5 things to know about the maternal health crisis

The Black maternal mortality crisis has gotten renewed attention in recent weeks amid growing concerns over the disparity in deaths between Black and white people.

The U.S. is among the wealthiest nations on Earth, yet it has the highest rate of death during pregnancy for up to a year afterward, according to the United Nations.

Black people are three to four times more likely to die from pregnancy-related causes than their white counterparts.

For years, Black leaders have worked to address these disparities, but with the newfound focus on the issues, advocates say the lives of Black mothers could be saved.

Here are five things to know about the maternal health crisis.

Implicit bias 

There are a number of underlying causes for maternal mortality, and they range from mental health conditions such as postpartum depression to physical disorders such as hypertension.

While Black patients are more likely to exhibit comorbidities such as high blood pressure, research also points to implicit and structural bias in the medical system.

In 2020, Harvard Global Health Institute reported that physicians are twice as likely to underestimate Black patients’ pain, while 60 percent of medical students and residents thought the skin of Black patients was thicker than that of white patients. Twelve percent thought Black patients’ nerve endings were less sensitive than those of white people.

These pervasive false beliefs affect Black mothers such as Stacey Brayboy, who was pushed into having a cesarean section delivery by her doctor.

When they began removing Brayboy’s stitches, she tried to tell her doctor she was in pain.

“And she says to me, ‘Oh, we can do this now because you’re acting like the baby,’” Brayboy, now senior vice president for public policy and government affairs at March of Dimes, told The Hill’s “The Switch Up” podcast.

“I let her remove the staples. I leave and four hours later, they have to rush me to the hospital because where they removed the staples, the body opened up and there was a wound and my blood pressure shot extremely high.”

Brayboy was in the hospital with an infection for three days. Eventually, Brayboy said her doctor came in and admitted she should have listened to Brayboy’s protests more.

“There was some bias that was there when I was trying to have a conversation with my health care provider about what I was experiencing and why I wanted us not to choose one form of birthing over another, as well as how we were going to go about removing the sutures at that time,” Brayboy said.

Nearly all deaths are preventable 

The Centers for Disease Control and Prevention (CDC) last year reported that 22 percent of maternal deaths occurred during pregnancy, 25 percent occurred on the day of delivery or within 7 days after and 53 percent occurred within one year after pregnancy.

But 84 percent of all deaths were preventable.

For Black women, cardiac and coronary conditions were the leading underlying cause of pregnancy-related deaths.

Challenges facing birthing people also depend on where they happen.

March of Dimes found that more than 2.2 million women of childbearing age live in maternity care deserts, or areas without hospitals offering obstetric care, birth centers or obstetric providers.

Women living in rural areas have a 9 percent increased probability of maternal mortality or morbidity as compared with women in urban areas with greater access, according to the CDC. Rural hospitals also report higher rates of hemorrhage and blood transfusions as compared with urban hospitals.

Socioeconomic status

The racial disparities in the maternal health crisis transcend socioeconomic status, meaning that a Black person with a college education could still face worse health outcomes than a white person without a high school diploma, according to the Equal Justice Society.

Rep. Lauren Underwood (D-Ill.) last year shared with The Hill that her friend Dr. Shalon Irving died just weeks after giving birth to her daughter.

“She has a dual doctorate in sociology and gerontology. We met in the masters of public health program. After we graduated, she went on to serve at the Centers for Disease Control and Prevention and the United States Public Health Service Commissioned Corps. And I remember the CDC director was at her funeral, and in her remarks was just stunned like, how could this happen?” Underwood said.

There are also economic barriers exacerbating the racial disparities in the crisis.

Researchers at Stanford University found that death rates among low-income mothers are three times higher than wealthy mothers.

Black Americans are more likely to be uninsured than their white counterparts and have less wealth and income, affecting their ability to afford high-quality care both during and after pregnancy.

But those who are insured could still face difficulties. Though 43 percent of births are financed by Medicaid, Medicaid is only required to provide coverage for 60 days after the pregnancy, despite a majority of deaths occurring up to a full year after delivery.

Newborns unspared

Black babies are more than two times likely to die compared with their white counterparts, according to the Office of Minority Health. They are also nearly four times more likely to die from complications related to low birth weight.

Reasons for the newborn disparities aren’t all that different from the disparities behind the maternal mortality rates, but the office also reports that in 2020, Black mothers were twice as likely to receive late or no prenatal care than white mothers.

The March of Dimes report found that the widespread maternal care deserts saw 16 percent of Black babies born in areas with limited or no access to maternity services.

Brayboy said infant deaths, just like maternal deaths, could be prevented.

“It’s access. It’s location. It is making sure that we’re able to take care of the mom as she’s going through the pregnancy journey,” she said. “It’s on society being able to set the parameters and look at where we are.”

Congressional work

Congressional leaders have been working to pass legislation to end the maternal mortality crisis.

In 2019, Underwood teamed up with Rep. Alma Adams (D-N.C.) to create the Black Maternal Health Caucus.

The caucus has worked to pass the “Momnibus,” a package of legislation that would address economic, social and cultural barriers perpetuating the maternal health crisis.

Earlier this year, Illinois Democrats Rep. Robin Kelly and Sen. Dick Durbin introduced the CARE For Moms Act, which would help address some of the most pressing issues including extending Medicaid coverage for postpartum mothers in all 50 states and establishing grants for rural obstetric mobile units.

Advocacy groups like the March of Dimes have continued to push elected officials on enacting legislation such as the PREEMIE Reauthorization Act, which would help address newborn deaths.

“We’ve got to put the onus on all of us. We’ve got to educate our community and people who don’t look like me to know why this is important, why what happens impacts all of us,” said Brayboy.

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