Invisible women: Maternal and infant mortality in women of color

By: Stacy Grundy, MPH, CHES

Problem

There is a silent epidemic that is taking the lives of women and children across our nation. According to the Central Intelligence Agency CIA, the United States (US) has the worst birth outcomes of any of the other developed countries. These adverse birth outcomes include rising maternal deaths, high infant mortality rates and high proportions of preterm and low birth-weight babies (CDC, 2018). Infant mortality is defined as the death of a baby before its first birthday.

Infant mortality rates are especially significant because sociologists use this rate to measure the health of a nation; and based on America’s rates, we are very sick. According to the CIA, an infant born in the US is almost three times more likely to die in its first year of life than an infant born in Finland or Japan.

But it is not only the children who are in danger; mothers are also at risk. From 1987, the number of reported pregnancy-related deaths rose nationally from 7.2 deaths per 100,000 live births to 17.8 per 100,000 in 2009 and 2011. According to the CDC, an estimated 31 percent of women who give birth have serious complications and these complications are the second leading cause of short-term disability and the sixth leading cause of long-term disability.

When you examine the infant mortality rates of African Americans, the infant mortality rate is double the rate of White Americans. In regards to maternal mortality, black mothers experience one of the widest of all racial disparities in women’s health. ProPublica and NPR found that in the United States black mothers are 243 percent more likely than Whites or Hispanics to die from pregnancy- or childbirth-related causes. So what is going on? What is it about being born in the United States that is putting black mothers and their babies at risk?

In the PBS documentary, Unnatural Causes: Is Inequality Making Us Sick, neonatologists Dr. Richard David and Dr. James Collins believe that African American women are at increased risk during pregnancy, not because of their genes, but because of the impact of experiencing racism over their lifetime – an impact that can outweigh even the benefits of higher social and class status.

Dr. Camara Jones, former president of the American Public Health Association and renowned researcher whose work focuses on the impacts of racism on the health and well-being of the nation, described in her article, A Gardner’s Tale, that there are three levels of racism that influence individual health: institutional racism, personally mediated racism, and internalized racism. These levels manifest in unequal access to healthcare, employment, housing, education, and pay; and perceptions that African American women have not achieved success because they are not doing something right.

Ways patients can advocate for themselves

As a patient, there are ways you can advocate for yourself. WebMD lists The ABCs on How to Talk to Your Doctor:

A: Ask questions

If you do not understand a diagnosis or a word that your doctor uses, do not be afraid to ask, your doctor, “What does that mean?” If you do not ask, your doctor might assume you know.

B: Be prepared

Research your condition and write down any questions that you may have.

C: Communicate concerns and desires

There are many barriers that impact a patient’s accessing health care: employment, housing, etc. Communicate these concerns to your doctor because, even if they may not have the direct answer, they can connect you to the right person.

Healthcare providers

As healthcare providers and professionals, it is our duty to first and foremost LISTEN TO BLACK WOMEN. Equally, when we see racism, we must call it out! It is our duty to provide equitable care to all mothers by ensuring we have a culturally competent and a culturally diverse healthcare workforce that provides care without judgment, bias, and discrimination.