Prioritize Black and brown women when addressing maternal mortality and morbidity

The United States is one of the most dangerous places in the world to give birth. This is a frightening sentence to write as a pregnant woman. Impending childbirth and parenthood are anxiety-inducing enough (even though I’ve been through it all before), but the work that my colleagues and I have been doing over the last several years lays out starkly the risks that pregnancy and childbirth bring. But while I think about the risks I face as a white woman getting ready to have a child, I can’t help but focus on my fellow mothers and mothers-to-be who are Black and brown and have disproportionately higher risks than I do of dying or coming away from childbirth with a debilitating condition.

 The United States is one of the most dangerous places in the world to give birth.

Not ‘counting’ Black and brown women denies their humanity

Black and brown women face three to four times the risks of mortality compared to what I face as a white woman college-educated and are twice as likely to suffer maternal morbidity. This is solely because of the racism and bias they encounter because of the color of their skin, pervasive in our healthcare system and across society. Structural racism within hospitals and health care settings along with the toxic stress that Black women are subjected to creates higher risks in pregnancy, as well as for other health conditions. How can we possibly ignore the factors that are contributing to Black and brown mothers dying at disproportionate rates? How could it even be suggested that by “removing them” from the maternal death rates, things really aren’t so bad? That’s a dismissal of the humanity of Black and brown mothers and we must do better.

 Studies have shown that college-educated Black women have higher risks of maternal death than high school-educated white women.

I don’t know any woman who hasn’t faced some headwinds in the healthcare system. During an appointment, I sometimes feel like I’m asking too many questions. Then I wonder whether I’m being dismissed if my doctor answers me too quickly and succinctly. I’m not sure why I feel that way; I have a right to ask questions about what’s happening with my baby and my body. But Black and brown women are routinely dismissed, have their questions and concerns ignored, and it doesn’t matter who they are. Serena Williams was roundly dismissed and nearly died of a blood clot after giving birth to her daughter in 2017. Studies have shown that college-educated Black women have higher risks of maternal death than high school-educated white women. This is unacceptable and demands every tool we have to address the people who are suffering the worst outcomes at the highest rates. Otherwise, what are we even doing?

Solutions focused on root causes will save lives

Recent headlines suggesting that by removing Black women from maternal mortality rates could make it look like the rates weren’t so bad were shocking and just plain wrong. Without acknowledging how bad things are for Black and brown moms in pregnancy and childbirth, we can’t get anywhere. Applying a one-size-fits-all approach to this issue isn’t going to work when white patients and Black patients are treated differently, have vastly different experiences in the health care system, and have different outcomes, across the board.  

We need to develop strategies specifically aimed at reducing rates of mortality and morbidity among Black moms. There are some good examples out there, which we’ve outlined in our written work over the last four years, but we need to go further.

• We need to ensure there are more Black and brown healthcare providers; we know patients have better outcomes when they have providers who look like them.
• We need to ensure that the root causes of toxic stress in society are laid bare and addressed, to prevent patients entering the health care system with decades’ of experiencing racism that can complicate their care.
• We all need to acknowledge that we can’t achieve better outcomes until we raise everyone up to an even playing field.

Every parent deserves the chance to focus on normal parenting things

There are inherent risks in our world, including risks with pregnancy and childbirth, but skin color shouldn’t be one of them. As a parent who is about to add another member to our family, I think about the usual things: sleepless nights, how our family will adjust to the changes a new person brings, how I can make sure both of my kids get what they need. Not once have I had to worry that my outcomes have anything to do with the color of my skin. I recognize that privilege and want to ensure the work that we’re doing at The Center for Community Solutions and the policies that we advocate for move toward a place that Black and brown moms get the privilege of worrying about the normal parenting things, too.

Community Solutions Maternal Health Resources

• House Bill 496, Families, Aging & Human Services Committee on Midwives and Maternal Health
• Equitable maternal health care remains priority for federal and state governments
• Dear Mayor, How Will You Address Infant and Maternal Mortality?
• Latest Maternal Morbidity Report Reveals Maternal Health Crisis Worsening
• Doulas play crucial role in maternal health
• Medical bias, weathering and the deadly impact on Black mothers
• Fertility and fibroids: The other side of Black reproductive health
• Call the Midwife!
• Lessons learned from the National Maternal Health Innovation Symposium
• The Status of Ohio’s Women: Maternal Mortality
• Report on Ohio’s maternal deaths provides look at contributing factors, makes recommendations for improvement
• The status of Ohio’s women: Birth spacing
• 2021 October Medicaid Institute
• Ohio Department of Health provides update to the Ohio Commission on Infant Mortality
• Ohio is again the focus of federal maternal health funding

Community Solutions Midwife Series

• Disparities in maternal deaths persist, what role can midwives play in reducing deaths and disparities?
• What is a midwife?
• How are midwives regulated in Ohio?
• Midwives can help to address inconsistent access to maternity care and disparities in maternal and infant health outcomes
• How midwives help outcomes for women and babies