Black maternal mortality in the United States

An article in the American Journal of Public Health identified the effects of slavery on current maternal mortality. The authors describe that laws making enslavement an inheritable status increased the scrutiny of Black women and forced them into bearing children for the economic gain of their enslavers. In addition, many medical and surgical techniques were developed by exploiting the bodies of enslaved Black women. This legacy has persisted to modern times, and has made Black women less likely to trust the medical community.[6]

The practice of redlining, in which governments identified neighborhoods deemed to be risky investments, effectively blocked Black neighborhoods from accessing federal and bank loans. Due to this designation, only lower-quality hospitals persisted in these redlined neighborhoods, affecting the access of Black women to quality care to this day.[7] Although legal segregation ended in the 1960s, hospitals for Black people are still generally lower-quality than those targeted to higher-income, white people.[7]

The historical context of institutionalized racism in the US has also had the effect of making the Black community less likely to trust medical institutions and professionals.[7]

The purpose of prenatal care is to support pregnant women at an early stage, and monitor potential risk factors in order to make pregnancy and delivery as safe and healthy as possible. The literature shows that increasing access to prenatal care through public health departments caused a subsequent decrease in Black maternal mortality rates.[8] Furthermore, having fewer than 5 prenatal care visits, not attending prenatal care appointments, and accessing prenatal care later in a pregnancy are associated with maternal mortality. As Black women are more likely to begin prenatal care after their first trimester, this is a contributing factor to adverse maternal outcomes.[8]

The Center for American Progress published a report in 2019 that described "maternal care deserts", or areas where ob/gyn care is not available. The authors point out that women in rural areas and low-income areas have lower access to high-quality maternal health care, and lower access to hospitals in general, which necessarily decreases access to prenatal care.[9] Other obstacles such as lack of providers accepting public insurance such as Medicaid and transportation requirements to get to prenatal appointments affect Black women more than white women in the United States.[8]

In terms of postpartum care, Black women are about 5% less likely to seek out postpartum mental health care, and are additionally less likely than white women to follow up with continued care. These results occurred after controlling for income.[10]

Income has been well studied as a social determinant of health, and it has been found that worse health outcomes at all-time points surrounding pregnancy are associated with lower socioeconomic status and income levels. Lack of insurance or using Medicaid, and experiencing homelessness are associated with severe morbidity rates, and are all more likely to apply to Black women and increase their risk of maternal death.[8]

Systemic racism contributes to the greater likelihood of Black women to belong to lower socioeconomic classes. A study from the Nature Public Health Collection journal pointed out that the COVID-19 pandemic increases the vulnerability of Black women who are more likely to work at jobs that carry greater exposure risks to COVID-19, and more likely to lose income due to unemployment. This is in addition to the pandemic making accessing perinatal care more challenging, and making income disparities even more stark. The researchers who authored this study recommend that the interlocking factors affecting Black mothers during the COVID-19 pandemic be specifically addressed in order to see tangible improvements in maternal health outcomes.[11]

Causes of maternal mortality worldwide

A study conducted by Amy Metcalfe, James Wick, and Paul Ronksley analyzing trends in maternal mortality from 1993 to 2012 showed that the percentage of Black women with pre-existing conditions increased from about 10% to about 17%, the highest out of all other racial and ethnic groups in the United States. On top of this, Black women are more likely to  have unplanned pregnancies–and are thus more likely to lack prior monitoring and treatment of pre-existing conditions before, during, and after the pregnancy.[3]

A different study by Deirdre Owens and Sharla Fett points out that everyday and institutional racism against Black people can affect the health of Black women, and increase their risk of high blood pressure, which in turn increases the risk of eclampsia, a main cause of pregnancy-related death.[6]

The Metcalfe, et al study analyzing trends in maternal mortality in the US over time cited evidence of the effect of structural racism on increasing Black maternal mortality.[3] One manifestation of this is in the lower quality of hospitals that Black women tend to visit in comparison to white women, and the hospitals Black women frequent tend to  report higher rates of maternal morbidity. In addition, Black and white patients are treated differently by healthcare professionals. Black women, in addition to other racial minorities, are less like to be treated with induced labor than white women.[3]

Another phenomenon contributing to Black maternal mortality is the dismissal of Black women's pain by medical professionals.[6] A Harvard School of Public Health publication discussed this phenomenon by collecting numerous examples of medical professionals being dismissive or providing delayed care to Black mothers expressing pain or problematic symptoms.[12] The publication tells the story of Shalon Irving, a Black woman who experienced symptoms such as high blood pressure, blurry vision, and hematoma after childbirth. However, her doctors advised her to not take further action, and Irving died soon after. According to the author, this was just one instance of medical caregivers being less likely to take Black women's concerns seriously, contributing to maternal death.[12]

Unsafe abortion is a major contributor to maternal mortality and morbidity and Black women, who are more likely to have unplanned pregnancies and be of lower socioeconomic status, are more likely to undergo unsafe abortions. Access to safe abortions can be more difficult for women lacking transportation, insurance, or who may be enduring social stigmatization.[13]