Black mothers are three to four times more likely to die of pregnancy complications than white women, and saving them will require addressing structural racism in American society and racial biases in the nation’s health care system, according to a panel of congresswomen and public health experts who spoke Thursday at the University of Minnesota.
Nationally, nearly 700 women die each year of pregnancy complications, according to the U.S. Centers for Disease Control and Prevention. But the need to improve medical care for black mothers has gained heightened attention amid increased activism among reproductive justice advocates, media coverage and revelations by singer Beyoncé and professional tennis player Serena Williams of their own life-threatening experiences during pregnancy and after delivery.
The role of structural discrimination has gained additional attention after studies found that black mothers are more likely to experience complications or death from pregnancy regardless of income, health insurance status or whether they received timely medical care. The issue has fueled a movement for providers to reckon with the ways that overt and subtle acts of racism, prejudice and gender bias in everyday life and the health system can contribute to illness, pregnancy complications and maternal death.
Common factors in the deaths include hemorrhaging, high blood pressure and pulmonary embolisms, which occur in black mothers at much higher rates than in white mothers.
The disparity “is staggering, it is unacceptable and it is a moral imperative that we change it,” said U.S. Rep. Ilhan Omar, D-Minn., who moderated the six-person panel discussion, which is part of a national tour organized by the Congressional Black Caucus.
The panel included her colleague U.S. Rep. Ayanna Pressley of Massachusetts; Rebecca Polston, a midwife and director of Roots Community Birth Center in Minneapolis; Rachel Hardeman, an assistant professor at the University of Minnesota’s School of Public Health; Amira Adawe, founder of the Beautywell Project; and Dr. Helen Kim, director of the Hennepin Healthcare Mother-Baby Program. Omar and Pressley are among the founding members of Congress’ Black Maternal Health Caucus, which aims to bring more national attention and policy changes.
Pressley told a packed auditorium at the U that “we are in a national crisis” that requires federal action. She pointed to a bill she is co-sponsoring that would expand postpartum coverage under the federal-state Medicaid program from six weeks to a year after giving birth. The bill would also increase the use of telemedicine and expand access to doulas, often used by pregnant women as added support.
“The pain of black women has been delegitimized for generations,” Pressley said. It is “entrenched racism in our health care system … when black women say they are in pain and people don’t hear them and they don’t believe them.”
Throughout the hourlong discussion, the panelists described their own pregnancy experiences, drawing nods, finger-snaps and loud cheers, particularly when they mentioned more compassionate approaches for patients who have experienced trauma, higher wages for doulas and midwives, and requiring health providers to get a better understanding of structural discrimination against communities of color.
Hardeman, who focuses on inequities in reproductive health care, said just a few years ago she would have had to explain to more people what doulas do and why they’re important. Doulas are deemed critically important for women of color and immigrant communities because they’re often trusted members of the community who provide physical and emotional support as well as information about care options. In Minnesota, Medicaid pays for doulas but at low reimbursement rates that can make it difficult for them to maintain a practice. While the growing role of doulas is encouraging, Hardeman said, there are still few doulas of color in Minnesota — and it will be hard to recruit more without higher pay.
“Doulas, in the absence of structural change, is going to continue to replicate the inequities that we see,” Hardeman said.
Part of increasing cultural competency among health professionals is “not diagnosing people as a problem,” said Polston, a midwife and founder of Roots Community Birth Center.
“What we see so frequently, particularly in maternal health care, is this blaming of the victim,” Polston said, “[of saying] ‘If women would just do this, and stop being like this, then they can live.’ ”