Eng 102
Instructor: Elisabeth Borchers
Lesson 11
The maternal mortality rates in the United States continuously affects black women at an alarming pace and continues to be a significant issue within the medical community. It is known that black women are four times more likely to die from complications that are due to misdiagnosed preexisting conditions and negligence. This essay will examine many different factors that persist within the medical community along with historical context regarding the relationship between medical professionals and the black community.
Historically the disconnect between African American's and the medical community is rooted in mistrust. Monumental moments such as the Tuskegee Experiment, which took place between 1932-1972. This experiment was conducted by the United States Public Health Service and the CDC. This involved knowingly injecting African American men with Syphilis and leaving the men untreated. This experiment was not just unethical, but also racist and inhuman. This experiment heavily impacted the black community along with creating a negative foundation between African American's and the medical community. Other instances where medical professionals abused power is involving the sterilization on indigenous women and Puerto Rican women to control the population. This act of coercion left under privileged women without proper autonomy over their own bodies. The absence of ethics set a standard of care toward women of color that lacks safety and empathy. These moments in history shape the way women of color are treated and cared for which usually tend to impact poorer communities and women with less access to adequate healthcare.
There is evidence that shows the United States allocates a tremendous amount of funds towards the healthcare system, yet the United States is considered to be the riskiest place to birth a child. It is expressed in an article by Krishna Chandra Sahoo (2021), that the common theme for African American women and maternal deaths are typically attributed to, "excess bleeding, high blood pressure, prolong labor." These risk factors are increased for women in communities that are considered disadvantaged. There are also genetic factors that should be taken into account, black women are more likely to have preexisting cardiovascular issues. Cardiovascular issues have the ability to increase maternal mortality. It is important to explain that maternal mortality among black women isn't just a "poor" issue.
In an article written by Layne, Rachel titled "Can the U.S reduce its high death rates?" (June 2020), Layne highlights the disparities within the healthcare system as a whole that embodies tiers of racism. Layne interviews the parent of epidemiologist by the name of Shalon Irving (an African American woman), with a Ph.D. working for the U.S Center for Diseases. Following giving birth, Shalon began having cardiac issues. Shalon had an extensive medical and science background, which allowed her to properly advocate for herself and convey her concerns. This woman was highly educated, did not live-in poverty and yet she encountered extreme levels of negligence and dismissiveness from doctors during her birthing experience which ultimately led to her death. In the article her mother states, "She had access to the kind of health care that should have saved her life."
Layne articulates the importance of a universal level of care given by medical professionals. Shalon's tragic story aligns with plenty of black women who go unheard due to discriminatory practices and racist behavior. Complaints are not uncommon, but this is purely an example of a missed opportunity to save a life. There should be outrage from all women, due to the fact this shows it can happen to any woman. "According to CDC data, in 2019 the maternal mortality rate was 44.0 per 100,000 live births for non-Hispanic Black mothers compared with 17.9 per 100,000 live births for non-Hispanic White mothers. Multiple factors contribute to preventable maternal deaths, including inequities in health care access and quality of care, underlying chronic conditions, structural racism, and bias. To allow the systems that permit these inequities to persist unchecked is unconscionable." (Health Affairs, Tanjala S. Purnell, 2022), despite the CDC's listed evidence there is still an absence of engagement from the medical community regarding the topic of black maternal mortality.
There are multiple preventative steps that can be taken to establish healthy doctor patient or nurse patient relationships. Hospital staff can be provided with proper education and resources which would be deemed as a precautionary specifically for women of color, thus creating a collaborative approach between black women and the physician. Formulating a bond between the patient and doctor will benefit both parties. Demonstrating the value of self-advocacy will allow trust and open dialogue between the medical community and black patients which due to historical events was abused in the past. It is also necessary to emphasis the value of representation and diversity within the medical field, thus forging a positive, trusting relationship with the black community.
Studies have been linked to increased quality of life from African American patients who have access to black doctors, in conjunction with reduced infant mortality rates, more likely to receive preventative care, along with longer life expectancy. This data suggests and gives credence to a stronger probability of narrowing disparities that plague the black community. More studies showed how communication is vastly enhanced when patients and physicians share the same race. What this means is that there's an immediate level of awareness when it comes to genetic preexisting conditions such as, high blood pressure, diabetes, and cardiovascular disease; thus, aiding in preventative care. Inclusion and diversity in the medical community shows the intent to forge a more favorable culture and environment. These studies are also a great indicator of who black physician's primarily treating and that's typically lower income areas. Lower income areas can consist of patients with less accessibility to healthy food, rural areas, that contain fewer resources, and individuals with less education. These are key disparities that affect African American communities, in return leaving black patients to stay silent.
Insufficient representation broadens the gap between the medical and black community by permitting the continuance of perpetuated stereotypes and implicit biases. Increasing hospital diversity will only highlight a more cohesive and inclusive culture within the medical space. The known factors are completely being overlooked; it would be obvious to assume that an array of African American women could have benefited from acquiring a black doctor. In November 2021 the Momnibus Act was signed into law to serve as an aid in funding community-based programs to refine maternal health outcomes. The Momnibus act has the ability to combat eighty percent of preventable maternal deaths in the United States. Addressing these disparities are a start to formulating equal opportunity to proper healthcare that has given to white women specifically at a disproportionate rate.
Racism and implicit biases contribute negative experiences between the patient and medical professional. It is known that black patients are less likely to receive proper pain management compared to white patients. The stigma within the medical community is the notion that African American's have a higher tolerance of pain. These types of implicit biases impact women particularly with preexisting conditions, therefore ultimately leading to death. There are several positive alternatives that can be adopted by the medical community. Creating a healthy professional setting that establishes proper cultural competency for patients of all backgrounds and socioeconomic status. This entails staff connecting and educating themselves about the communities they serve. Indoctrinating mindful practices and becoming aware of genetics predispositions that typically impact African American women. Actively integrating these practices regularly would only enhance the patients experience, decrease mortality rates, as well decrease overall health care cost. A primary goal of the healthcare industry should be developing trusting relationships within under represented communities in addition to practicing high quality care for all patients.
There are numerous obstacles Black women endure regarding access to prenatal and postnatal care that can be instrumental to maternal mortality. Some of the obstacles included are insufficient funding, absence of representation, poverty and education deficiencies. The listed disparities also affect women of color in urban areas. African American women who are impacted by these issues are two times more likely to suffer from diseases. Consequently, the result of diseases increases the likelihood of maternal mortality. For instance, the diseases can range from heart disease, diabetes, and obesity; hence, resulting in pregnancy difficulties. In order to tackle the issues head on, solutions must be considered and put into action. During the pandemic we witnessed a rapid introduction to telehealth. Instant accessibility via telehealth services provided instant doctor patient communication building a bridge between those who reside in rural areas.
Research conveys the benefits of expanding Medicaid coverage in order to reduce maternal mortality among Black women. With expansion this can also reduce stress in Black women which black women who are impoverished are prone to developing. By expanding coverage this will qualify black women to receive care and after child birth for a long period of time. This would essentially enhance pre and postpartum care along with a reduction racial disparity. There are preventable deaths that taken place within seven days to a year postpartum. In order to embrace new strategies, the medical community must advocate to improve the inadequacies of poor treatment. These examples are highlighted in an article by Usha Lee McFarling (April 2023), who weighs in on the link uniting African American's who live longer due to having an African American doctor in conjunction with community resources.
Through Medicaid expansion this will allot women more access to care distinctively for African American women in lower income communities or women who can not obtain private care. States that have implemented the expansion of Medicaid have witnessed an increase in women of color proactively taking prenatal vitamins such as folic acid in addition to decreased maternal mortality rates for African American women. The disconnect and removal of transparency in the medical community is highly alarming and disappointing. What is being experienced in mass quantities for African American women compared to their white counterparts is a reflection of the inequality the United States consistently embodies as a society. Childbirth is extremely difficult yet a joyous time for a new mother. It is one of the hardest achievements in a woman's life. The thought of having the odds stacked against an individual thus, leading to potential death due to your race is a challenge black woman consistently face in the United States while pregnant and giving birth. These systemic challenges should be faced with urgency from local and state level.
With the help of policies and the expansion of Medicaid, another potential solution to inhibit maternal mortality is the use of midwives and doulas. Midwives and doulas can be used as a positive aid through Medicaid. The use of doulas through covered services, are considered to be highly beneficial. Policy's such as The Mamas First Act would assist in doulas and midwife services, offering care from prenatal to one year postpartum. A doula serves as an advocate for the patient and understands not all patients require a one size fits all level of care along with educating and empowering the patients. In some instances, these relationships become very meaningful attributed by good communication and trust, resulting in awareness and cultural empathy. An article written by Akilah Townsend, titled, "I Don't Want to Die: Fighting Maternal Mortality Among Black Women" (New York Times 2023), Townsend details the utilization of doulas in impoverished predominately black communities. Doulas have the opportunity to be a vessel of knowledge and promote autonomy for the patient. Through the amplification of these resources, black women and communities have the potential for voices to be amplified and strengthened.
Black women overall have been disregarded within the medical field that is heavily deep rooted in supremacy. African Americans makeup 5.4% of the physicians in the U.S. and 2.8% are Black women. Data shows there are less Black women in academic roles due to racism and black women being viewed as lacking qualifications and underserving of prestigious academic roles. These limitations only promote racial bias and increase incompetent care towards black patients. Black women in medical community are continuously at a disadvantage contrary to their white counterparts as patients and academically. Prioritizing these issues have to ability to address diversity and endorsing inclusion initiatives that can improve hiring opportunities for women of color. The fact of the matter is that healthcare organizations along with academic institutions have intentionally removed African Americans out of the conversation far too long. The only way we can grow and thrive is to reevaluate and remove outdated formats that do not serve our diverse society. There is a high demand and an intense necessity for Black healthcare providers throughout the U.S. Without supporting these initiatives would be a financial disserves to the promotion of economic growth. Offering a space for black women also means joining the fight to irradicate racial and implicit biases. This is not an assignment dedicated to Black Americans but, relies on a conjoining effort from the masses. It must be fundamentally understood that Black American concerns to this magnitude are American concerns due to the fact our societal structure can be affected entirely.
By creating alternative healthcare access for African American women in low income and impoverished communities, accessibility can be put into effect with options such as non-hospital-based care. For instance, providing local birth centers for low-risk pregnancies. This option saves money while improving patient experiences. Data supports lower rates of cesarean sections, no maternal deaths, fewer reports of premature deliveries and healthy infant births. The option of birthing centers assists in progressive and positive doctor/nurse, patient relations and outcomes due to availability. This could be the difference between life and death in emergency situations with high-risk patients. Another innovative option that would be highly beneficial for African American mothers is the introduction of black owned birthing centers. Due to lack of accessibility, there are only twenty black owned birthing centers in the United States yet, this option has been deemed an essential necessity in black communities. Although these centers tend to have less funding and limited resources, the benefits of offering black owned centers also provide equity within the black community and a substantial amount of one-on-one support for potential mothers.
Formulating incentives state wide within the healthcare system is a possible option. This would allow states to produce a universal standard of care and encourage diversity with offered services and doctors. This model would be inclusive along with ensuring underfunded communities are receiving adequate care and introducing strong and productive policies that are in favor of the patient while promoting a comprehensive healthcare culture.
Indoctrinating updated policies and practices will only commence if the healthcare system prioritizes not being complicit. Adopting a culture within the field would further advance growth while extending safe patient relations and increase trust should always be the main goal. There should be a desire to remove inadequacies, bias and racial disparities that affect preventable mortality. Healthcare professionals have the ability to take a proactive stance that sides with supporting decreasing African American maternal mortality rates. This entails proper training that spotlight high risk conditions that are common threats for Black women while pregnant. Addressing concerns such as expressing elevated levels of pain, out of range blood pressure and treating high risk patients with urgency. These signs are pertinent observations that can save lives. As medical professionals become aware of the disadvantages Black women face it should be their goal overall to remove implicit biases and reduce stressful encounters.
A vast majority of Black women have experienced negative interactions with medical professionals between the ages of 18-49 years old. A study conducted in 2022 by the Pew Research Center, states fifty five percent of black Americans share negative experiences with healthcare providers. This particular demographic prefers an African American as the primary physician. This statement is based off of the notion that a high level of care would be given due to racial concordance. Black Americans collectively face a wide disparity that led to poor health and mortality. Less access to quality healthcare is considered a known stressor as well as environmental factors that afflict Black communities. What this illustrates is a pattern in the healthcare community, establishing providers as the cause and effect of underrepresenting people of color, which in return strengthens divisive tactics.
According to Zahra Shahin, future solutions are given to eradicate maternal mortality rates in the state of Georgia (July 2020). Ten years' worth of research is provided without bias in conjunction with data charts comparing maternal deaths throughout multiple regions in the state of Georgia. What is concluded is an increase of maternal mortality within rural areas of Georgia compared to affluent suburban areas. In fact, Black Americans in lower income and rural areas are less likely to report health issues pregnancy related and non-prenatal related. These factors intensify negative relations with healthcare providers as well as increasing mortality. By conducting continuous research that identifies the cracks within the healthcare system is the only way to edify Black voices and promote change. Requiring hospitals and medical professionals to be held accountable for their negligence is the only way to hold them to the fire.
Advocating for Black women to be equipped with resources and knowledge regarding their own healthcare will assist in empowerment along with encourage healthy communication. Formalizing standard practices that assist in supporting Black women and allowing their stories and concerns to be taken seriously is a solution-based option that can be carried out by medical professionals. All of these steps can be taken through enforcing diversity training. Diversity/ cultural awareness training would impose healthcare workers to recognize cultural essentials of Black mothers without their socioeconomic status being factor. Confronting maternal mortality would be considered precautionary and lessen the chance of death.
In conclusion, the systemic racism within the healthcare system is not new but, must be addressed with the intention to reform a broken racist system. Education among medical professionals is the only way to reform and create equity. Pouring into underfunded communities will secure support and provide safeguards for Black mothers who typically do not have access to proper healthcare. Currently the United States is attempting to merge the gap between system racism and the healthcare system while combating socioeconomic discrepancy's that affect black communities. Listening to the needs of Black mothers by allowing medical professional to interact with the community is another way to create engagement. The emergence of Black women advocating for themselves along with newly funded community-based programs are being offered, attributed to legislation and the Momnibus Act. Since COVID-19, states have reduced Black maternal death rates but there's more to be done in order prevent racial disparities and remove implicit bias from care. Enhancing diversity in the medical field presents positive outcomes and grants access to allowing people of color to serve low-income areas. This also can establish healthy relationships within the community. Emphasizing the safety of Black mothers while integrating programs that support and employ people of color such as healthcare professionals, doulas and midwives who are capable of providing care. These are all important solutions that require a holistic approach to properly handling disparities that have burdened the Black community and increased Black maternal mortality. Advocating for policy change through the expansion of Medicaid would permit postpartum coverage past sixty days and extend to a full year. This is also a preventative measure due to the fact postpartum deaths are alarmingly high, this is connected to pre-existing conditions that affect Black women. In the end, it is the healthcare systems duty to prioritize health along with empowering Black mothers with knowledge.
Work Cited: Funk,Cary. PewResearch.org, (April 2022), Titled: Black Americans Views of and Engagement in Science
Layne,Rachel. "Can the U.S. Reduce Its Death Rates?", June 2020
Townsend, Akilah. I Don't Want to Die: Fighting Maternal Mortality Among Black Women. New York Times, January 2023
Shahin, Zahra. Maternal Mortality Among African American Women in the State of Georgia. July 2020
About Maternal Black Health, 2021, blackmaternalhealthcaucus-underwood.house.gov
