Last month, over a thousand people gathered in Mexico City for the Global Maternal and Newborn Health Conference. Much of the discourse centered on improving health care for mothers and babies, as it tends to both globally and nationally in the United States. The conference also had an equity theme, which is a critical part of the conversation on maternal health in the United States. Without it, our opportunities to make real progress for all women are limited.
In the United States, the pregnancy-related mortality rate in 2011 was 17.8 women per 100,000 live births. A closer look reveals that the pregnancy-related mortality rate for Black women is three times higher than that of white women (42.8 versus 12.5 per 100,000 live births). But that’s not the worst. In some parts of the United States, Black mothers are as likely to die as mothers in much less developed nations. In Fulton County Georgia (which includes the city of Atlanta), the maternal mortality ratio for Black women is 94 deaths per 100,000 live births. This is comparable to the developing country of Peru, where the MMR is 89 deaths per 100,000 live births.
While lack of access to health care has certainly contributed to maternal and infant death in the Black community, it doesn’t account for the extreme racial disparities seen in pregnancy-related outcomes. A growing body of evidence indicates that social, economic and psychological factors play a role as well.
Expanding access to health care in the United States is a good start, but it may not be enough. We have to address race—and racial discrimination in particular—if we are going to see any improvement in maternal and infant health in the United States.
The documentary series Unnatural Causes shares the story of a middle class Black mother, Kim Anderson. Anderson ate healthy, exercised during her pregnancy and received prenatal care. Despite these efforts, her baby was born over two months prematurely. The series also describes the connections between race and inequality and the disparities in maternal health outcomes – it comes down to stress.
The chronic stress of navigating American society while Black and the compound experiences of discrimination, for instance, wreak havoc on the body, disrupting normal physiological and biological processes. The consequences are stark: Black women are more likely to experience severe maternal morbidity like shock and blood clots than their white counterparts and Black infants are more likely to be stillborn, born prematurely and born low or very-low birthweight than white infants.
Health insurance reform has increased access to health care and important preventive services like prenatal care for millions of Americans, but it doesn’t mitigate the experience of living in the United States while Black. Black women and babies suffer because of the systemic racism they experience.
Indeed, all women deserve to bring life into this world without the threat of death and disease. Focusing on women with the worst outcomes and eliminating racial disparities in maternal and infant health is a good place to start. Efforts that focus on social and racial factors could prove fruitful and yield innovation and action that ultimately benefits all.
The time for strategic, innovative and thoughtful action to benefit Black mothers and babies is now. That’s why in June 2015, over twenty advocates, activists, researchers, policy influencers and care providers gathered in Atlanta, Georgia for the “Black Mamas Matter” convening. What became clear at the convening is that a multi-sectoral approach that accounts for the role of race is absolutely necessary for progress on Black maternal health. Black Mamas Matter attendees and others across the country are working to influence the dialogue on maternal health in the United States. Their effort is well worth it: changing the conversation could ultimately save lives.
This post originally appeared on the MHTF blog on 11 November 2015.
Learn more about racial disparities on the Maternal Health in the United States topic page.
Read other posts from the Inequities in Maternal Mortality in the U.S. blog series.