 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 a simultaneous federal and state program that offers health care insurance for low-income people and presents any form of disability. In a concerted effort to assist more individuals in obtaining healthcare coverage and accessing healthcare services, the Affordable Care Act greatly facilitated this effort by expanding the range and increasing the income threshold. The ACA Medicaid expansion expanded the scope to adults with incomes up to 138% of the Federal Policy Level(FPL), which equates to $17,774 for a single individual. Thrity-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.

Dr. Jamila Taylor provided some examples of tangible benefits from the expansion in her "Structural Racism and Maternal Health among Black Women" article. For example, states that have expanded Medicaid have witnessed an overall significant decrease in infant mortality rates by 50%. Another successful outcome of Medicaid expansion is the decrease in maternal deaths at a rate of 1.6 per 100,000 live births, and finally, expecting mothers and new mothers were able to maintain the continuity and integrity of their regular medical care treatment.

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 in recognizing implicit biases, cultural competency, and ongoing personal self-reflection will be the foundation for cultivating culturally competent and well-informed healthcare 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 healthcare professionals, as evidenced by Dr. Taylor's article mentioning them. 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.

Sources:

Taylor, J. K. (2020). Structural racism and maternal health among Black Women. Journal of Law, Medicine & Ethics, 48(3), 506–517. https://doi.org/10.1177/1073110520958875 https://journals.sagepub.com/doi/epub/10.1177/1073110520958875

https://www.kff.org/other/state-indicator/infant-mortality-rate-by-race-ethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

https://www.kff.org/other/state-indicator/preterm-births-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/