August 2nd, 2023

High maternal morbidity rate remains a deep concern for Black women

Rate of death more than doubled white women’s over the past decade, state study says

One pregnant Black mother-to-be reported that her doctor minimized her concerns about whether her chronic hypertension would harm her while giving birth.

Another said she could not get her doctor to listen to her about her health issues. And a third said she began limiting the time she saw her physician due to previous mistreatment.

These women had their babies, but their concern about their harsh medical treatment is one Black pregnant women share – some at a deadly cost.

“We know that Black women have a lot of chronic [health] issues and problems. Racism is also part of it,” said Colette Dieujuste, dean of nursing at Wheaton College, who is leading a study on Black pregnant women and morbidity.

The disparity was highlighted in a recently released report by the Massachusetts Department of Public Health that showed that pregnant Black non-Hispanic women had more than double the morbidity rate than white women in the past decade.

Morbidity among Black pregnant patients has drawn national attention, including the tragic events that led to the recent death of Olympian sprinter Tori Bowie, who was eight months pregnant and died due to complications from childbirth.

Tennis legend Serena Williams publicly described her near-death experience after giving birth to her daughter Olympia. Williams, who had blood clots, began having trouble breathing after the birth and expressed that she was having another pulmonary embolism. But the hospital staff didn’t seem overly concerned despite her insistence on getting tested.

“They were trying to talk to me, and all I could think was, ‘I’m dying, I’m dying. Oh my God,’” she said, according to a USA Today article about the incident.

Severe maternal morbidity is defined as unexpected complications during labor and delivery that result in significant short- or long-term consequences to the health of the mother.

High morbidity rates signify poor maternal and reproductive health care in a specific area, according to the report, released last month, which examined data from 2011 to 2020.

“These persistent disparities arise from inequities in care and access, social and economic factors and the enduring effects of structural racism,” the report said.

Severe maternal morbidity rates increased from 52.3 per 10,000 deliveries in 2011 to 100.4 per 10,000 deliveries in 2020, the report said.

The rates among Black non-Hispanic women were 2.3 times higher — and 1.2 times higher for women who are Hispanic and non-Hispanic Asian/Pacific Islander — than rates among white non-Hispanic women, according to the report.

The report’s researchers said that to improve the health outcomes of pregnant people, state policy efforts must “continue to target structural racism and ableism, as well as other socioeconomic and community drivers of adverse maternal outcomes, including access to and quality of primary and prenatal care,” the report says.

Dieujuste said the disparity in rates can be a result of multiple factors such as a patient’s environment, medical history and racial biases by medical professionals.

“It’s looking at all of their chronic problems,” she added.

Dieujuste and Laurie Nsiah-Jefferson are both leading the Boston Birth Equity study based out of UMass Boston. They are researching the effects of racism and sexism on Black pregnant people and developing policy initiatives to address their experiences.

Nsiah-Jefferson, the director of the Center for Women in Politics and Public Policy at UMass Boston, said maternal care should be provided using a reproductive justice framework. That includes acknowledging racism in medical practice, listening closely to pregnant patients, and taking their concerns seriously to get to the root causes of their prenatal health issues.

“Without acknowledging this, we will not get too far with making improvements, and dare I say transformation, which is really what we need in the healthcare system,” she said.

Dieujuste also shared the experiences of women who had a variety of concerns with their doctors, including not being heard or taken seriously.

She added that many Black mothers-to-be feel as though their doctors do not hear their concerns or pay attention to them, and sometimes they avoid going to the hospital because they fear how they would be treated.

“Women are pushed aside in a way,” she said.

Black pregnant women often request a Black practitioner or Black OB-GYN who they feel better understand their health issues.

“We have to listen to what they are saying and believe them,” said Nsiah-Jefferson. “They’re telling you about their experiences in prenatal, postnatal and delivery care. What they tell you is something we should listen to and take heed.”

Solutions for such matters include offering culturally competent and affordable doula support and consultations with mental health professionals for prenatal visits, and educating pregnant women on available services and support, according to a report by the state’s Special Commission on Racial Inequities in Maternal Health that was released last year.

“We need to increase the number of midwives of color,” Nsiah-Jefferson said. “These midwives and doulas should all have skills that are culturally relevant.”

Dieujuste said hospitals should try to make each pregnant “woman feel as comfortable as she can and help her reach the best care that she can get for herself and for the new babies she brings into this world.”

black women, health, health equity, maternal morbidity, pregnancy