The focus of today’s blog is to bring awareness to some of the strains on Black women giving birth in America today. I am by no means the most authoritative person to be writing on this topic, but I feel it is important for this blog to bring awareness to the seriousness of the health disparities that Black women face. There are many amazing and inspiring Black women who are leaders in bringing more awareness and action on this topic—far too many for me to name them all, but among those who have inspired me are: Hakima Payne , Jennie Joseph, Tara Mudalair, and Nikia Michele. I thank these women and the many others who are working hard to make change.
THE PROBLEM
“Black women in the United States are between three and four times more likely to die from pregnancy-related causes than White women, and are twice as likely to suffer from SMM <severe maternal morbidity—essentially they nearly died>.” (source)
The first time I heard this statement my science brain went into overdrive—Why could this be? What are the differences between white and black women that could cause this to be the case? Is it the same everywhere? Is it genetics? Is the data accurate? Then, the more emotional side of my brain kicked into action—and it didn’t like this at all! How could such a significant difference be true? I don’t like this—it must not be true (this is also why people have such a tendency to disregard reports of abuse, pain, racial injustice, etc. We don’t like that such things happen and so we’d like to pretend they are not actually happening.) Well, actually, it is:
“Black women in Georgia have an MMR (Maternal Mortality Ratio) of 39 deaths per 100,000 live births, a ratio that is four times greater than the ratio for White women there. Similarly, Mississippi has an MMR of 29 for White women, but the MMR for Black women is even higher at 54.24 At that rate, a Black woman in Mississippi is more likely to suffer a maternal death than a woman in Palestine, Mexico, or Egypt.“ (source)
“Black mothers accounted for just 11 percent of all births — but 20 percent of maternal deaths — in Texas from 2012 to 2015. As a result, their maternal mortality rate was much higher than that of other women.” (source)
Ok, that’s the South, it’s probably not like that here in Greater Puget Sound, we’re much more progressive, right? Ummm, no.
“From 2009-2013 the infant mortality rate in King County was 3.9/100 live births. Among black babies, it was 7.1.” (source)
That means Black babies are nearly twice as likely to die as white babies. Black babies were also more likely to be born early or underweight then the overall population in King County.
From 2014-2015 in King County the overall Maternal Mortality Rate was 29.8/10,000; but for Black women it was a staggering 78.4 (source). That means a Black woman was more than twice as likely to die in a pregnancy or birth related death as a white woman—right here in King County.(as a side note, “American Indian/ Alaskan Native” MMR was 196 for this time period, meaning a Native woman was six times more likely to die than the overall population in King County!! Today’s blog post is focused on Black women’s experiences, but this is a staggering statistic that should not be brushed aside.)
NO MORE DENIAL. This is real, and it is morally unconscionable to keep putting our heads in the sand. These stats definitely show a very serious, life threatening struggle, and Black Lives Matter. My compassion and my empathy for people, even people I do not know personally, compels me to strive to make change.
THE CAUSE
So what’s going on here? Access to Care? Health? Genetics? All three it turns out, overlain by a rather substantial dose of Institutional Racism.
“In the United States, racial disparities in health are closely linked to economic disadvantage, reflecting systemic obstacles to health that disproportionately affect women of color. Factors such as poverty, lack of access to health care, social inequality, and exposure to racism all undermine health, and may contribute to the elevated number of Black maternal deaths.” (source )
If someone has limited access to healthy food, lack of access or education around healthy habits for exercise, eating, and prenatal care, an environment that makes it nearly impossible to be healthy, or is itself toxic with air pollution or other toxins, of course they will be less healthy than someone who has better circumstances.
Access to health care—it’s not the same as having health insurance. If someone can’t access the health care because appointments are not available when they are off work, or they can’t afford to take time off work for an appointment or they have providers they don’t trust, then they don’t really have access to care. Or suppose the clinic is not accessible by mass transit, or it is far away. Now throw in the complication of getting signed up for Medicaid, and the limited providers that even accept patients on Medicaid. These are all barriers to healthcare faced by low income people. Certainly not all Black women are low income and/ or on Medicaid.
Hold on folks, because it doesn’t stop there. It turns out that higher income Black women still have worse outcomes statistically than low income white women. This isn’t just about how much money one makes.
Getting to the appointment for prenatal care is just one piece of getting good health care. One also needs to have their concerns listened to, validated and addressed. Here’s where we have a couple of really stunning examples of having “access” to care, but still not receiving it.
“Black expectant and new mothers frequently said that doctors and nurses didn't take their pain seriously — a phenomenon borne out by numerous studies that show pain is often undertreated in black patients for conditions from appendicitis to cancer. When Patrisse Cullors, a co-founder of the Black Lives Matter movement who has become an activist to improve black maternal care, had an emergency C-section in Los Angeles in March 2016, the surgeon "never explained what he was doing to me," she said. The pain medication didn't work: "My mother basically had to scream at the doctors to give me the proper pain meds."” (source)
Serena Williams, of long time tennis fame, had an astonishing and disturbing experience during her postpartum stay that provides a very enlightening view of what it means to not get adequate care, regardless of income or education level:
“...only hours after giving birth through a major surgery, Williams needed to convince the medical personnel that she was in need of care—and run them through what she needed.” (source) Including a CT scan and heparin drip. She was experiencing a potentially life threatening blood clot—a condition she was familiar with due to her medical history—and doctors and nurses did not take her concerns seriously.
These are individual examples of what happens everyday as Black women go to prenatal visits and enter maternity wards to give birth.
But wait—there’s more and here’s where it gets really insidious. Every day Black people in the United States face a sort of toxic stress—concern about themselves, their friends and family being harmed by racism- of both the intentional and unintentional sort. It can be just being followed in the store by the security guy, or being pulled over for “driving while Black”; or not being called on in class because the teacher doesn’t really see you. (see here for more examples of everyday micro-aggressions: or here.). As individual experiences they are annoying, as a daily event, they add a constant stress that impacts health over time. Micro-aggressions are one piece- institutional racism, in the form of redlining, food deserts, voter registration laws, and banks refusing to lend to people because of race significantly adds to the daily stress of living for people of color. We haven’t even touched on more obvious, intentional racism—that’s beyond the scope of this blog, but certainly influences the daily stress of Black communities.
This is something white people generally just don’t experience on a regular basis—indeed, it can be difficult, as a white person to understand these stresses and feel they are valid. Stress impacts a person’s health.
This daily stress impacts the epigenetics of the entirety of Black people in America. Epigenetics is essentially the turning on or off of various genes influenced by a person’s environment. To boil it down to the simplest terms—that toxic stress of experiencing daily racism is impacting the health of an entire group of people AND it gets passed down from one generation to the next. Epigenetics is part of what’s at play when Black women are more likely to have a premature or low birth weight baby relative to white women.
SOLUTIONS
I applaud you if you’ve made it this far into my unusually long and heavy blog post. But now we get on to the piece were you—dear reader, can make a difference. Because I just can’t imagine how anyone can read this far into the post and not feel moved to improve the situation.
1) Listen to and believe Black people. I have links to many inspiring leaders at the top of this post where you can read about what they are doing in this world to make a difference. Listening also means validating their experiences as real. someone may have a very different experience with a person, place or thing than you hold dear.
2) Raise awareness. If one is not reading about and hearing this information or interacting in a direct way on a regular basis, as a white person it can be put out of mind. That doesn’t mean people stopped dying, it just means we stopped noticing. Be willing to keep learning about and talking about uncomfortable topics.
3) Speak up and call in to understanding when you see injustices. As a white person you can leverage that privilege in opposition to racism. Speak up in support of the people who are being oppressed. Bring awareness to those who are, intentionally or not, adding to that toxic stress of microagressions, and institutional racism. These are often not comfortable conversations to have. No one wants to be called a racist, but many would like to do better, including myself.
4) Speaking of uncomfortable conversations—have humility when addressing the topic of Institutional Racism, White Privilege and Health Disparities. Persistently seek to understand, uncover, dispel, and purge yourself of any learned, undetected or retained racism. We are all on a continuum of understanding.
5) Support organizations that are doing good work to make change. Do this with your money or your volunteer hours. Here are a few I suggest:
Open Arms Perinatal Services provides culturally matched birth doulas to low income women in Puget Sound. They also have Outreach Doulas who provide support to families in their community over a two year time period, adding continuity and trust to their care, and providing resources and education.
Rainer Valley Community Clinic provides individualized perinatal care and family medicine in an area with the most challenging health disparities. They seek to remove many of the barriers around access to care, providing care that is gentle, kind, collaborative and affordable.
The International Center for Traditional Childbearing, (ICTC) is a non-profit infant mortality prevention, breastfeeding support, and midwife training organization, comprised of women and men who want to improve birth outcomes and provide training opportunities in their communities.
6) Educate yourself. If you are local to Puget Sound and a Birth Professional you have two excellent opportunities this spring:
REACHE Conference Confronting Racial Inequities in the Perinatal Period, March 9th , Shoreline
Shafia Monroe – Cultural Competency for Healthcare Providers, March 31st, Seattle, sponsored by PALS and NAPS Doulas.
This article links to quite a few educational readings online. There are many good resources near the end of this article, which is also insightful itself.
Making change at the level needed to affect the unconscionable health disparities experienced by women of color is a truly significant challenge. It can’t be done by individual acts or programs, but rather by changing American culture. That will take years and a great deal of dedicated effort. Every bit counts. Keep bringing awareness, understanding and humility to this effort and change will happen.