County study on Black maternal health provides local context for national crisis

·7 min read

May 26—Through a combination of data and extensive community discussion, a recent study released by the Frederick County Health Department identified factors influencing pregnancy and birth inequities for Black mothers in Frederick County.

The study sought to contextualize data that show a higher rate of negative health outcomes — including preterm birth and low birth weight — for Black mothers and infants in the county compared to non-Black mothers and infants.

The county contracted Washington, D.C.-based Health Management Associates (HMA), a research and consulting firm that specializes in health care policy, to help conduct the study. The county health department assisted HMA.

Then-Frederick County Executive Jan Gardner allocated $300,000 in American Rescue Plan Act funding in early 2022 to fund the study.

The report's contributors and community members gathered for a virtual forum earlier this month to discuss its findings and the path forward to additional research.

"So we know what the data says: that Black women are experiencing these disparities at a greater rate than their counterparts," said Brandin Bowden, a senior associate with HMA. "But we really wanted to know and define that experience from what was really happening on the ground."

To do so, the study relied on the experiences of Black mothers in Frederick County, and through discussion, traced back the causes of the disparities identified by those they affect.

The root cause of those disparities, according to the study, is anchored in systemic racism.

The study's authors identified systemic racism's influence by controlling for certain factors to find that disparities in Black maternal health outcomes exist regardless of quality of health care and health behaviors.

"The disparities are not explained by income, age, marital status or education" said Danielle Haskin, director of the county health department's Equity Office. "Even [Black] families that are at a higher socioeconomic class have a disproportionate, higher risk of death."

Systemic racism's influence plays out in a variety of cultural and socioeconomic factors that hinder the quality of care Black mothers receive and their ability to access medical services, according to the study.

Together, the two organizations hosted five 5-hour retreats between July and November of 2022 with a Community Advisory Board comprised of 15 Black mothers advising the study through their lived experiences.

To lower barriers for attending, women who attended at least four retreats received a $25-per-hour stipend for their participation and were offered additional stipends for child care and transportation expenses.

Guiding those retreats were the participants' personal experiences, as well as stark nation- and countywide data that reveal significant differences in both the rate of care Black mothers receive and negative health outcomes for them and their infants.

For example, Black women in the United States are three times more likely to die from a pregnancy-related cause than white women, according to the study.

In Frederick County, Black women are more likely than white or Hispanic women to give birth by cesarean section, not receive early prenatal care and give birth before they've been pregnant for 37 weeks, according to data from the 2022 Community Health Needs Assessment, which the county cited in its report.

In 2017, according to the CHNA, the infant mortality rate for Black babies was more than twice the rate for white babies — 15.5 per 1,000 babies, compared to 6.1 per 1,000.

A culmination of these statistics and the personal experiences of participating Black mothers identified five primary drivers, stemming from systemic racism, that lead to health disparities.

In one driver identified by the study, participants outlined how inadequate health insurance prevents access to high-quality care for Black mothers.

And, when Black mothers do receive care, participants said there is a dearth of culturally competent providers in Frederick County, where non-Hispanic Black residents make up 11% of the county population, according to 2022 U.S. Census data.

Also present in the participants' birthing experiences are racial tropes, Bowden said, which further complicate getting adequate care.

"This systemic racism, as a root, is influencing and directly attributed to the strong Black woman trope," Bowden said. "Meaning that there's very little wiggle room for a Black woman not to show up as strong and able to persevere despite systems and structures set against them."

When receiving care from Black providers in other cities, participants contrasted their experiences with care they received in Frederick County, which they perceived more negatively.

Past traumas during pregnancies or birthing experiences further hinder access to quality care, the study noted.

Participants also said that living in a predominantly white geographic area like Frederick County makes it difficult to connect with other Black women and share information or support.

The study went on to connect these experiences to data in prenatal care, pre-term birth, and low birth weight by race or ethnicity.

One statistic cited by the report shows that between 2016 and 2020, 59% of Black Frederick County women sought early prenatal care, compared to 73% of white women.

" ... [F]eedback suggests that there is a strong possibility that poor access, intertwined with low perceived quality of care delivery, may intersect to affect receipt of early prenatal care," the report stated.

When discussing the report's findings in the virtual forum, Dr. Chidinma Ibe, an associate professor of medicine at Johns Hopkins University, said she was not surprised by the experiences of the participants.

However, Ibe said, "What I did find very heartening was the level of passion that all of the CAB members brought to the table and the vulnerability with which they shared."

Ibe commended the participants' intensive deliberation on the broad theoretical concepts outlined, and their recognition that Black maternal health outcomes were bad, and went a step forward to ask what could be done about them.

"They got to the point where they felt like, 'We have heard enough, we've seen enough in our own lives. It's time for action,' and I really admired that so much and I found it very inspiring," Ibe said.

Yewande Oladeinde is an adjunct public health professor at Hood College and a founder of Black Mamas Building Bridges, a group of Black mothers whose analysis of these stark maternal health outcomes in 2020 contributed to the creation of the study.

At the study's end, it outlined how its conclusions could be acted on to improve health outcomes for Black mothers and discussed where further research is needed to develop best practices.

Collaboration with Black Mamas Building Bridges is an integral part of that future, according to the study. In an interview, Oladeinde suggested key efforts to build on the study's findings.

"The solution has to be a collaborative effort with the stakeholders," Oladeinde said, referring to the CAB members.

That includes working with clinicians at Frederick Health Hospital and local OB-GYN practices to unpack the study's findings and make them aware of the lived experiences people of color bring with them when they walk through a clinic's doors.

Such progress can be gained by not only having a more diverse workforce of Black and Brown health care providers, Oldadeinde said, but also by ensuring cultural sensitivity among current clinicians.

"The goal really is about having a workforce that is culturally congruent and culturally humble enough" to recognize what they don't know about their patients and actively listen, Oladeinde said.

Like Oladeinde, Haskin said in the virtual forum that the crucial first step this study took is wholly evaluating how disparities arise in Black maternal health outcomes to be better informed before seeking solutions.

"It was really important that we were able to say yes, this is on a national level happening, yes, this is happening in the state, and connecting it to our local community," Haskin said. "Because that is going to be really important when we look at what the the solutions are ... to address these things that are directly in line with what our community sees and what our community is able to leverage."