Medical bias, weathering and the deadly impact on Black mothers

For the past several years, The Center for Community Solutions has been committed to examining and improving maternal and infant health for families in our state. By analyzing disaggregated maternal mortality data, infant mortality reports and other critical statistics such as birth records, we’ve developed policy solutions to help combat an escalating maternal and infant health crisis. For example, Black women in Ohio are currently two and a half times more likely to die of a pregnancy-related death than white women. And in 2018, white infants in the state averaged 5.3 deaths per 100,000 live births, while Black infants averaged 15.6 deaths for 100,000 live births.[1] Our organization, and many others, have reached the tragic conclusion that African-American women and their babies are dying at alarming rates, especially compared to their white counterparts.

Black women in Ohio are currently two and a half times more likely to die of a pregnancy-related death than white women.

Research suggests that even when controlling for education, income and health, the disparities remain. Race is a consistent factor threaded throughout the data, leading us to believe the driver of the inequality is racism.

Medical bias occurs when people of color receive disparate care from medical professionals because of implicit biases they hold about particular populations, and myths about physical racial differences. This usually results in people of color’s health complaints being taken less seriously.

Unfortunately, this bias is engrained from the beginning of medical training. A 2016 study of 418 medical students at the University of Virginia revealed that more than half of them endorsed at least one myth about physiological differences between Black people and white people, and that these false beliefs are related to racial bias in pain perception. Examples of endorsed myths, which were often used to justify slavery as appropriate, include whites have larger brains than Blacks, Blacks’ nerve endings are less sensitive than whites’ and Blacks’ skin is thicker than whites’.[2] As a result, Black people have suffered at the hands of trusted, licensed medical professionals for decades. A 2013 American Medical Association Journal of Ethics study that examined the racial disparities in pain management revealed that black and Latino people had their pain needs met less frequently and adequately than their white counterparts. This is despite the fact that white people are more likely to endanger themselves with the misuse of drugs.[3]

When it comes to birth outcomes, medical bias tends to lend itself to more grave outcomes.

Famously, tennis star Serena Williams shared her excruciating postnatal, near death experience publicly after giving birth to her daughter in September 2017. Because of her history of blood clots, she became increasingly concerned that she was experiencing a pulmonary embolism after feeling short of breath following birth. Hospital employees did not act immediately on her concern. They instead performed unnecessary testing and brushed her off as being confused due to her pain medication.[4]

She’s not alone, however, Black women across the country have died during or after childbirth due to medical bias for a long time. In 2016, Kira Johnson of Los Angeles died after giving birth from postpartum hemorrhage. After hours of her husband, Charles, letting hospital employees know that the catheter coming from her bedside was pink from blood, they finally made the decision to take her to surgery, where they found she had been bleeding internally for almost 10 hours.[5] In 2020, Amber Isaac of New York City suffered the same fate. Amber spent months pleading to see a doctor in-person in lieu of telehealth visits (due to COVID-19) because of her platelet levels. In late April she was admitted to the hospital after her condition worsened, where it was discovered she had hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome and was thus induced more than a month early and rushed into an emergency C-section. She later died after giving birth.[6]

Doctors complicate births when they do not listen to Black mothers.

A survey conducted by The National Partnership for Women & Families of California in 2018 drew the clear conclusion, doctors complicate births when they do not listen to Black mothers. Key findings included, that while 4 in 10 women overall reported that a health professional tried to induce labor by using medicine or other methods, Black women were more likely than white women to have a C-section, and Black women reported more frequent symptoms of anxiety and depression.[7]

Another explanation for the disparities is weathering, a term used to describe how enduring constant racism, discrimination and stress leads to premature aging and poor health outcomes. Coined by Dr. Arline Geronimus, a public health researcher and professor at University of Michigan, who through research around genetics and stress physiology determined that discrimination exacts a significant toll on physical health.

For Black women, weathering can manifest itself in mortality and morbidity rates for both mothers and infants. This can be seen throughout Geronimus’ research, i.e. observing that young Black women are more likely to have poor pregnancy outcomes if they are in their mid-20s than if they are in their late teens. This is the exact opposite outcome of their white counterparts.[8] Black women who wait a few more years to have a baby suffer poorer outcomes because their bodies are more weathered and biologically older than their age.

Because the stressors of living in a race-conscious society that stigmatizes and disadvantages people of color are chronic and persistent throughout the entire lifespan, the body of a Black person – a Black mother — wears at a much faster rate.

Systemic and institutional racism is at the heart of why Black mothers are more at-risk while giving birth due to the wear and tear of discrimination.

While chronic stress is unhealthy for any person, for pregnant women it can be life threatening. Symptoms of stress such as loss of appetite and trouble falling asleep can significantly impact a growing fetus. High blood pressure, which chronic stress induces and exacerbates, can directly increase the chances of preterm labor as well as giving birth to a baby with low-birth weight.[9] While weathering research is focused primarily on infant outcomes, The Journal of Maternal-Fetal & Neonatal Medicine determined that the correlation of severe maternal morbidity and preterm birth is a strong one.[10]

Systemic and institutional racism is at the heart of why Black mothers are more at-risk while giving birth due to the wear and tear of discrimination. While it is important that the state’s infant and maternal mortality rate continues to decline, until the gaps between white women and women of color are adequately addressed, the crisis will continue.