Hi friends, February is Black History Month! While there is much to be celebrated, there are some things in the United States that we should not be proud of, and while we have made many steps towards equality in the last several decades, there is still a large problem in healthcare disparities.
Black women are 3-4 times more likely to die from pregnancy-related causes compared to their non-hispanic white counterparts (Collier, 2019; Omizek, 2018). Black women also have a higher risk of complications from pregnancy compared to white women, regardless of socioeconomic status and comorbidities (Collier, 2019).
In the 1800s 7 out of every 100 women died in the hospital in the United States while giving birth (Omizek, 2018). This rate significantly improved over the last century, but in the United States it has started to rise again (Collier, 2019). From 2000-2014 the rate of maternal deaths doubled while other high-income countries continue to decrease (Collier, 2019). The United States is the only developed country that has an increasing rate of maternal mortality, and that rate is twice that of the maternal mortality rate in the United Kingdom and Canada.
Some factors that can increase the risk of maternal death include (Ozimek, 2018):
Cesarean delivery
Unintended births
Unmarried status
4 or less prenatal visits
For black women, the most common causes of death include preeclampsia/eclampsia and embolism (Collier, 2019). Multiple studies have shown that almost half of the pregnancy-related deaths in the United States are preventable (Omizek, 2018). Some of the preventable causes of death include hemorrhage, high blood pressure, infection, and heart disease (Omizek, 2018).
While cesarean sections can be life-saving interventions, the rate at which these deliveries are performed is increasing in the United States (Collier, 2019). Cesarean deliveries are associated with higher rates of maternal deaths and morbidity, while also increasing the risk of complications in future pregnancies, when compared with vaginal deliveries (Collier, 2019).
One survey found that more than 40% of women reported difficulty communicating with their providers regarding prenatal care and 24% reported perceived discrimination during hospitalization for birth. These issues increase the risk of maternal death and complications related to pregnancy and delivery.
While there may not be a simple solution to this issue, there are some successful programs that have been implemented to decrease the maternal death rate and the risk of complications.
To combat their maternal mortality rate, the United Kingdom successfully implemented a national system to review all maternal deaths. This system has helped to significantly lower the maternal mortality rate among black African women (Omizek, 2018).
The state of California has implemented a similar program which has reduced it’s maternal death rate by 55%, while also decreasing the preterm birth rate and maternal morbidity (Omizek, 2018).
The CDC started a campaign, “Hear Her,” in an effort to decrease pregnancy-related complications. Visit the campaign’s website here to learn more.
Addressing biases in the healthcare system may help to combat racial disparities. Training on implicit bias is critical to addressing these inequalities to sensitize providers on the role it may play in their interactions with patients (Collier, 2019).
As healthcare providers, it is crucial that we recognize these disparities in maternal care. While there may not be a simple solution to this problem, our patients deserve the best care possible, regardless of race.
Written by Emily Reul, PT, DPT
References
Collier AR, Molina RL. Maternal mortality in the United States: updates on trends, causes, and solutions. Neoreviews. 2019;20(10):561-574.
Ozimek JA, Kilpatrick SJ. Maternal mortality in the twenty-first century. Obstet Gynecol Clin North Am. 2018;45(20)