Black Women and their Babies are Dying at an Alarming Rate, and it’s not their fault
This Wednesday marks the celebration of Juneteenth, a holiday recognizing the end of slavery in America. Although the most recently added federal holiday in the United States, becoming official in 2021, Juneteenth is so much more than a day off in the middle of June, and has been observed by the Black community for over 150 years as a celebration of freedom, unity, joy, and community.
While the 13th Amendment to the U.S. Constitution officially emancipated enslaved persons effective January 1, 1863, the law did not immediately become implemented across the country, particularly in areas still under Confederate control. On June 19, 1865, Union troops arrived in the westernmost Confederate state of Texas and informed Black men and women of their freedom. For two and a half years, the 250,000 people enslaved in Texas had remained unaware of the law that granted their freedom. In the post-emancipation period, Black people sought to reunify their families, run for office, establish schools, advocate for legislation, claim land, and attempt to seek compensation from former slave owners. The resiliency and hope of the Black community ran deep, but 200+ years of slavery had left its mark on society, and the pervasive attitudes and ideas towards Black people would interrupt the efforts towards progress and continue to deny the rights of Black Americans. It would be many more years before Black people were finally granted the right of citizenship, to vote, own property, or fully participate in public places.
The wheels of change turn slowly, and the reality of freedom for Black people was not as simple as the Emancipation Proclamation becoming law, or the Union troops coming to Galveston over two years later to enforce it. Instead, each freedom enjoyed by Black Americans today has been painstakingly fought for, and society has often dragged its feet kicking and screaming. The impact of the ongoing struggle for the same freedoms and rights to be enjoyed by all, and the obvious and more insidious impacts of racism, continue to be felt today by Black Americans. One of the areas these disparities are seen the most are in Black pregnancy and maternal health.
It’s Racism, not Race: Black Maternal Health Crisis in America
There is a Black maternal health crisis in America. On the surface, I think we can all fundamentally agree that the color of a person’s skin should not determine their outcome in childbirth, or how a person is treated while giving birth. However, years of ongoing systemic racism and healthcare disparities collide with interpersonal racism and implicit bias to create catastrophic outcomes for Black pregnancy and birth in America. Black women are three to five times more likely to die in childbirth than their white counterparts, and 80% of those deaths are considered preventable.1 Further, black infants are twice as likely to die in the first year of their lives than infants of other races.2 We are losing Black mothers and babies at alarming rates.
Historically, the Black community has been blamed for these upsetting statistics. Much of the research previously done on this crisis focused on finding an imagined genetic flaw in the Black race to blame poor outcomes on, or efforts were focused on trying to blame individual behaviors by examining things such as nutrition, substance use, or attendance of prenatal care.3 Unsurprisingly, this racist approach to understanding the Black Maternal Health Crisis has left us empty-handed. Research actually found that Black women were less likely to drink and smoke during pregnancy, and that even when they had access to, and regularly sought prenatal care, their babies were often born smaller, and in poorer health than babies born to white mothers. Despite being proven to be false, the narrative that Black women care less about their pregnancies, and are more likely to smoke, drink, use drugs, or eat poorly has persisted among healthcare providers and greatly impacts the quality of care Black families receive during pregnancy and the first year of life. Black women can neither educate, nor exercise, nor medicate, nor buy their way out of these gnarly statistics, because it is not their race or themselves, but the racism of their providers, the healthcare system, and society that has created this horrific problem.
Black Infant Mortality – the youngest casualties of the crisis
We are not only losing Black mothers in childbirth as part of this devastating crisis, we are also losing Black babies. Black infants in America are now twice as likely to die as white infants, according to the most recently available government data.4 Each year, America sees the death of 4,000 Black babies in their first year of life (a death rate of 11.3 per 1,000 Black babies, compared with 4.9 per 1,000 white babies) — a racial disparity that is actually wider now than in 1850, a full 15 years before the end of slavery, a time when most black women were considered chattel. In fact, a Black woman with a middle-class income and a college degree is more likely to lose her infant in the first year of life than a low-income white woman with an 8th grade education.5 Again, the problem is not poverty, nor education, but racism, that is causing American Black babies to die. Even Black families with the most advantages and access to care experience being ignored and dismissed when reporting symptoms and legitimate concerns. From the moment a Black woman enters the healthcare system, the life of her and that of her child are at risk.
Examining the real problem: the impact of racism on physical health
The Black Women’s Health Study is a first of its kind study, beginning in 1995, that has followed 59,000 Black women throughout their lives, and continues to do so. The study is an ongoing examination, funded by the National Institutes of Health, of conditions such as breast cancer, hypertension, diabetes, stroke, and preterm birth that affect Black women disproportionately. This study was the first to really examine the health impacts of racism on preterm birth. In 1997, the study investigators added several yes-or-no questions about everyday race-related insults: People act as if I am not intelligent; people act as if they are better than me; people act as if I am dishonest; I receive poorer service than others; people act as if they are afraid of me. They also included a set of questions about more serious discrimination: I have been treated unfairly because of my race at my job, in housing or by the police. The findings showed higher incidence of preterm birth among women who reported the greatest experiences of racism.
In other words, the more we study the impact of racism, the more we have begun to understand that this is not something that can be alleviated by a little more “me” time or meditation. Rather, the accumulation of traumatizing experiences and insults across a person’s lifetime is altering the way the body responds to illness. When we encounter a threat, the brain responds to the acute stress by flooding the body with intense hormones in an effort to allow the body to adapt and respond. For Black women then, being exposed to long-term, sustained stress is flooding the body with an overabundance of these intense stress hormones, and can cause damage to the cardiovascular, metabolic and immune systems, making the body vulnerable to serious illness and even early death.6
What should we do? Responding to the Black Maternal Health Crisis
There is no simple or fast solution to fixing the Black Maternal Health Crisis. Now that we understand how intimately linked maternal and infant deaths are with the health system itself, and the way it interacts with Black Mothers, where do we go from here? In 2002, researchers issued a groundbreaking study, analyzing over 100 previous studies, taking great caution to separate class from race and compare subjects with similar income and insurance coverage. In “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” the very serious findings were outlined. People of color, and more specifically, Black people, were less likely to receive life-saving medications needed for serious health conditions like heart disease, or to undergo coronary bypass surgery. The absence of these life-saving measures often results in more serious illness, or even death. Black people received kidney dialysis and transplants less frequently than white people, which also resulted in higher death rates. Black people were 3.6 times as likely as white people to have their legs and feet amputated as a result of diabetes, even when all other factors were equal. One study analyzed in the report found that cesarean sections were 40 percent more likely among black women compared with white women.
The researchers went on to recommend improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other programs that help alleviate some of the barriers to receiving adequate healthcare. In order to understand the improvements needed in medical care financing, we must understand the issues with the way our current medical system is financed. In our current medical system, Medicaid pays pennies on the dollar when compared to private health insurance. To make up the difference, there is supplemental funding for care that takes place in a hospital, but there is not supplemental funding for care that happens in the community. Therefore, doctors get paid adequately, for example, to amputate a diabetic limb, but do not get paid adequately to provide disease management and prevention care to prevent that limb from needing to be amputated in the first place. As a result, the most performed procedure in many hospitals in “Medicaid communities,” or communities where the majority of patients are Medicaid recipients, are diabetic amputations. This indicates a failure of community based care and a failure of the funding system if we cannot prevent serious illness, but only treat that illness when something bad has already happened. So long as the care Medicaid patients receive is valued at a lesser rate than private paid health insurance, it will remain a separate and unequal health care program.
Diversifying Clinical Care Teams – More Black babies being delivered by Black doctors
Taking that one step further, if a doctor is not adequately compensated for disease management and education, they are unlikely to spend as much time doing those things. Which patients will receive the extra attention and counseling then? Research tells us it will be the patients that look like the doctor and share lived experiences with them. Likewise, when Black babies are delivered by Black doctors, their mortality rate is cut in half.7 Being cared for by someone that looks like you, that understands and has lived experiences that you have gone through, is powerful. An important way we can improve the outcomes for Black mothers and their babies, is to diversify clinical care teams and create more pathways for Black doctors, nurses, doulas, and medical professionals. Training and investing in Black providers, such as through the work The Opportunity Agenda is doing, is an important component to improving outcomes.
Legislative Solutions – Supporting policies that will improve the Black Maternal Health Crisis
Half of all Maternal Deaths happen in the postpartum period.8 Members of Congress have been considering a 12-month postpartum Medicaid package that would expand the coverage of Medicaid from 6-weeks postpartum to 12-months postpartum, providing essential care to postpartum women. This expanded coverage, along with the Black Maternal Health Momnibus Act, are crucial pieces of legislation that would expand access to Black families at the highest risk. Supporting government-funded programs is an important component to finding systemic solutions to the Black Maternal Health Crisis. The above-mentioned policies are federal legislation, but your own state might also be working on important changes. Getting involved at the local level is another great way to show your support for this cause.
Get Involved
Showing your support to the many organizations that are already doing the important work of addressing this crisis is a great way to get involved. You can donate to their causes, share about them on social media, or with others in your network of friends and family, and encourage them to get involved too. Happy Family After will be making a donation to the Black Mamas Matter Alliance and the Opportunity Agenda in observance of Juneteenth and we invite our readers and supporters to do the same. I am providing a list below of organizations doing important work towards addressing this crisis.