004: Tragic and preventable: 5 ways to help address the Black maternal mortality crisis
"The Black maternal health crisis *is* the American maternal health crisis."
In the past few weeks, several newly released reports on maternal mortality have made headlines—highlighting an issue that hits home in the U.S., where maternal mortality rates rose in 2020, and where maternal mortality is a public health crisis. Data suggests that U.S. mothers here face the highest rates of preventable maternal mortality when compared to mothers in 10 other high-income countries.
Headlines about the maternal mortality crisis can feel…big. They can feel scary. They can feel overwhelming. That’s why we wanted to devote this issue to discussing some of these updates, explaining what you *really* need to know about them, and, if you want, how to take action.
So first, three of the studies/reports/updates:
(1) Earlier this month, the U.S. Preventive Services Task Force released a new draft recommendation stating that all pregnant people should have their blood pressure measured at each prenatal visit to screen for all hypertensive disorders of pregnancy.
The takeaway: As a standard part of prenatal care, your provider is likely already taking your blood pressure at every visit. But this news is an important update to a 2017 recommendation, which suggested screening for preeclampsia (a high blood pressure disorder of pregnancy) with blood pressure measurements throughout pregnancy. This new update is more specific, suggesting blood pressure checks to screen for all hypertensive disorders of pregnancy (not just preeclampsia) at every prenatal visit. “This recommendation makes it clear that all pregnant people should have blood pressure measurements at every prenatal visit,” says Boston-based OB-GYN Rachel Blake, M.D. “Likely, many patients are already having this done, particularly in places with ample resources, but it is important that this new recommendation is made such that all pregnant people and their providers understand the importance of frequent blood pressure screening for hypertensive disorders of pregnancy.”
This update also notably draws attention to the deep racial disparities that exist in these diagnoses. The report states that “inequities in hypertensive disorders of pregnancy and related morbidity and mortality for Black individuals are well documented and persistent.”
U.S. Preventive Services Task Force vice chair Wanda Nicholson, M.D., M.P.H., M.B.A. has also said: “We are using this … to call attention to the inequities related to hypertensive disorders of pregnancy.”
Broader screening is one helpful step forward, *and* there’s more to be done: These troubling inequities will require “interventions at multiple levels, including policies, health systems, and clinical practices,” the recommendation states.
(2) This week, the World Health Organization (WHO) released a new global report on maternal mortality.
The takeaway: The report found a mix of things—including, importantly, that while maternal mortality remains unacceptably high, rates are far from equal all over the globe: In some places (Australia, New Zealand, and central and southern Asia), maternal mortality rates dropped; in some places, rates stagnated; in others (Europe, Northern America, Latin America, and the Caribbean) maternal mortality rates increased; in 2020, almost 95% of all maternal deaths happened in low- and lower-middle-income countries.
The report also noted that the high number of maternal deaths reflects inequalities, inequities, and social determinants in care, and that progress in preventing maternal mortality isn’t where experts would like it to be.
It also made this clear: Most maternal deaths are preventable.
(3) A recent “groundbreaking” new study of two million births found that, regardless of socioeconomic status, Black families were disproportionately at risk of worse childbirth outcomes when compared to white families.
The takeaway: This study crystallizes the fact that the Black maternal health crisis doesn’t stem from differences in income or biology, but rather from racism.
“The data are quite clear .... This is about the environments where we live, where we work, where we play, where we sleep,” Tiffany L. Green, an economist focused on public health and obstetrics at the University of Wisconsin-Madison, told The New York Times.
(Look no further than instances like Serena Williams’ life-threatening pulmonary embolism postpartum with daughter Olympia for further proof that for Black mothers, not even wealth, power, or celebrity are enough to keep you safe or ensure you’re heard.)
In a recent campaign for infant formula company Bobbie, journalist Elaine Welteroth echoed this sentiment, too, while speaking about her choice to give birth via midwifery at home—a decision she saw as a safer plan. “There's this idea that if you have a certain amount of education or a certain network or a certain status, maybe the stats don't apply to you,” said Welteroth. “But you would be gravely mistaken.”
Ultimately, when you see big reports like these ones—and the unacceptable disparities that exist—it’s natural to worry or to strategize solutions.
In a broad way, we know what those are: In a foreword to the WHO report, Dr. Tedros Adhanom Ghebreyesus, WHO’s director-general, wrote: “The evidence is clear: Investing in women’s health and education results in healthier communities.”
*But* we also know that maternal mortality rates are not the same for every mother. Here in the U.S., for example, Black women are three times more likely to die from a pregnancy-related cause than white women.
To this extent, Charles Johnson, founder of 4Kira4Moms—the non-profit he founded in 2017 after losing his wife, Kira, during a routine Cesarean section—has been quoted as saying: “The Black maternal health crisis is the American maternal health crisis. You cannot separate the two.”
And that brings us to this: The maternal health crisis and the Black maternal health crisis are big-picture issues that require big-picture solutions. *And* there are smaller, approachable ways to support the work being done to take action and seek support around birth and beyond.
If you’re looking for ways to act, here are some important resources and educational tools that will help:
Donate…to non-profits actively working to address the Black maternal health crisis, such as 4Kira4Moms, National Birth Equity Collaborative, Black Mamas Matter Alliance, Shade of Blue Project, and others.
Support…the Black Maternal Health Momnibus Act—a piece of legislation aimed at solving the maternal health crisis in America. “It was introduced a year ago, and though it has not been finalized, together we can ensure it is passed into federal law,” Johnson said.
Stay up to date…with The Black Maternal Health Caucus, founded by Congresswomen Alma Adams and Lauren Underwood in 2019 to improve health outcomes for Black mothers.
Ask about…minority representation in the healthcare system. (Did you know only 2 percent of active physicians are Black women?) Research suggests an increase in Black physicians could help address existing racial disparities. Your voice matters. Ask your local hospital or healthcare provider: What specific steps will you take/are you taking to increase representation?
Seek out…culturally-competent maternal health providers, such as doulas and midwives. Some research finds that if incorporated more into the healthcare system, midwifery care could work toward preventing up to 80% of maternal and newborn deaths.
COMING SOON…
» RELATED: Stay tuned for an upcoming Q&A with birth and postpartum doula Keesha Hernandez all about culturally-competent care: what it is, why it matters, and how to build a birth team that works for you.
» MARCH BOOK CLUB: ICYMI, our March Book Club selection is Real Self-Care: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble Baths Not Included) from our friend and colleague Pooja Lakshmin, M.D. Preorder your copy now and start reading on March 14—then stay tuned for excerpts, discussion questions, a conversation with Dr. Lakshmin, and more.
» TRUTH TELLER: We chat with industry leader Karen Kleiman, LCSW, founder and director of The Postpartum Stress Center, about the beginnings of perinatal mental healthcare in the U.S., why she’s drawn to suffering, and the dialectical nature of motherhood: “It sounds harsh, but the experience of mothering represents the quintessential paradox when it comes to emotions. It can feel both exhilarating and cruel in the same breath.” This is an interview you’ll want to send to every mom you know and love.
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