Mortality of Black Mothers in The US

Birth – what’s meant to be the exciting and climatic arrival of new life becomes an unexpected death for others. “Who is this other?” you ask. As history often repeats itself, Black women are ignored, belittled, and silenced. Ultimately, left to be forgotten despite being amongst the most disadvantaged. 

“In the United States, black women are three to four times more likely to die doing the most natural thing they could ever do, which is bring life into the world,” said Shawnee Benton  Gibson, LMSW / FDLC. This information alone should become an international humanitarian crisis however it’s left untreated like many issues are towards the marginalized.   

Up to the mid to late 1800s, in the U.S., most women gave birth at home with the help of midwives who were typically Black, Indigenous, and or foreign women. Their skills and care allowed them to play an essential and fundamental role in reproductive health. However, they were never consulted or involved in the construction of systems and policies for maternal health in the United States. Instead, white male physicians took over the profession, moving it in a different direction – surgery. 

History reveals that some of the pioneers of the United States’ current prenatal systems were supporters of eugenics. Take Fred Adair for example, an obstetrician-gynaecologist who  believed black people are inferior and wanted to “prevent the birth of those who are defective  and constitute a burden or menace to society.” So, it is not a surprise that The Sheppard-Towner Act of 1921 Adair helped orchestrate, and negatively placed regulations on midwives, who were predominantly black women. In some states, the regulation mandated midwives to attend nursing school and work under the direct supervision of physicians. However many programs did not allow Black women to attend. Therefore, limiting Black women’s ability to not only become midwives but to advocate for black mothers within the healthcare system. 

“A black woman having a baby is like a black man in a traffic stop with the police” – Felicia  Edwards 

In California, 350 babies born to the poorest white mothers die and 437 babies born to the richest black mothers die. As this horrifying statistic highlights, class and wealth are unable to protect black women from experiencing racial disparities in healthcare. From Beyoncé and Tori Bowie to Shamony Makeeba Gibson and Amber Rose Isaac. Even Serena Williams, a 23 Grand  Slam singles winner, was ignored by medical staff whilst gasping for breath due to experiencing a pulmonary embolism. Considering that blood clots are a common side effect of C-sections, and they are part of Serena’s medical history, this medical team should have prepared themselves to monitor her for this. Despite treatment, her coughing, triggered by the embolism, persisted,  eventually resulting in her C-section wound rupturing. On her next trip to the hospital, physicians discovered a hematoma (large collection of blood) in her abdomen. This mother was forced to spend the first six weeks of their baby’s life bedridden. Should a mother have to suffer such hellish consequences because medical personnel can’t simply listen to a mother’s concerns? 

This story highlights how when racism is excused and downplayed, it quickly pervades every aspect of life. Within healthcare, we see this in the form of racial bias, like the dismissal of legitimate concerns and symptoms raised by Black individuals. It seems to stem from white medical students and staff wrongly believing Black people have a higher pain tolerance than white people and therefore treat Black patients for pain. No wonder Black women in the  United States are over 50% more likely to deliver a premature baby than white women. 

Such dehumanizing treatment only adds to the pre-existing and mostly unavoidable atmosphere of racism and misogynoir that Black women battle in everyday life. This tiring and suffocating predicament manifests as physiological stress which has now been widely recognized to cause conditions such as hypertension and pre-eclampsia which directly link to higher rates of not only maternal death but infant death too. 

Unfortunately, this issue is not exclusive to the United States. A report done in the UK found that “Babies from the Black ethnic group have the highest rates of stillbirths and infant deaths” Karen Luyt, a professor of neonatal medicine at Bristol University, believes “There’s an element of racism and there’s a language barrier,” “Minority women often do not feel welcome. There’s cultural incompetence and our clinical teams do not have the skills to understand  different cultures.” 

As revealed by the birthing experience of Serena Williams, surviving is not always the end of issues. Facing such a traumatizing and insulting ordeal can cause stress to accumulate in the 

body over time. Continued activation of the body’s stress response system results in too much exposure to stress hormones such as cortisol. This wears down the cardiovascular, metabolic, and immune systems, putting the body at greater risk of heart disease, high blood pressure,  digestive problems, stroke, and muscle pain. This can make it quite dangerous to give birth again. 

To minimize the disparities, many Black women are now including doulas and/or birthing centers in their pregnancy and birthing journey. In 2017, the American College of Obstetricians  and Gynaecologists released a statement noting that “evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor.” Midwifery can also be a beneficial option for one-on-one support. Midwives have a holistic approach that focuses on each woman as a person rather than a surgery to execute quickly. Labor is allowed to unfold at its own pace. Ultimately, the goal is for the mother to safely go through the rewarding journey of birth knowing that she is surrounded by staff that truly care. A 2018 study ranked U.S. states using scores out of 100 based on how easy it was for midwives to practice and collaborate with obstetricians and other providers. Washington had the highest score of 61.  States with higher scores had better birth outcomes including more spontaneous vaginal deliveries, higher rates of breastfeeding, fewer premature births, and fewer C-sections. Contrastingly, states in the South had the lowest scores and were associated with higher rates of premature births, underweight babies, and infant mortality. This is likely due to the restrictions these states put on midwifery care despite its clear and compelling advantages.  

All women, particularly Black women need to know about the options available for birth.  However, too few states have robust midwifery services in the same way that the top three states (Washington, New Mexico, and Oregon) do. So, it is equally important that states allow these other birth services and spaces to flourish. This is why the reintroduction of the bipartisan bill: The Midwives for Maximizing Optimal Maternity Services Act into the House this June is very promising. It aims to “improve maternal health outcomes; ensure access to high-quality maternal health services for women, newborns, individuals, and families; and help end crisis level U.S. maternal mortality rates”. It would do so by establishing two new streams of funding for midwifery education to increase the number of midwives attending U.S. Department of  Education-accredited midwifery programs. This funding would support student midwives, establish or expand midwifery programs, and ensure more instructors are available at clinical training sites to train students to become CNMs, CMs, or CPMs. Additionally, the legislation is intentionally focusing on increasing racial and ethnic representation within the midwifery workforce to address the racial health disparities that are costing people their lives. 

This suggests that medical schools need to get involved by shaping their curriculums so that students become more aware of systemic racism in medicine and healthcare systems. This way, they will transform into healthcare workers who are dedicated to reshaping their places of work into anti-racist spaces for the betterment of patients.  

These disparities are also being addressed by states such as Illinois and Connecticut which are in the process of expanding Medicaid coverage to doula services. Currently, only 9 out of 50  states require Medicaid to cover doulas. Despite studies showing that reduces rates of C-sections, prematurity, illness in newborns, and the likelihood of postpartum depression.  

But work still needs to be done. This year, Alabama state officials changed the rules surrounding birth centers. One of the rules requires midwives to have certain nursing qualifications to operate and assist in out-of-hospital births. Secondly, birthing centers in Alabama are now required to secure agreements with local hospitals for patients to be transferred if necessary.  Thirdly, to open, centers must be within a 30-minute drive of hospitals where obstetricians are on staff. This could be a significant problem for rural communities. 

The color of your skin has very real effects - detrimental for some and advantageous for others. If the benefits that people receive are at the expense of the lives and joy of others, then the systems keeping such an unfair system running must be reconstructed to establish equity for all. 

BLACK BIRTH MATTERS 

BLACK MOTHERS MATTER 

BLACK FUTURES MATTER 

Anti-blackness kills. Being anti-racist saves lives. 

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Annabel Ovonlen is a current Year 12 student from England. She has a deep passion for clinical and medical research driven by her love for science and a desire to close inequality gaps. Outside of this, she loves watching movies, reading books, knitting and baking, not to mention keeping her Duolingo streak alive and watching various sports from basketball to Formula 1.

References

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