By Chelsea Crittle, MS (2018 SPSSI Dalmas Taylor Fellow)
According to the latest research from the Centers for Disease Control and Prevention (CDC), roughly 700 women in the U.S. die each year due to pregnancy or delivery-related complications.1 Alarmingly, maternal mortality rates for women living in the U.S. are the highest in the developed world with stark racial disparities. Black women specifically have the highest maternal mortality rate in the U.S. and are nearly four times more likely to die from pregnancy-related causes compared to White women.
SOURCE: The Global Burden of Disease 2015 Maternal Mortality study as published in The Lancet medical journal
National health organizations are pushing for better documentation of pregnancy-related complications and for research into the causes and prevention of these unfortunate deaths.
What does the research tell us?
In general, women of color stand a greater chance of dying during pregnancy or delivery compared to White women.
According to the CDC:
White women experienced 12.7 deaths per 100,000 live births.
Black women experienced 43.5 deaths per 100,000 live births.
Women of other races experienced 14.4 deaths per 100,000 live births.
Maternal Mortality is prevalent amongst Black women regardless of education level and socioeconomic status. Five years of data ranging from 2008-2012 found that black college-educated mothers who gave birth in local hospitals were more likely to suffer severe complications of pregnancy or childbirth than white women who never graduated from high school2.
Disparities in Maternal Mortality Causes
The leading causes of pregnancy-related death vary greatly depending on race/ethnicity3.
SOURCE: Review to Action. (2018) Report from Nine MMRCs.
What’s most alarming is research showing that roughly 63.2% of maternal mortalities are preventable3.
Researchers have begun to identify factors that contribute to such stark disparities in pregnancy-related deaths, for Black women specifically. On a broader scale, social inequities involving differential access to healthy food and clean drinking water, safe neighborhoods, quality schools, good jobs, and reliable transportation influences various aspects of Black women’s lives, including pregnancy4. For example:
Black women who are uninsured pre-pregnancy are slower to start pre-natal care and more likely to lose coverage postpartum.
Black women receive care in a concentrated set of hospitals and these hospitals are more likely to provide lower quality of care compared to hospitals where White women deliver5.
Unconscious biases are prevalent throughout the medical system, impacting how medical professionals perceive and respond to Black compared to White patients’ pain6.
Limited diversity in the medical profession has been shown to lead to culturally inappropriate treatment as well as Black mothers’ feelings of isolation.7, 8
What can we ALL do to combat maternal mortality risk for women of color?
Contact your member of Congress and urge them to support legislation to address maternal health disparities, specifically the Maternal Health Accountability Act and the PREEMIE Reauthorization Act.
States should implement Maternal Quality Improvement Toolkits in hospitals so that medical professionals are better equipped to respond to the leading causes of preventable death among pregnant and postpartum women9.
States and Hospital systems should participate in Alliance for Innovation on Maternal Health (AIM), a community of multidisciplinary healthcare providers, public health professionals, and cross-sector stakeholders who are committed to improving maternal outcomes in the United States10.
States should implement legislation requiring medical students and physicians to complete cultural competency courses as part of their licensing or accreditation programs11, 12.
Social scientists, in collaboration with medical professionals, should continue to consider how racial biases in perceptions of others’ pain affect racial disparities in health care13.
1Centers for Disease Control and Prevention. (2017). Pregnancy Mortality Surveillance System. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html
2New York City Department of Health and Mental Hygiene (2016). Severe Maternal Morbidity in New York City, 2008–2012. New York, NY. Retrieved from https://www1.nyc.gov/assets/doh/downloads/pdf/data/maternal-morbidity-report-08-12.pdf
3Review to Action. (2018) Report from Nine MMRCs. Retrieved from http://reviewtoaction.org/sites/default/files/national-portal-material/Report%20from%20Nine%20MMRCs%20final%20edit.pdf
4Nina Martin and Renee Montagne, (2017). Nothing Protects Black Women From Dying in Pregnancy and Childbirth. ProPublica. Retrieved from https://www.propublica.org/article/nothing-protects-black-women-from-dying-in-pregnancy-and-childbirth
5Howell, A. E., Egorova, N., Balbierz, A., Zeitlin, J., & Hebert, P. (2016). Black-White Differences in Severe Maternal Morbidity and Site of Care Am J Obstet Gynecol. 2016 Jan; 214(1): 122.e1–122.e7.
6Hoffman, M. K., Trawalter, S., Axt, R. J., & Oliver, N. (2016). Racial bias in pain assessment. Proceedings of the National Academy of Sciences 113 (16) 4296-4301
7AAMC Facts & Figures (2016). Diversity in Medical Education. Retrieved from http://www.aamcdiversityfactsandfigures2016.org/report-section/section-3/#figure-20
8Review to Action. (2018) Report from Nine MMRCs. Retrieved from https://reviewtoaction.org/Report_from_Nine_MMRCs
9California Maternal Quality Care Collaborative. Retrieved from https://www.cmqcc.org/resources-tool-kits/toolkits
10Council on Patient Safety in Women’s Healthcare. Alliance for Innovation on Maternal Health (AIM). Retrieved from https://safehealthcareforeverywoman.org/aim-program/
11Amnesty International. (2012). Deadly Delivery: The Maternal Health Care Crisis in the US. Retrieved from https://www.amnestyusa.org/files/pdfs/deadlydelivery.pdf
12Betancourt, J. R. (2003). Cross-cultural medical education: Conceptual approaches and frameworks for evaluation.” Academic Medicine, 78(6), 560-9.
13Hoffman, K. M., Trawalter, S., Jordan, R. A., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. PNAS Proceedings of the National Academy of Sciences of the United States of America, 113(16), 4296-301.
Chelsea Crittle, MS, is a doctoral student in the social psychology PhD program at Tufts University where she is a member of the Social Cognition lab as well as the Social Identity and Stigma lab. She earned her BA in Psychology with a minor in Comparative Women’s Studies from Spelman College in 2015 and her MS in Social Psychology from Tufts in 2017. Chelsea’s research interests include racial/gender identity, implicit bias, and confrontation. In particular, she is interested in exploring ways to reduce the negative effects of racial and gender bias in different contexts (i.e., educational settings, law enforcement interactions, etc.). Chelsea is currently investigating the ways in which allies can use their identities to effectively confront bias.