Justice in Motherhood: Combating a Maternal Mortality Crisis Divided Along Racial Lines
The United States has a maternal mortality crisis, and communities of color are on the frontlines.
Black women die from pregnancy-related complications at a rate of three times that of white women. Despite recent calls to action, disparities in access to quality medical care persist — a startling 3 in 5 maternal deaths are preventable, fueled by a broken healthcare system tainted by chronic inefficiency and larger institutional racism. Contenders for the Democratic Party’s 2020 presidential nomination have coalesced around a platform aiming to improve maternal outcomes among racial minorities, with the looming election intensifying rhetoric surrounding the problem and positioning it as a hot-button issue attracting increased political attention.
The pipeline of maternal inequity begins with contraceptive care and counseling. Black women are less likely than white or Latina women to receive postpartum contraception and, even when they do, less likely to receive an effective method, a phenomenon that exacerbates rates of unintended pregnancy. Because of a long history of distrust in healthcare providers stemming from a racially charged eugenics movement, egregious reproductive oppression renders black women significantly less likely to use birth control and information about medical choices unavailable to them.
And amid mounting legal challenges to landmark Supreme Court case Roe v. Wade and a cascade of state-wide attempts to severely limit or entirely ban abortion, emboldened by a presidential administration that prides itself on jettisoning constitutional precedent, reproductive rights have been under siege. This systematic upheaval has been linked to an uptick in illegal procedures, which constitute an unrelenting public health challenge and occur as a direct consequence of restrictive law. Women of color suffer the sharpest blow from legislative assaults on these fundamental freedoms and are thus at particular risk of dying from self-induced or unsafe abortions, contributing to maternal mortality rates.
Upon seeking obstetric care, black women are impacted by pervasive racial bias in clinical decision-making, pointing to a rising need for structural change and evidence-based interventions in order to close demographic service gaps. A comprehensive review published in Academic Emergency Medicine uncovered implicit racial prejudice among health care professionals that resulted in differential treatment and morbidity rates even after adjusting for socioeconomic factors. Bias inhibits professionals from identifying prenatal risk factors and signs of potential complications during the pregnancy and postpartum stages, with reports of hostility or continued dismissal of symptoms and concerns characterizing interactions between women of color and clinicians. Investments in bias training under the train-the-trainer model have empirically been found to reduce stereotypes that could harm the physician-patient relationship, measured according to the Implicit Associations Test.
Additionally, recent efforts to repeal sections of the Affordable Care Act as well as state Medicaid programs that not only guarantee coverage for maternal care but also finance nearly half of all births nationally disproportionately affect communities of color, who are more likely to be uninsured. A study presented at the AcademyHealth 2019 National Health Policy Conference held in early February unearthed a correlation between the expansion of Medicaid under the Affordable Care Act and a decrease in maternal mortality. Addressing the issue of broader healthcare coverage, especially in the context of a growing political debate ravaging the national stage about the merits of a single- versus double-payer system, must be recognized as a critical step to curtailing maternal deaths.
Expanding access to housing and transportation alongside emergency response support also plays a key role, since geographic barriers can distance women from treatment. Seventy-five percent of black women receive care from predominantly black-serving hospitals, which perform worse on 12 of 15 birth outcomes. States have experimented with telehealth initiatives to improve care in rural communities, establishing a nationwide network that mitigates imbalances caused by provider shortages and hospital closures. The Georgia Department of Public Health implemented a similar project that facilitates the stationing of telemedicine carts to enable video conferencing and the dissemination of health education as well as clinical tools as part of a Centering Pregnancy Program that boasts a 98 percent follow up rate for care.
Illuminated by a historical movement for reproductive equality that took root in 20th-century struggles for birth control and that now manifests itself in modern activism, far too many black mothers have lost their lives, amounting to a national failure. The epidemic demands reform through policy and governmental action, especially since it remains statistically interlinked with other social determinants of health from employment to education to environmental risk. We must take it upon ourselves to erase this divide and return justice to motherhood.