BLACK MATERNAL AND INFANT MORTALITY

The Maternal Mortality Rate (MMR) is the number of maternal deaths during a given time period per 100,000 live births during the same time. Black women have a 3 times higher rate of dying from a pregnancy-related cause than white women. This is due to variations in quality healthcare, underlying chronic conditions, structural racism, and implicit bias. From a health view, this imbalance stems from a variety of causes of death including postpartum cardiomyopathy (disease of the heart muscle) as well as preeclampsia and eclampsia (blood pressure disorders). 

Black women who are pregnant or postpartum are 2 to 3 times more likely to die of hemorrhage or embolisms than white women, even when controlling for their age, education, and income levels. Furthermore, black infants in America are also more than twice as likely to die as white infants - 11.3 per 1,000 black babies, compared with 4.9 per 1,000 white babies, according to the most recent government data - a racial disparity that is actually wider than it was in 1850, 15 years before the end of slavery, when most black women were still considered chattel. In one year, that racial gap adds up to more than 4,000 lost black babies. Education and income offer little protection. In fact, a black woman with an advanced college degree is actually more likely to lose her baby than a white woman with less than an 8th grade education.

The crisis of maternal death and near-death also persists for black women across class lines. In 2018, tennis star Serena Williams shared in Vogue, the story of the birth of her first child. The day after delivering via c-section, Williams experienced a pulmonary embolism (a sudden blockage of an artery in the lung by a blood clot). Though she had a history of this disorder and was gasping for breath, she says medical personnel initially ignored her concerns. Though Williams should have been able to count on the most attentive health care in the world, her medical team seems to have been unprepared to monitor her for complications, including blood clots, one of the most common side-effects of c-sections.

The reasons for the black-white divide in both infant and maternal mortality have been debated for more than 2 decades, but recently there has been growing acceptance that for black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions including hypertension and pre-eclampsia that directly lead to higher rates of infant and maternal death - and that societal racism is further expressed in a pervasive, long-standing racial bias in health care that includes the dismissal of legitimate concerns and symptoms. These can all help to explain the poor birth outcomes even in the cases of black women with the most advantages. The theory is that pregnant women of color, especially black women, who have endured the long-term impact of racism have consequently had negative effects on their bodies causing trauma and stress as early as in-utero. This is known as adverse childhood experiences. 

Healthcare providers can help to lower this rate by addressing unconscious biases, standardizing care for pre and post-birth, and emergency response training. States can aid by monitoring hospitals for risk-appropriate care, reviewing maternal death causes, and addressing social factors such as housing/transportation, medical access, substance usage, and economic and racial inequality.