Despite Black Americans making up 13.6% of the U.S. population, the maternal mortality rate for non-Hispanic/Latina Black women in 2020 was 55.3 deaths per 100,000 live births—almost three times more than that for non-Hispanic/Latina White women [1]. Unfortunately, during the COVID-19 pandemic, the Black maternal mortality rate increased to 68.9 deaths per 100,000 live births in 2021, a much larger mortality rate increase than for non-Hispanic/Latina White women [2]. As a Black woman who wants to have children someday, these statistics terrify me, and I believe that we should not be complacent in accepting this disproportionate mortality rate as the norm. More needs to be done to address the social determinants of health that lead to racial disparities in maternal healthcare, and more needs to be done to protect Black mothers.
Researchers have found that disparities such as lack of access to care, poor health insurance coverage, socioeconomic inequalities, racism, discrimination, and chronic stress contribute to worsening maternal health outcomes [3]. Health insurance coverage before and throughout pregnancy allows mothers to have better access to prenatal care, which includes physical exams, discussions on the health of the mother and the fetus, weight checks, breast checks, and blood tests [3, 4]. Access to this care is essential in reducing the risk of pregnancy complications, but people of color, specifically Black Americans, experience differences in health insurance coverage and more barriers to healthcare, especially in rural populations that are typically medically underserved [3]. The structure and finance of the U.S. healthcare system have been shaped by racial discrimination since the Jim Crow era (1875-1968) [5]. For instance, when the Hospital Survey and Construction Act was passed in 1946, states were allowed to build healthcare facilities that were racially separate and unequal. Additionally, federal programs to provide care to the poor were not supported by many state governments, and even today, inequalities under the Affordable Care Act exist in insurance coverage, financing care, and quality of care [5].
Concerning mortality rates, the leading causes of maternal death for Black women were the gestational high blood pressure disorders pre-eclampsia and eclampsia and a form of heart failure called postpartum cardiomyopathy. Black women were five times more likely than White women to die from these illnesses, and they were also two times more likely to die of severe bleeding or blood vessel blockages during and after pregnancy [6]. Therefore, frequent access to adequate care and better health insurance coverage is necessary to bridge the gap of the disparities that burden and kill pregnant Black women in our country.
Though a lack of access to adequate healthcare negatively contributes to poor maternal health, the combination of socioeconomic inequalities, systemic and structural racism, and discrimination against Black mothers are reported to be the primary factors of poor maternal health outcomes [3]. A survey on race and health that was conducted in 2020 and included over 800 Black participants found that most Black adults felt that the American healthcare system discriminates against people according to their race; this same survey reported that 37% of Black mothers were mistreated due to their race when receiving healthcare for themselves or a relative [7].
Other inequalities, especially those exacerbated by the COVID-19 pandemic, have disproportionately affected the Black community and Black mothers. For example, it is widely known that poverty disproportionately affects communities of color, especially with affordable housing, public transportation, access to healthy food, and quality of education. Research has shown that the chronic stress associated with this poverty has contributed to racial maternal health disparities [8]. Overall, these inequalities contribute to the problems we are seeing in Black maternal healthcare and show that America, specifically the U.S. healthcare system, needs to do better in providing care and listening to Black women.
One way that Black maternal health outcomes can be improved is through more government support in increasing access to maternal healthcare. In June 2022, the Biden Administration published the Blueprint for Addressing the Maternal Health Crisis. This document describes how federal agencies need to prioritize increased health insurance coverage, data collection and research, a larger and more diverse prenatal workforce, and other incentives to improve maternal health [3]. Additionally, the Health Resources and Services Administration has allotted over $300 million for states to strengthen maternal and infant health, and the Office of the Assistant Secretary for Health has invested over $8 million into initiatives to reduce maternal deaths and health complications that hurt people of color and people living in rural areas [3].
Only time will tell if these initiatives can decrease the overall maternal mortality rate and decrease the number of Black women who die every year due to pregnancy-related issues. The maternal mortality rate being three times higher for Black women than it is for White women should not be viewed as just another statistic or number on a piece of paper. This epidemic is scary, preventable, and unacceptable, and it highlights the injustice that Black women constantly face in healthcare settings. I am tired of seeing this disparity grow bigger and bigger every year, and I hope that one day, I will live in a country where I do not have to worry about Black women being pushed aside, disregarded, and ignored by our healthcare system.
Edited by: Sanjana Anand
Graphic Designed by: Natalie Chou
References
Hoyert, D. L. (2022, February 23). Maternal mortality rates in the United States, 2020. Centers for Disease Control and Prevention. Retrieved March 3, 2023, from https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm#Suggested_citation
United States Government Accountability Office. (2022, October). Maternal health: Outcomes worsened and disparities persisted during the pandemic. GAO Report to Congressional Addressees. Retrieved March 4, 2023, from https://www.gao.gov/assets/gao-23-105871.pdf
Hill, L., Artiga, S., & Ranji, U. (2022, November 1). Racial disparities in maternal and infant health: Current status and efforts to address them. KFF. Retrieved March 3, 2023, from https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/#:~:text=Research%20has%20documented%20that%20social,of%20mortality%20among%20Black%20infants
National Institutes of Health. (2017, January 31). What is prenatal care and why is it important? Eunice Kennedy Shriver National Institute of Child Health and Human Development. Retrieved March 3, 2023, from https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care#:~:text=Prenatal%20visits%20to%20a%20health,tests%2C%20such%20as%20ultrasound%20exams
Yearby, R., Clark, B., & Figueroa, J. F. (2022). Structural racism in historical and modern US health care policy. Health Affairs, 41(2), 187–194. https://doi.org/10.1377/hlthaff.2021.01466
PRB. (2021, December 6). Black women over three times more likely to die in pregnancy, postpartum than white women, new research finds. PRB.org. Retrieved March 3, 2023, from https://www.prb.org/resources/black-women-over-three-times-more-likely-to-die-in-pregnancy-postpartum-than-white-women-new-research-finds/
Hamel, L., Lopes, L., Muñana, C., Artiga, S., & Brodie, M. (2020, October 13). KFF/The undefeated survey on race and health. KFF. Retrieved March 3, 2023, from https://www.kff.org/racial-equity-and-health-policy/report/kff-the-undefeated-survey-on-race-and-health/
National Partnership for Women & Families. (2018, April). Black women's maternal health: A multifaceted approach to addressing persistent and dire health disparities. National Partnership for Women & Families. Retrieved March 3, 2023, from https://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html
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