The United States is one of the leading nations in medical advancement and spends a significant portion of expenditures in healthcare and yet, we have the highest rate of maternal mortality (ratio of 57) among developed countries. About 57 mothers die during childbirth per 100,000 birth in a year. Maternal mortality is defined as the death of a mother due to pregnancy and/or childbirth complications . These complications can arise due to a variety of factors including environmental lifestyle, predisposing conditions, risk factors, genetics and socioeconomic factors . Pregnancy complications are likely to arise in women with higher maternal age and those with chronic cardiovascular conditions. Preeclampsia is a condition in which women develop high blood pressure due to preexisting cardiovascular conditions and kidney disease. Black non-Hispanic mothers are 2.5 times more likely to die from pregnancy or labor complications compared to white women and 3.5 times more likely to die than Hispanic women . Why is there a disparity in maternal mortality?
Let’s look at some of the causes for maternal mortality. While there are genetic predispositions towards developing preeclampsia, it is certainly not the only risk factor. A recent study conducted by the Journal of American Medical Association investigated prevalence of preeclampsia and other cardiovascular risk factors between white Caucasian women, Hispanic women, African American women who have lived 10 or more years in the U.S and African American immigrant women . They found that Black women who immigrated to the US experienced 26% less risk in developing preeclampsia and therefore lower rate of maternal mortality . We have known that race is in fact an important factor in healthcare inequities, but specifically, it is especially a significant player in the United States healthcare inequities [1,4]. Healthy women who come to the U.S become unhealthy overtime due to “unhealthy acculturation” . Therefore, the assimilation of US culture leads to poor health outcomes among black women. Systemic racism causes chronic stress in Black women due to the segregation of neighborhoods, lack of healthcare access, care for children as single mothers and toxic and conflict-driven neighborhoods. These conditions lead to “weathering,” a process in which exposure to racism, discrimination, political marginalization literally harms someone and makes them sick overtime [1,4].
However, shouldn’t physicians address this systemic racism and practice equitable medicine? Many physicians do not exhibit cultural competence and display implicit racial bias towards patients of color that indirectly affects treatment and care. A great example is the assessment of pain. A study in 2016 found that over half the medical students believed that Black patients experienced less pain than white people . Pain is just one example of bias where a common assumption is that Black women know less about their bodies and are often misdiagnosed by physicians for condition such as endometriosis where many are diagnosed with sexually transmitted diseases. Therefore, their symptoms of pain are given less importance and often leads to misdiagnosis of disease .
All these studies point to race being a major issue in reproductive health justice and affecting communities of color disproportionately. So, what can we as do to reduce maternal mortality? First, medical education and training should introduce implicit bias training and cultural competence training to work with diverse group of patients. We should not TREAT the disease, but instead the patient and listen more . More importantly, Black physicians should engage with Black patients and reproductive health to earn the trust of this community. It is impossible to eliminate systemic racism due to intricate nature in our society, but we sure can begin somewhere, something we’ve failed to do for a long time: LISTEN.
- Collier, A. Y., & Molina, R. L. (2019). Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. NeoReviews, 20(10), e561–e574. https://doi.org/10.1542/neo.20-10-e561
- Hatch, C. (2021, December 29). U.S.-born black women at higher risk of preeclampsia than foreign-born counterparts; race alone does not explain disparity. Retrieved June 7, 2022, from https://www.hopkinsmedicine.org/news/newsroom/news-releases/us-born-black-women-at-higher-risk-of-preeclampsia-than-foreign-born-counterparts-race-alone-does-not-explain-disparity
- Hoyert, D. L. (2021, March 23). Products – health e stats – maternal mortality rates in the United States, 2019. Retrieved June 7, 2022, from https://www.cdc.gov/nchs/data/hestat/maternal-mortality-2021/maternal-mortality-2021.htm
- Joseph, K., Boutin, A., Lisonkova, S., Muraca, G., Razaz, N., John, S., . . . Schisterman, E. (2021, May 1). Maternal mortality in the United States: Recent trends, current status, and future considerations. Retrieved June 7, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055191/
- Kozhimannil, K., & Westby, A. (2019, October 15). What family physicians can do to reduce maternal mortality. Retrieved June 7, 2022, from https://www.aafp.org/pubs/afp/issues/2019/1015/p460.html