Pregnancy is supposed to be a time of joy for most families. But it’s also a time when pregnant women may worry about the health of their unborn child and, to some extent, their own health. That’s because pregnancy comes with some significant risks, particularly during labor and delivery.
However, that risk increases when you’re Black. Research shows that the maternal mortality rate among Black pregnant women is 3.5 times higher than that of white women, and that’s mainly because of racial disparities in maternal care. While there is still a lot of work to be done, organizations and people are stepping up and making strides to improve this statistic.
Raising awareness of Black maternal health inequities
One of the biggest tools to combat disparities in Black maternal health is raising awareness about the issue. Black Maternal Health Week, which started in 2018, aims to do just that. In his proclamation declaring April 11-17, 2022, as Black Maternal Health Week, President Biden called on all Americans “to raise awareness of the state of Black maternal health” in the U.S. “by understanding the consequences of systemic discrimination, recognizing the scope of this problem and the need for urgent solutions, amplifying the voices and experiences of Black women, families, and communities, and committing to building a world in which Black women do not have to fear for their safety, their well-being, their dignity, or their lives before, during, and after pregnancy.”
Dr. Kecia Gaither, director of perinatal services at NYC Health + Hospitals/Lincoln in the Bronx, agrees that there is an urgent need to address the inequities in Black maternal health. She tells Yahoo Life that “there exists a pandemic of perinatal morbidity and mortality among pregnant Black women.”
Gaither adds: “There needs to be an obviation of biases, institutionalized/individualized racism, and a recognition that not listening to your patients kills. It's a national crisis that can be reckoned with by a recognition and attention to patterns of behavior.”
Investing in solutions
The hope is that awareness about the issue will drive change — and that corporations, organizations and celebrities will help to put their weight behind the cause. Serena Williams, who has shared her own near-death experience delivering her daughter, has funded a start-up directly aimed at lowering the Black maternal morbidity rate.
Williams is the lead investor funding for Mahmee, a maternal and infant health tech company. The Los Angeles-based startup aims to create the missing digital infrastructure that connects the maternal health industry and prevents critical gaps in care. The technology platform allows hospitals, doctors, health systems and maternity providers to carefully manage a mother's pre- and postnatal care journey. The intention is to have a tool that closely monitors both mother’s and baby’s health, to identify and treat health issues before they become life-threatening.
As Mahmee’s founder and chief executive officer, Melissa Hanna, told Forbes: “The time has come for solutions to the maternal healthcare crisis.”
Having a system with providers that acknowledge the risk exists and creating tools to catch and prevent morbidity is key. Preeclampsia, eclampsia (a severe complication of preeclampsia) and embolism are the leading underlying causes of death among pregnant Black women, according to the American Medical Association, while postpartum hemorrhage, hypertension, cardiovascular disease and infection also contribute to increased morbidity and mortality among women of color.
Gaither says the “recognition that specific underlying etiologies lead to increased adverse perinatal outcomes is imperative to be attuned to, so increased attention should be paid to Black women.”
Black women are also 50% more likely to give birth prematurely (before 37 weeks), compared to white women, according to the Centers for Disease Control and Prevention, and Black infants are about twice as likely as white infants to have low birth weights.
How other organizations are improving Black maternal health outcomes
The consensus is that Black pregnant women need to be listened to and to feel safe. According to the study Impact of Doulas on Healthy Birth Outcomes, published in the Journal of Perinatal Education, “doula-assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding. Communication with and encouragement from a doula throughout the pregnancy may have increased the mother’s self-efficacy regarding her ability to impact her own pregnancy outcomes.”
Policymakers appear to be listening, and a number of free doula programs are being launched across the country. The recently expanded doula program announced by New York City's Mayor Eric Adams is one such program. The doula initiative intends to hire 50 people to serve as doulas and assist 500 families by June 2022.
While the program is not intended exclusively for Black women, the doulas will work in 33 areas identified by a city task force as having high health and socioeconomic disparities, primarily the Bronx, upper Manhattan, northeast Brooklyn and southeast Queens.
As reported in 2019, New Jersey had the fourth-highest maternal mortality rate in the U.S, with 38.1 maternal deaths per 100,000 live births. The Sister to Sister Community Doulas is one organization that seeks to address this issue. Rachel Ruel, the co-director of SPAN Parent Advocacy Network, which sponsors the program, shared with Yahoo Life that “Sister to Sister Doulas has three pilots in New Jersey — Newark, East Orange and Irvington. In 2018, we partnered with Uzazi Village [a nonprofit organization dedicated to decreasing maternal and infant health inequity among Black and Brown communities] and created Sister to Sister Doulas. We provide trained community doulas that support mothers before, during and after birth. We also support the extended family.”
Research has shown that Black mothers do best with providers who look like them. The National Medical Association is one resource that can help Black women find providers of color in their area. Organizations such as Black Mamas Matter and National Birth Equity Collaborative are also helpful in navigating pregnancy resources, providers and support groups for Black families.
While the alarm has been sounded, there is still a lot of work to be done. This includes increased recognition and education for both provider and patient, to achieve better maternal health outcomes. Having more states fund and implement programs for trained, community-based doulas, similar to the ones in New York City and New Jersey, is also crucial.
According to the Institute for Healthcare Improvement, doulas “help improve prenatal care, raise breastfeeding rates, decrease unnecessary medical interventions, increase positive birth experiences, and improve parenting skills. Furthermore, community-based doulas play a critical role in combating the discrimination, racism, and loss of autonomy that Black people who give birth frequently report experiencing.”
The hope is that with a combination of increased awareness and changes in policy that acknowledge and improve racial disparities in Black maternal health, we will see Black families entering and leaving maternity wards alive, whole, happy and healthy.
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