I started my day today (ironically, Martin Luther King Day) reading another tragic story about a young Black mother who hemorrhaged to death after giving birth in a large public hospital in Brooklyn.
Statistics tell a shocking story. The maternal death rate increased by 79 percent from 2018 to 2021. Women of color had even worse numbers, with the maternal mortality rate among Black women increasing from 37 per 100,000 in 2018 to almost 70 per 100,000 in 2021. That’s almost three times the rate for white women. These numbers are staggering. In case you think that is within the realm of normal, the U.S. maternal death rate is more than ten times that of other high-income countries. Australia, Japan, Israel, Spain, and Austria hovered between 2 to 3 deaths per 100,000.
Why do Black mothers have such dismal experiences and mortality? Variations in health care, funding of health care, underlying chronic conditions, systemic racism, and implicit bias are all contributors. Social and economic disparities are real and deadly. Access to maternal health care is dependent on insurance, transportation, co-pays, lack of childcare, and getting off work. Economic instability and the food choices women can access are wildly different depending on where they live. Poor communication with health care providers and clinics is a factor. In fact, 30 percent of Black women in the United States reported neglect or mistreatment during their pregnancies, according to a survey from the CDC Vital Signs report.
The lack of doctors and midwives of color plays a huge role in communication, trust, believing women, and addressing their concerns. I could go on and on. Let’s quit analyzing the problems and get to some fixes.
We in health care need to acknowledge that we have a problem and commit to change. The repeal of Roe v. Wade is making this worse, with poor women suffering the most. Hospitals should formulate pregnancy support groups, led by a midwife for women of color so that they can discuss concerns and share experiences. Insurers and Medicaid need to provide postpartum home visits and PT/OT for women. One of the biggest differences between women giving birth in America and elsewhere in the world is routine follow-up visits after birth. A new mom’s life and body have completely changed with childbirth, and problems like postpartum depression, pelvic floor issues, breastfeeding, infection, hemorrhage, and eclampsia can be addressed before they take a life. More than half of all maternal deaths take place after delivery.
The U.S. must provide paid maternity leave. Attention: Women work! Women support their families! More than 120 nations provide paid maternity leave. The U.S. doesn’t. Health systems must acknowledge and develop staff training for implicit bias. Black women’s concerns and pain are often discounted, and cultural differences and income disparities can create communication barriers that are hidden until a crisis occurs. Immediately develop training and funding for physicians and midwives of color. Get this! Only 5.7 percent of physicians in the U.S. are Black. More than 90 percent of all midwives are white. Midwives in training can face tremendous financial pressures. Getting preceptorships often requires moving to secure the training, and financial support is not provided. Out of 4,000 midwife students, only 22 received scholarships, and fewer than 400 were awarded loan repayment support.
Affirmative action was overturned by the Supreme Court in 2023. California was a test case of how this would turn out, as Prop 209 outlawed it in 1996. Undergrad enrollment of unrepresented minorities fell 40 percent at UCLA and Berkeley. In 2021, only 3 percent of California physicians were Black, despite the state medical schools initiating other socioeconomic admission criteria to increase diversity. When you look at the health care priorities we have, it is not a surprise that we have a big problem.
We can do better. We owe our Black sisters more. We owe society more. We owe ourselves more.
Toni Brayer is an internal medicine physician.
