Black maternal mortality rates have spiked. Here’s why, according to experts.
When Shalon Irving, who lived in Atlanta, got pregnant in 2016, her mom, Wanda Irving, says was overjoyed about becoming a mother and threw herself into preparing for her baby. As an epidemiologist at the Center for Disease Control and Prevention (CDC) and a lieutenant commander of the U.S. Public Health Service Commissioned Corps, Shalon didn’t fit the bill of being a Black woman at risk of maternal death. At 36 years old, she was relatively young, healthy, educated and had excellent insurance — what could possibly go wrong?
However, as a March 2023 CDC report illustrates, maternal death rates are on the rise in the U.S., spiking significantly in 2021. Black women in particular are nearly three times more likely to die from a pregnancy-related cause than white women.
A new report from the March of Dimes on maternity care deserts in the U.S. — which the organization defines as "any county without a hospital or birth center offering obstetric care and without any obstetric providers" — points out that "significant racial and ethnic disparities exist in maternal and infant perinatal outcomes."
One contributing factor is that nearly 7 million American women of childbearing age are living in areas with no or limited maternity care access, according to the report, and closures of obstetric units in hospitals are affecting "a higher percentage of non-Hispanic Black women and low-income women."
The March of Dimes report also pointed out that severe maternal morbidity (SMM) — defined as "unexpected outcomes of labor and delivery that result in significant short or long-term health consequences" — affects about 50,000 women in the U.S. each year. But they occur twice as often in Black women as compared to white women, "even after taking into consideration social, economic factors and co-existing medical conditions," per the report.
Although Shalon was aware of the national maternal mortality rates prior to having children, Wanda tells Yahoo Life that Shalon felt confident that being healthy and educated, with access to excellent care, would mitigate her risk. “She chose her providers based on perceived medical competence and did everything right,” Wanda says.
Within four or five days after giving birth to her daughter Soleil, however, Shalon wasn’t feeling well. She developed severe headaches, her legs began to swell and her blood pressure skyrocketed. Despite repeated visits to her health care providers, Wanda says her concerns were brushed off since she’d just had a baby. But just 21 days after giving birth, Shalon suffered a sudden cardiac arrest at home and died.
Black maternal mortality by the numbers
According to the CDC, in 2019, the maternal mortality rate was 20.1 deaths per 100,000 live births in the U.S. Instead of decreasing, the rate rose to 23.8 deaths per 100,000 live births in 2020 and then spiked to 32.9 deaths per 100,000 live births in 2021. These statistics are even more grim when broken down by ethnicity. For Black women, the maternal mortality rate in 2021 was 69.9 deaths per 100,000 live births. This is 2.6 times the rate for white women.
The biggest impact on people’s health and the health care system in the past three years has been the COVID-19 pandemic. The pandemic also uncovered health disparities at astounding rates.
“We saw a lot of maternal deaths from COVID during that time period,” Dr. Carol Major, director of maternal fetal medicine at the University of California, Irvine School of Medicine, tells Yahoo Life. “COVID was a huge factor in the overall maternal deaths because not only did Black maternal mortality increase, the maternal mortality of all races increased.”
Major explains that pregnant women got COVID more easily and they were more likely to become very sick and more likely to die. COVID vaccines, however, improved those outcomes, and even though pregnant women who were vaccinated still got infected, they stopped dying at such high rates. But vaccine hesitancy among Black and brown women kept unvaccinated pregnant women at risk of serious illness and death.
COVID isn’t the only factor in maternal mortality rates. These rates are typically centered around three primary health issues: hemorrhage, hypertensive disorders such as preeclampsia and gestational hypertension and preterm birth.
Rochelle Townsend started hemorrhaging after giving birth to her third child in Palm Beach, Fla., in January 2020. This was due to a complication called retained placenta. Townsend shares with Yahoo Life that, other than having a pre-diagnosed blood-clotting issue, her third pregnancy proceeded normally. She recalls being terrified after being rushed off to the emergency room on the brink of a hysterectomy, having lost half her body’s blood volume. Townsend believes that the blood that was initially earmarked for her due to her clotting disorder ultimately saved her life.
She remembers the anesthesiologist at her side. “He just reassured me and he kept on rubbing my eyebrows and saying, ‘You're OK, you're gonna be OK, we have you,’” she says, “and he just kept on being at my eye level.”
But that level of care is something many Black mothers don’t typically experience. Major says that she often senses fear when treating Black expectant patients and makes a point to stay in labor and delivery with them. “There’s a lot of hand-holding for a long period of time,” she says. “I want to make sure that they don't have a bad outcome, and I want to make sure that those patients are treated with respect.”
Why Black mothers are at risk
Black women are historically more at risk for maternal death because of systemic racism and how that influences social determinants of health. Redlining, for example, affects where people of color typically live, reflected by poor housing conditions, businesses polluting the air and water, poor-quality hospital health care systems, lower employment opportunities and pay, and underfunded school systems.
“Patients who represent these demographics have higher adverse perinatal outcomes,” Dr. Kecia Gaither, director of perinatal services/maternal fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx, tells Yahoo Life. Gaither says that air and water pollution increase respiratory illnesses, food deserts contribute to “poor nutritional choices, thus poor nutritional status,” and poor housing and employment opportunities increase stress — “all impact maternal outcomes.”
Research also shows that health care providers are the least likely to listen to Black mothers and, according to another study, are more likely to diminish their “ability to maintain autonomy and make health care decisions for themselves and their children.”
Support for Black expectant mothers
Gaither says that when celebrities of color like Serena Williams share the life-threatening complications they experienced giving birth, it helps raise awareness about the risks Black expectant mothers face.
It can also help influence government officials to consider policy changes that recognize and decrease adverse perinatal outcomes. One such policy is the Black Maternal Health Momnibus act, a proposed federal legislative package sponsored by the Congressional Black Maternal Health Caucus, that would build on existing legislation to “make critical investments in social determinants of health that influence maternal health outcomes, like housing, transportation, and nutrition.”
Having more Black health care providers, nurses and doulas can also improve patient outcomes. Major says that, in her experience, “I have found out that most patients want someone on their team to be a person of color. They feel that they will be better understood if that person taking care of them looks like them.”
Another initiative proven to reduce maternal mortality rates for Black women is having a doula. In New York, California and Florida, research shows that Medicaid coverage of doulas improved birthing outcomes. Pregnant people who used doulas had fewer inpatient hospital admissions during pregnancy, lower odds of cesarean delivery, lower overall costs and less likelihood of having babies with low birth rates.
Experts say that advocating for yourself is also crucial. Townsend, who says she is fortunate to have survived, encourages pregnant Black women to ask questions, even when you’re afraid. Wanda Irving, who is raising Shalon’s daughter Soleil by herself and honors her daughter’s legacy through the work of Dr. Shalon’s Maternity Action Project, agrees. She advises all expectant Black mothers to listen to their bodies and not be afraid to seek treatment elsewhere if you’re not being heard.
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