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We must address America’s black maternal health crisis

by Marcela Howell and Linda Goler Blount, opinion contributors - 08/25/18 2:00 PM ET

Serena Williams made headlines when she shared that she almost died as a result of giving birth to her daughter. Sadly, her experience is all too common for women in the United States — especially black women, who are three to four times more likely than non-Hispanic white women to die as a result of giving birth: Nationally, the maternal mortality ratio is 40.0 deaths per 100,000 live births for black women, compared to 12.4 for white women, according to the latest available Centers for Disease Control and Prevention data, from 2014.

Among them, Shalon Irving, a black Atlanta-based researcher, complained of feeling unwell and died two weeks after giving birth. Georgia ranks near the bottom of the list (48th in the country) when it comes to maternal health outcomes.

{mosads}While access to health care and structural racism in the health care system are part of the problem, black women’s maternal health also is impacted by the societal stress of ongoing racial discrimination in all aspects of our lives. That’s why even black women who have the resources to get top-notch health care are at risk.

We know that prolonged stress — over the course of a person’s life — creates what Arline Geronimus, a public health researcher at the University of Michigan, calls “weathering,” an effect that accelerates a woman’s aging process and leads to the premature development of chronic disease. Research suggests that “weathering” and the accumulation of stressors also lead to poor birth outcomes. This makes pregnancy riskier for black women — even at an earlier age. A clear example was found in the Black Women’s Health Study, which showed a causal relationship between experiences of racial discrimination and uterine fibroid tumors that can lead to low birth-weight babies and maternal bleeding.

We also know how to address the conditions that are literally killing black women. Fleda Mask Jackson — a researcher inspired by Byllye Avery (the founder of the Black Women’s Health Imperative) — developed a race- and gender-specific stress measure in an attempt to advance the methodology for assessing stress. Her work emphasized the need for health care providers and local communities to be responsive to the particular stressors that pose risks for pregnant Black women and their babies.

The country, and Georgia in particular, are failing black women. Instead of improving access to the support we need, we are seeing ever-increasing cuts to education, food access and health care at the state and federal level. As a recent study notes, Georgia is making policy decisions that directly lead to increased maternal mortality for black women. For example, Georgia’s decision not to expand Medicaid under the Affordable Care Act (ACA) has created a “coverage gap.”

Many nonpregnant women of reproductive age who may become pregnant fall into the gap of people who make too much money to qualify for Medicaid and too little to qualify for ACA subsidies. This means that nonpregnant women of reproductive age who may become pregnant likely will not have insurance coverage to receive preconception care, or timely diagnosis and proper management of chronic conditions (such as diabetes and hypertension) that can later influence maternal outcomes.

We need a multi-faceted approach that addresses black women’s health across the lifespan; addresses bias in provider care and systems of care delivery; improves access to quality care; addresses social determinants of health; and provides greater economic security. To improve black maternal health outcomes, social determinants of health must be addressed through policies that raise incomes and build wealth; provide access to clean, safe and affordable housing; improve the quality of education; prioritize reliable public transportation and transport for medical appointments; and increase the availability of healthy, affordable food.

We also need to change the system of care delivery to ensure providers listen to black women and incorporate their lived experiences into the care they provide.

We know what needs to happen to save black women’s lives and improve their health. We know how to reduce black women’s maternal mortality and morbidity. The question is whether our elected officials — at the state and federal level — have the political will and moral courage to implement policies that would improve the health and well-being of black women and our children. We cannot let losing Shalon Irving, and nearly losing Serena Williams, be in vain. As voters, we have an opportunity — and an obligation — to make politicians understand that black women’s lives matter. We urge you to vote as if black women’s lives depend on it.