Written by: Chelsea A. Cooper, Julia Hakeem, Dylaan Jarmon, Henry E. Maldonado, and Fatou Ndiaye
What is Maternal Mortality and Who is Most Affected?
Maternal mortality refers to the death of a birthing individual due to pregnancy-related complications. In the United States, there are 22 maternal deaths per 100,000 live births, which is more than double the rate in other developed countries. A significant majority of these deaths occur among African American women, who are 3 to 4 times more likely to experience maternal mortality than their white counterparts. As of 2022, African American women face 69.9 deaths per 100,000 live births, compared to 19.0 deaths per 100,000 live births among white women in 2021. To understand this health disparity, we must first examine the history of maternal mortality in our country.
The Racist History of Maternal Mortality
Present-day gynecological advancements are directly linked to dark and disturbing experiments on Black women. For example, American physician James Marion Sims is often referred to as the “Father of Gynecology,” but the truth of how these advancements came to be has been purposefully omitted from medical education. Sims performed torturous experiments on Anarcha, Betsy, Lucy, and other enslaved women without anesthesia. His disregard for their pain, fueled by the myth that Black people do not feel pain, reflecting the dissmissive treatment of Black women in healthcare today. The racist treatment of Black women in medicine did not end with Sims or Dr. Thomas Hamilton, who also experimented on Black individuals. Rather, it has fueled a structural racism that remains deadly for African American women today. To properly address this health disparity, the NIH states that we must acknowledge the “legacies of slavery,” which are evident in the structural racism resulting in disproportionate maternal and infant mortality among African Americans.
According to the Kaiser Foundation's 2023 survey on Racism, Discrimination, and Health a majority (54%) of Black women say they experienced at least one form of discrimination asked about in the survey in the past year, such as receiving poorer service than others at stores or restaurants.
In addition to these everyday forms of discrimination, Black women also report experiencing disproportionate levels of discrimination and unfair treatments in health care settings. For example, about one in five (21%) Black women say they have been treated unfairly by a health care provider or by health care administrators due to their racial or ethnic background. Additionally, (22%) of Black women who have been pregnant or gave birth in the past ten years say they were refused pain medication they thought they needed.
Causes of Maternal Mortality in African American Women
Pregnancy-related deaths can occur during pregnancy and up to one year postpartum, with over a third of maternal deaths happening between one week and one year after giving birth. African American women face particularly grave risks, being 3.5 times more likely to experience postpartum death. Leading causes of maternal mortality among African American women include obstetric hemorrhage, obstetric embolism, postpartum cardiomyopathy, surgical complications, and preeclampsia/eclampsia, the latter being the leading cause of death.
While these physical causes are critical to understand, it's essential to recognize that many social determinants of health, alongside deeply rooted systemic racism, play a major role in health outcomes for Black mothers.
Social Determinants of Health that Affect Maternal Mortality
When considering the causes of African American maternal mortality, it is crucial to understand the structural and social determinants of health and their impact on maternal mortality rates.
Social determinants of health—such as neighborhood environment, economic stability, access to healthcare, and food deserts—are directly tied to the history of slavery and Jim Crow in America, and they continue to affect health outcomes for Black mothers today. Black women, regardless of income or educational level, experience poor maternal outcomes. Factors such as safety, access to care, housing, income, and food stability contribute to maternal mortality rates by acting as stressors for pregnant Black women, potentially leading to complications or limiting access to essential resources for themselves and their children.
It is important to recognize that this situation is not the fault of the mothers, who strive to support themselves and their families. Rather, they face disadvantages stemming from historical setbacks that have disproportionately impacted Black communities.
A Deeper Dive into Social Determinants of Health
Delving deeper into social determinants of health that affect maternal outcomes, environmental factors emerge as significant contributors. A systematic review conducted in 2020 found that pregnant women exposed to higher temperatures and air pollution are more likely to experience premature births, low birth weight, or stillbirth. With climate change leading to rising temperatures, heat exposure is increasingly prevalent. This exposure can cause dehydration, inefficient thermoregulation, and altered blood viscosity, potentially reducing uterine blood flow and resulting in premature or underweight births.
Similarly, there is growing evidence that air pollutants, such as ozone and particulate matter, have direct toxic effects on pregnancy. Three studies indicated that exposure to ozone throughout pregnancy increases the likelihood of low birth weight from 6% to 13%. Research on particulate matter exposure during three specific periods—before delivery, the third trimester, and the entire pregnancy—identified an increased risk of stillbirth ranging from 3% to 39%. Many studies have noted that African American mothers face a higher risk of preterm delivery due to air pollution. Social determinants, such as residing in areas with high levels of air pollutants and experiencing long-term stress, are correlated with adverse obstetrical outcomes.
In addition to environmental factors, food deserts also represent a significant social determinant of health contributing to maternal mortality among African American women. Only 8% of African Americans live in a census tract with a supermarket, compared to 31% of white Americans. Food deserts and food insecurity increase the likelihood of developing chronic diseases such as diabetes, heart disease, cancers, obesity, and hypertension. A USDA national Health Interview Survey found that the number of chronic conditions in adults living in food-insecure households was about 18% higher than in those living in food-secure households. For pregnant women, food deserts and food insecurity elevate the risks of preterm birth, postpartum depression, gestational hypertension and gestational diabetes. Since food deserts predominantly affect minorities in the U.S., particularly African Americans, food insecurity can directly contribute to higher maternal mortality rates in this population.
Psychological Impact of Maternal Mortality in African American Women
Maternal mortality affects not only the mother but also the entire family. It leaves children without their mothers and husbands as widowers, often forcing them to raise their children alone. Parents lose their daughters, siblings lose their sisters, and friends lose their companions. Entire families and communities mourn the loss, leading to drastic changes in their lives. The consequences of maternal mortality can result in immense grief, trauma, and stress, as well as the loss of economic stability, increased risk of poverty, and mental health challenges.
Why Awareness Matters
It is imperative that healthcare professionals and families of expecting Black mothers stay informed about the rising rates of maternal mortality among African American women and the factors that contribute to it. Healthcare professionals and future practitioners must continually examine their implicit biases to create a supportive and safe environment for Black women, ensuring they receive high-quality medical care. Additionally, Black expecting mothers and their family members should educate themselves to effectively advocate for both the mother and baby. It is essential for all of us to increase our understanding of maternal mortality in order to combat the disparities that are plaguing our country.
Further Resources
This module, offered through the National Anti-Racism in Medicine Curriculum Coalition, provides valuable insights into the role racism plays in maternal mortality. Through open-ended questions, videos, articles, and thought-provoking prompts, participants gain a deeper understanding of this health disparity and explore strategies to combat it.
Book: Medical Apartheid: Chapter 2 Profitable Wonders
By Harriet A. Washington
Medical Apartheid by Harriet A. Washington focuses on the cruel history of medical experimentation on Black Americans. Chapter 2, “Profitable Wonders”, discusses the gynecological advancements made by James Marion Sims, through tortuous surgical procedures on enslaved Black women.
Video: Aftershock Documentary on Hulu
Aftershock is a moving documentary centered around bringing awareness to the impact of maternal mortality on African American women. The documentary tells the true story of the death of two black women named Shamony Gibson and Amber Rose Isacc and the aftershock of effects their deaths had on their communities. In addition, the documentary sheds light on the historical contributions to maternal mortality in African American women.
The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) is an organization providing support and information to nurses caring for mothers, newborns, and families through research, education, and advocacy. Providing resources, professional development, and a plethora of media sources will be beneficial for the health and well-being of women and newborns.
Video- Listen to Me
Listen to Me is a documentary that tells the stories of four women and the complexities and challenges Black women face on their journey to motherhood. These women are at the front lines of the Black maternal health crisis while also navigating the troubling reality of birthing in the United States.
Sources
Black Women Over Three Times More Likely to Die in Pregnancy, Postpartum Than White Women, New Research Finds. Population Dynamics Research Centers. (2021, December). https://popresearchcenters.org/research-highlights/black-women-over-three-times-more-likely-to-die-in-pregnancy-postpartum-than-white-women-new-research-finds/
Cooper, C., Ndiaye, F., Maldonado, H., Hakeem, J., & Jarmon, D. (n.d.). The Racist Hostory of Obstetrics and Gynecology . Nearpod Lessons: Download ready-to-use content for education. https://www.namcc.net/learning-modules
Latoya Hill, A. R. (2024, October 25). Racial disparities in maternal and infant health: Current status and efforts to address them. KFF. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/
Njoku, A., Evans, M., Nimo-Sefah, L., & Bailey, J. (2023, February 3). Listen to the whispers before they become screams: Addressing black maternal morbidity and mortality in the United States. Healthcare (Basel, Switzerland). https://pmc.ncbi.nlm.nih.gov/articles/PMC9914526/
Population Reference Bureau. (2023, March 9). Maternal death among U.S. black women. PRB.org. https://www.prb.org/resources/maternal-death-among-u-s-black-women/#:~:text=Preeclampsia%2FEclampsia%20Is%20the%20Leading%20Cause%20of%20Black%20Maternal%20Death
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