The ability to care for and heal new mothers is one of the most important measures of a country’s healthcare. Despite being one of the wealthiest countries in the world, the United States has the highest maternal mortality rate of any developed country at over 17.4 deaths per 100,000 live births. Eugene Declercq, a professor of community health science at Boston University, agrees that this maternal mortality rate would rank last out of all developed nations.
Declercq added, “No matter how one analyzes the data, we still lag well behind other countries”.
Between 2000 and 2017, the global maternal mortality rate (MMR) decreased by 38 percent. Simultaneously, the MMR of the U.S. increased by 27 percent! It is significant to note that this is the only developed country for which these statistics stand. When broken down further, the data reveals that America’s horrifying maternal mortality rate is driven heavily by racial disparities.
Over time, the average maternal mortality rate has declined since the 20th century due to improved medical technology. The mortality rate for non-Black women fell at an extremely steep rate, while that of Black women only declined steadily. This extreme gap elevated the persistence of racial disparities in maternal care.
The graph above shows that the maternal mortality rate for Black women in the U.S. is three to four times that of the average American woman. This has remained constant for the past six decades. Why is this the case? Many supposed risk factors for maternal mortality cannot fully explain such an extreme disparity.
Supposed Risk Factors
Poverty and Socioeconomic Status: Studies have shown that even after controlling education levels, income, age, and health status, Black women are still at three times higher risk of dying from pregnancy/delivery complications than White women.
Prenatal Care: Research has shown that women of color have lower access to prenatal care than White women. However, studies have shown that Black women who seek out prenatal care during their first trimester still have higher mortality rates than White women who obtain late or no prenatal care. This may be due to the lower quality of prenatal care for Black women as opposed to White women.
Physical Health: Smoking, drug abuse, and obesity are the top 3 health conditions contributing to higher maternal mortality. Several studies have shown that Black women are less likely than White women to smoke during pregnancy and no more likely than White women to abuse drugs. Though obesity is more prevalent among Black women, studies have shown that Black women of normal weight still face higher mortality rates than obese White women.
As those risk factors cannot fully explain the disparities in maternal mortality rate, the factors below are more realistic determinants of why Black women are dying at such a high rate compared to their White counterparts.
Realistic Risk Factors
Access to Care: Women of color tend to have less access to important reproductive health resources as opposed to White women. (e.g. family planning, STI and cervical cancer screenings, abortions)
Quality of Care: Studies show that Black women receive a lower quality of general healthcare than White women. This can lead to the development of pregnancy-related risk factors---hypertension, diabetes, heart disease, HIV, and cancer---that can contribute to higher healthcare disparities.
Implicit Bias: This is one of the largest risk factors for maternal mortality in Black women. Data collection has shown a general theme of Black women feeling disrespected and devalued by their physicians. It was also found that their pain was not taken seriously by medical providers (leading to pain being undertreated), which has developed into a common theme around general healthcare.
As future health professionals, we must strive to foster an environment where patients from all backgrounds feel welcome and cared for. We must work to become aware of our implicit biases and provide equal access and quality of healthcare for everyone.
If you are particularly passionate about disparities in MMR specifically, consider supporting organizations such as the Black Mamas Matter Alliance and the National Birth Equity Collaborative!
Thank you for reading!
Sincerely,
Alisha Khodabocus
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