Racial disparities in maternal mortality among Black Texas women
TEXAS (CBSNewsTexas.com) - The number of women who die during or shortly after childbirth in the U.S. is higher than in any other developed nation, as reported by CBS News. The agent of three-time Olympic medalist Tori Bowie, who died in May, confirmed Monday the athlete was eight months pregnant and in labor at the time of her death at her Florida home. Bowie's untimely death at 32 years old is renewing the spotlight on the maternal mortality crisis across states in the U.S. — and the disparate risks for women of color.
Black women in the Lonestar State, in particular, have a higher risk for poor outcomes, such as preeclampsia, cardiovascular conditions and postpartum hemorrhage, during and after giving birth than any other race or ethnicity. That's according to data in a letter Texas Department of State Health Services (DSHS) Interim Commissioner Jennifer A. Shuford wrote to Gov. Greg Abbott in December 2022.
The state's DSHS is trying to improve maternal health overall and prevent maternal deaths in the state. One way it's doing that is by sharing information on warning signs, health risks and other resources through the Hear Her Maternal Health Campaign.
The campaign features five women who shared their stories in hopes of helping other women during or after childbirth. One woman, Brianna, shared she was diagnosed with peripartum cardiomyopathy (PPCM), also known as postpartum cardiomyopathy, after her second pregnancy. According to the American Heart Association, PPCM is defined as "an uncommon form of heart failure that happens towards the end of pregnancy or in the months following delivery, when no other cause of heart failure can be found."
Brianna is one Black woman in Texas who suffered from pregnancy risks, but she's not alone. More DSHS data shows Black women in the Lonestar State were 2x more likely to experience critical health issues, such as:
1.7x more likely to have hemorrhage-related health issues3.2x more likely to have preeclampsia-related health issues2.3x more likely to have sepsis-related health issues
What's more, that data found obstetric hemorrhage in non-Hispanic Black women were disproportionately impacted, as well.
Qiana Lewis-Arnold is a doula and a birth justice associate at The Afiya Center in Dallas, an organization that supports Black women and their health, especially when it comes to pregnancy and Black maternal mortality – a crisis they face everyday.
"We have a woman who gave birth three weeks ago, she's still in the hospital. She had an emergency C-section, she had a near fatal hemorrhage," said Lewis-Arnold.
The tragic death of Olympic sprinter Tori Bowie shocked the sports world.
"You're talking about a woman that's fairly young, extremely healthy. A whole system failed her. We're talking about the systemic racism that's in the healthcare system, but we're talking about the systemic racism that we live in in this society," said Lewis-Arnold. "We have to talk about how Black voices aren't heard, how we are so conditioned not to believe Black voices when we say 'Oh I'm not feeling well', or 'This doesn't feel right for me.'"
In an interview on CBS News' "Face the Nation" in July 2022, Harvard's Maternal Health Task Force Director Dr. Henning Tiemeier said "most of these deaths are preventable." However, when it comes to determining the cause of racial disparity in maternal mortality, he says that poses "one of the biggest challenges of public health."
"We see that as a top of the iceberg of poor health in women and poor health in Black women," Tiemeier continued. "And there are several reasons, there seems to (be), from poverty to discrimination to poor care for this group of women."
As for Texas, the Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services Joint Biennial Report shared recommendations in accordance with the 2022 data to help reduce pregnancy-related deaths and maternal morbidity:
Increase access to comprehensive health services during pregnancy, the year after pregnancy, and throughout the preconception and interpregnancy periods to facilitate continuity of care, implement effective care transitions, promote safe birth spacing, and improve lifelong health of women.Engage Black communities and those that support them in the development of maternal and women's health programs.
Implement statewide maternal health and safety initiatives and incorporate health equity principles to reduce maternal mortality, morbidity, and health disparities.Increase public awareness and community engagement to foster a culture of maternal health, safety, and disease prevention.
Improve integrated behavioral health care access from preconception throughout postpartum for women with mental health and substance use disorders.Improve statewide infrastructure and programs to address violence and intimate partner violence at state and community levels.Foster safe and supportive community environments to help women achieve their full health potential.
Support emergency and maternal health service coordination and implement evidence-based, standardized protocols to prevent, identify, and manage obstetric and postpartum emergencies.Improve postpartum care management including education and health care coordination for those with mental health and/or high-risk medical conditions. Prioritize continuing education, diversification, and increasing capacity of the maternal health workforce.
Apply continuous process improvement strategies for maternal mortality review protocols to support and increase case review capacity, quality, and recommendation development.
Dr. Alison Cowan, an OB-GYN and head of medical affairs at the health technology company Mirvie, says a combination of awareness and and a personalized plan of action is important to help change these disparities and health outcomes across the board.
"We're really looking to help individuals as much as possible with predictive testing," she says. "By translating that knowledge into action and prevention, that's going to be what really will move the needle in the right direction on maternal mortality."
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