How we can lower maternal mortality rates for Black women | Opinion

Getty Israel
·3 min read
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Maternal mortality among Black women in the U.S. has received a considerable amount of attention over the past several years and with good reason. The risk of Black mothers experiencing a pregnancy-related death, maternal death, is three to four times that of white mothers.

Some health and social policy experts argue that postpartum Medicaid extension would decrease maternal deaths particularly among non-Hispanic Black mothers. Despite the maternal death reduction in states that have extended coverage, deaths among Black women − including those with private insurance− continue to climb.

Merely extending Medicaid coverage to give new mothers continued access to clinical care is not adequate. Deaths will continue until risk factors, hypertension, diabetes and obesity, associated with cardiovascular diseases are effectively addressed− which often don't occur during standard 15-minute office visits.

Cardiomyopathy, blood clots, gestational hypertension, preeclampsia, eclampsia, stroke, heart failure and valvular disease account for most pregnancy related deaths. However, for most women these conditions are preventable and should be tackled before and throughout pregnancy, particularly among young women who are overweight or obese.

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Black women are suffering at a higher rate than white women

In the U.S., the percentage of women who are overweight or obese has increased by 60% over the past three decades. The pervasiveness of obesity has substantial consequences for pregnancy and birth.

Expectant mother Victoria Roberts (left), 19, of Stuart, shows Natalie Peraza, the resident program director of Mary’s Home, the diaper truck she won in the raffle during the Martin County Healthy Start Coalition’s Community Baby Shower on Saturday, April 16, 2022, at the 10th Street Community Center in Stuart. The event’s goal was to raise awareness of Black maternal health and the racial disparities that exist. According to the Centers for Disease Control and Prevention, Black women are three times more likely than white women to die from pregnancy-related complications.

Obesity is strongly associated with spontaneous miscarriage, fetal malformations, gestational diabetes, stillbirth, preterm birth, low birth weight, cesarean surgery, fetal overgrowth and distress, hypertensive complications, preeclampsia and eclampsia, postpartum thromboembolism, longer hospitalization, congenital malformations, intraoperative and postoperative complications, postpartum hemorrhage, heart disease, neonatal diseases and death.

For example, the rate of preeclampsia among Black women is 60% higher than the rate for White women. It is linked to a four-fold increase in future heart failure events and a two-fold increased risk in coronary heart disease, stroke and death.

Women who are Black, obese and reside in the poorest areas of the South− namely Mississippi− which is the nation’s second fattest state, have a higher percentage of preeclampsia diagnoses. According to the United Health Foundation, the national obesity rate among Black women is 39% compared to 25% for White women.

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Employ community health interventions

In Mississippi, the obesity rates are 47.3% and 30.8% among Black and White women. Among reproductive-age women in Mississippi, approximately 38% are diagnosed with obesity.

Mississippi has the highest prevalence rate of Type 2 diabetes in the nation as reported by the CDC, and Black women have the second highest rate in the State. Therefore, any initiative to reduce maternal deaths among Black women must include a strong component of a lifestyle change intervention program that includes structured dietary counseling, physical activity and stress management within community health organizations.

Getty Israel
Getty Israel

Community health interventions are more practical and efficient than clinical care because providers are less likely to engage women about gestational weight gain and to refer obese patients to nutritionists or fitness experts. Also, community health worker programs have been shown to be very effective at helping patients to change behaviors that improve birth outcomes.

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Taxpayers cover most births in the U.S., about 65% in Mississippi. Pregnant Medicaid beneficiaries should be required to participate in lifestyle change programs, which have been proven to reduce maternity morbidity and mortality and medical costs.

The prenatal phase is the most ideal time to intervene, because most pregnant women are more likely to adopt healthy behaviors for the sake of their child. Lifestyle changes adopted during this period can lead to short and long-term positive health benefits for mother, child and future offspring. This will reduce the progression of obesity, chronic diseases and premature deaths among Black women and their children.

Getty Israel is a population health expert, author, writer, mother and CEO of Sisters in Birth midwifery clinic located in Jackson, Mississippi.

This article originally appeared on Nashville Tennessean: How to lower maternal mortality rates for Black women