Here’s how the medical system needs to change to support women of color who have children.
From maternal mortality to breast cancer survival to mental health treatment, healthcare outcomes for women of color in the U.S. can be challenging. Shondaland decided to take a deep dive to uncover the root causes of this urgent problem, and to shine a light on the solutions that can bring inequities to an end.
The CDC has been tracking maternal mortality since 1987. The trend line is rising — and rapidly. Data from the most recent report from 2017 shows that for every 100,000 births, 17.3 women die either in childbirth or in the year following childbirth. That’s up from 2016, when the CDC reported that for every 100,000 births, 16.9 women died.
Those numbers are even worse for both Black women and women of color in general. The CDC says that Black women are three to four times more likely to die from pregnancy and postpartum complications than non-Hispanic white women. The same report shows that for every 100,000 live births, 41.7 Black women died. For women of color, the numbers are equally grim, especially compared to the rates for white women. Related Story Mental Health Treatment Isn’t Always Equitable
“This is a decades-old problem,” says Jamille Fields Allsbrook, the director of the Women’s Initiative at the Center for American Progress, a progressive think tank based in Washington, D.C. “Women, in general, are more likely to have any of their complaints about pain ignored. Black women are even more likely to have their pain ignored — especially around childbirth.”
As Fields Allsbrook points out, “If people like Beyoncé and Serena Williams are having trouble getting the right maternal and postpartum medical care that they need, just imagine the barriers that other people of color are facing.”
Why is maternal health for women of color so poor?
Fields Allsbrook has written extensively on women of color and health care, and she says that the issue is wide-ranging and endemic. “Systemic racism is the driving force,” she says. “Even when you divide the data up for protective factors, geographic location, education, etc., all these things that supposedly lead to better health outcomes — racism comes up again and again. We have long talked about how the U.S. health-care system fails women, and people of color specifically. It fails in terms of access to maternal and reproductive health, fails in cost, discrimination, in what people face.”
Causes of death for women of color and Black women during pregnancy, delivery, or within a year postpartum include things like what the CDC classifies as “other cardiovascular conditions,” infection or sepsis, cardiomyopathy, hemorrhage, thrombotic pulmonary or other embolisms, cerebrovascular accidents, hypertensive disorders of pregnancy, amniotic fluid embolism, anesthesia complications, and “other noncardiovascular medical conditions.”
Efforts to change things
Fields Allsbrook points out, however, that there’s been some positive movement in improving outcomes for maternal health care and toward fighting systemic racism in the healthcare system. She says that over the last year, in the context of the broader social-justice and Black Lives Matter movements, organizations and states have started to openly recognize racism as a health determiner. The American Public Health Association (APHA) released a statement to this end, and last summer several states and localities declared racism a public health crisis. “I hope that recognition continues,” Fields Allsbrook says.
There is a shortage of doulas and midwives of color…and that has an impact on maternal outcomes.
To that end, there is a bill, referred to as the “Momnibus” bill, currently working its way through Congress. H.R. 6142, the Black Maternal Health Momnibus Act of 2020, includes provisions to extend Medicaid-covered postpartum health care to a year (beyond its current 60-day coverage period), provide funding to local community-care groups who are working to improve maternal health on the ground, and grow and diversify the perinatal workforce, amongst other infrastructure and transit investments to help make access to good women’s medical care more readily available to women of color. The bill was introduced to the House in March 2020 and was sent to the subcommittee on health in July last year. No movement has been made on the bill since.
Diversity in midwives and doulas is key
“Patient-centered health care means different things to different communities,” Fields Allsbrook notes. “For example, doulas and midwives have been a natural and normal part of the birthing process in indigenous and Black women’s lives for centuries. While awareness is growing, today these advocates are typically only thought of as resources for wealthy white women.”
She points out that most doulas and midwives tend to be white women. “There is a shortage of doulas and midwives of color,” she says, “and that has an impact on maternal outcomes for women of color and Black women. We need to improve and diversify the workforce.”
Part of that diversification work means raising awareness about career opportunities in the perinatal space, but it also means making education and access to education more affordable for people of color through grants and scholarships. Another bill, H.R. 6164, the Perinatal Workforce Act of 2020, is currently working its way through Congress as well and offers provisions for funding education and studying the best practices for “culturally congruent maternity care (i.e., care that is in agreement with the preferred cultural values, beliefs, worldview, and practices of the health-care consumer and other stakeholders).” The bill was introduced in the House Committee on Energy and Commerce in March of last year. No actions have been taken since.
Fields Allsbrook points out that education around implicit bias and racism for current staff and doctors is also key, as is improved health-insurance coverage.
“Providers and their staff, whether that’s the person in the room, the ob-gyn, or person at the front desk, all need to be trained on anti-racism and recognizing the implicit bias we all have. Providers and staff need to be held accountable when there are egregious actions,” she says. “Medicaid covers nearly 50 percent of the Black and Latino births in the U.S. Yet new moms might only be eligible for Medicaid for just 60 days postpartum. Women die up to one year postpartum. We can’t be kicking people out of health coverage when they need it most. A lot of insurance does not cover doulas or midwives, and they don’t cover birth out of hospitals — even though that’s been a traditional experience for women of color, it has become a privilege for wealthy white women.”
What pregnant women of color need to know
While various bills hang in limbo in Congress, there are things that Fields Allsbrook says you should know if you are a mom-of-color-to-be in order to improve your own maternal-health outcome. First, she says that it’s vital that you know that you have autonomy and choice when it comes to working with a provider. “Consider the provider you choose in advance,” she says. “Do some digging around and research. Trying to find the right ob-gyn for you can literally be lifesaving. Do the hard work.”
She also says that it may be worthwhile to investigate whether or not your insurance will cover a doula, midwife, or a non-hospital birth if it’s safe for you, based on your health status and the advice of your medical-care provider. “Doulas and midwives are advocates for you,” she says. “You can be the smartest woman in the room and know the health-care system the best but still have trouble navigating because you are in a vulnerable position. Doulas and midwives can help. Knowing that you have an option for a hospital birth or home birth can also support you through your maternal journey. I think that it’s important for people to know that these are viable, safe, and healthy options.”
It also pays to take care of yourself whether you are planning to get pregnant, already pregnant, or just beginning your journey as a new mom. That means eating right, exercising regularly, managing stress, and maintaining a healthy weight throughout your pregnancy and after it to reduce your chance of heart disease, stroke, and other cardiovascular conditions that could threaten your life.
Finally, Fields Allsbrook says that it’s vital to speak up when you feel that something isn’t right. “On the individual level, women’s pain compared to men’s is more likely to be ignored, especially around pregnancy. But we know when something is wrong, it’s not hysteria. Speak up,” she says.