October 11th, 2023

Maternal health report finds fatal disparities

BPH commission identifies alarming inequities in mortality rates of Black mothers and infants

Lisa Mitchell

Obstetric racism.

Those words hung in the air during the EQTY 2023: A Summit for Health Justice Conference held in Boston last month. At the time, a panel of doctors and community activists addressed critical questions related to “Equity in Pregnancy.”

The conference came well before last week’s report by the Boston Public Health Commission showing Black people experiencing the highest rates of infant mortality, preterm births and low birth rate than other racial and ethnic groups.

The report also found that neighborhoods with higher concentrations of Black residents also experienced significantly worse maternal health outcomes than others.

The framework of “obstetric racism” magnifies that the patients’ experiences within the biomedical structures of gynecological, reproductive and obstetric, where clinical practices often violate a Black woman’s autonomy in their birth plan, safety and humanity.

Framing the issue as “obstetric racism” helps health institutions understand that not only are race and poverty determents of poor birth and maternal outcomes, but also that racism is a primary factor.

As a postpartum African American registered nurse working in a major Boston hospital, I have witnessed both compassion and dismissive behaviors by clinical and nursing staff towards women of color and their families.

While both attitudes can be true, it is clear that the health care system is failing Black women and their families.

We know that maternal and infant mortality rates greatly affect the outcomes of families. It is impossible for Black families to make gains in other facets of societal wellness, health and financial wellbeing, if the both mother and infant are at risk of death.

Boston is the bedrock of higher education and acclaimed medical institutions servicing these affected neighborhoods. So how is it possible that we are seeing such disproportionate rates?

The health commission’s 2023 Maternal and Infant report aims to shed light on these issues and is cause for concern.

It reveals the alarming infant mortality rates in Boston based on ZIP code and race.

The report analyzed data from 2012 to 2021.

It found the rate of infant mortality among Black infants in Boston (9.7 deaths per 1,000 live births) was more than twice the citywide average (4.6 deaths per 1,000 live births) and more than three times the rate for white infants (3.2 deaths per 1,000 live births) in 2021.

Boston’s infant mortality rates are below the national average at 5.4%, according to the report.

The data show that where Black families live, Boston infants are dying at two to three times the numbers as white residents.

The report showed that ZIP codes in Hyde Park, Mattapan and parts of Dorchester had nearly three times higher infant mortality rates than Back Bay and Roslindale.

CDC links infant mortality is low birthweight, followed by congenital malformations, Sudden Infant Death syndrome, accidents and maternal complications.

Low birthweights lead to poor infant development, cognitive delays and increased health care costs, the CDC said.

In Boston, the low birthweight average is 8.3% is below the national average. However, Mattapan and Dorchester had the highest low birthweight among Black (13.4%) and Latina (7.7%) — significantly higher compared to whites (6.2%).

Nurses, obstetricians, family medicine providers and midwives advocated for opportunities to standardize care for mothers with issues of high blood pressure pre and post pregnancy. This maternal condition is common in infant born with low birthweights and who were premature at birth.

Monitoring blood pressures with results sent directly to the clinic during pregnancy and post pregnancy has been a game changer.

Innovative programs, like the Blood Pressure Cuff program at Boston Medical Center, which sends results directly to a secure patient portal, also demonstrate that solutions in standardizing maternal and infant health care are possible in order to ensure that all babies and mothers in Boston no matter their ZIP code are entitled to optimal health outcomes.