by Abigail Shumate
*The use of gender-affirming language is incredibly important, and it is vital to remember that women are not the only people capable of giving birth or the only people subjected to maternal risks. Unfortunately, research on transgender, intersex, and nonbinary births is incredibly limited, so for the sake of concision, this post will refer to the maternal mortality crisis largely in the context of women. *
Maternal Mortality
Maternal mortality is perceived as a thing of the past. In the 21st century few feel as apprehensive about the idea of them or a loved one giving birth as they would have in centuries prior. One group that does not share this same luxury is black mothers. In America, black women are three times more likely to die from pregnancy-related causes than white women. Causing these issues are years’ worth of issues, including differences in the quality of healthcare, implicit bias, and structural racism.
With 80% of pregnancy-related deaths being preventable, it empowers no one to learn that Alabama is one of the greatest perpetrators of maternal mortality with the third highest rate in the country. A piece of anecdotal evidence that I stumbled upon while researching this topic is local to not only Birmingham, but to UAB as well. A former faculty member of UAB, Angelica Lyons, was subjected to pregnancy-related trauma that was, simply put, unnecessary and preventable. Lyons, after emphatically describing her symptoms to her doctors, was brushed off and the severity of her symptoms was not realized. Because of this neglect, she was forced to live with an undiagnosed case of sepsis that resulted in an emergency C-section months before her due date. Fortunately, both she and her baby survived although it was a close call for the Lyons mother. This is not an atypical experience for women of color, and black women specifically. Historical bias against black women results in many doctors dismissing their pain as typical or as something they can handle.
To understand the racism incorporated in the gynecological field, it is important to briefly address the history of gynecology. Gynecological science began in the 1840s, when J. Marion Sims, the so-called “father of gynecology,” performed experimental C-sections on black slaves without any anesthetics. This inhumane treatment continued after the abolition of slavery, with unnecessary hysterectomies being performed on black women. Dr. Deirdre Cooper Owens said it best when she stated, “the advancement of obstetrics and gynecology had such an intimate relationship with slavery, and was literally built on the wounds of Black women,” Following this, black families were kept from white hospitals with substantial funding until the Civil Rights Act of 1964. The Civil Rights Act did not completely eliminate the disparity, and healthcare discrimination still follows us to this day.
Maternity Deserts
One cause of inadequate care for all mothers is maternity deserts. Maternity deserts are counties that have no hospitals offering obstetric care, no birthing centers, and no obstetric providers. Over two million women between the ages of 15 and 44 live in these maternity deserts, and between 2020 and 2022, the number of counties determined to be maternity deserts increased. Maternity deserts disproportionately affect Black and Hispanic neighborhoods (although, this post focuses on black mothers, as the difference between black and white mothers tends to be starker). Maternity deserts often have lower access to transportation as well, and these transportation barriers can hinder the utilization of prenatal care.
A Broader Scale
Health disparities amongst black people are not isolated to maternal issues. Black people must struggle with medical practitioners throughout their entire lives. Doctors habitually brush away the concerns of black people of all ages, causing them to be misdiagnosed, and resulting in worse treatment than their white counterparts, or no treatment at all. As written about in this post, this begins when black people are in utero and can lead to lifelong health conditions that are misunderstood and under-addressed.
For example, black children are more likely to have asthma and less likely to have treatment. There are many reasons for this; however, I am choosing to focus on the long-term effects of Jim Crow laws. Unfortunately, many areas with below-average housing (or areas located near toxic sites) are the same areas that were the result of previous redlining. Comparatively, 4 in 10 black children live in areas plagued by poor environmental factors, as opposed to just 1 in 10 white children. People are quick to discount the social factors that play into conditions such as asthma; however, many scientists agree that structural conditions can worsen asthma and cause certain groups to be unable to obtain treatment.
Later in life, black people are more likely not only to have Alzheimer’s, but they are also less likely to be properly diagnosed, which delays or prevents their ability to get treatment (not dissimilar to the conditions referenced above). Statistically, black people who are over 65 are 4% more likely to have Alzheimer’s than white people (14% versus 10%), but it is likely that this disparity is even larger due to said misdiagnosis.
Progress
While black maternal mortality is still an incredibly pertinent issue, progress has been made in recent years. In 2019, two members of the House of Representatives, Lauren Underwood and Alma Adams, created the Black Maternal Health Caucus. This caucus is one of the largest bipartisan groups in Congress, and its goal is to “work with…partners in industry, nonprofits, and the Administration to find solutions to ending disparities and achieving optimal birth outcomes for all families”. One creation by the caucus is the Black Maternal Health Momnibus Act, or more casually, the Momnibus. The Momnibus aims to address the maternal mortality crisis through investments in every aspect that may exacerbate mortality rates. It includes 13 bills that aim to enlarge the perinatal workforce so that it addresses diversity needs, extend the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) eligibility so that mothers can have support for longer periods of time after giving birth, increase support for mothers who are incarcerated, invest in federal programs that benefit mothers and infants during public health crises, promote vaccination among mothers, and more.
Another move towards progress is with President Biden’s proposed 2024 budget. This budget incorporates $471 million in funding. One of the tangible things that it will include is Medicaid for twelve months postpartum. These efforts are admirable beginning steps; however, the work is far from complete.
