Racial Disparities in Pregnancy-Related Death in the U.S.
12-05-2022
In the United States, according to the CDC, 13 white women in every 100,000 pregnant women die from pregnancy-related health complications, but the numbers are staggeringly higher for black women and women of indigenous or native descent. For every 100,000 pregnant women 41 black women and 30 American Indian/ Alaskan Native women die of pregnancy-related complications (Petersen et al, 2019). It is essential to use the intersectional theory to analyze these health disparities in pregnancy-related death- and the reasons why there are race-based health disparities and inequities for pregnant women in the United States. According to Lisa Bowleg, PHD, “Intersectionality is a theoretical framework that posits that multiple social categories (e.g., race, ethnicity, gender, sexual orientation, socioeconomic status) intersect at the micro level of individual experience to reflect multiple interlocking systems of privilege and oppression at the macro, social-structural level (e.g., racism, sexism, heterosexism)” (Bowleg, 2012). This essay will analyze mainly systemic and institutional racism in the United States as a major factor in why black and native women are more likely to die of pregnancy-related complications. However, educational opportunities and access to peers in positions of power in healthcare also play a role in creating and enforcing systems of oppression that lead to these disparities. As do micro-level factors such as discriminatory bias and stereotypes held by healthcare workers and agencies.
Using the Accumulation of Risk Model (Tse-Chuan, PPT 4) to look at the life circumstances and risk factors these women are exposed to, then we can begin to get an idea of why this disparity exists and how to combat it. Firstly one must consider how bias has been ingrained in US healthcare systems. All people have bias, and healthcare workers in the US are indoctrinated with incorrect ideas about black health- such as the idea that black women have a higher pain tolerance. This is because institutional and structural racism are key parts of the U.S. social structure and cause many health disparities for people of color (Hummer et al 2020). This bias and the potential for race-based violence during childbirth and prenatal health care visits is only one of the many factors impacting black women, that do not impact white women. Furthermore, black women and communities may have feelings of mistrust toward medical communities. “The medical establishment has a long history of mistreating Black Americans — from gruesome experiments on enslaved people to the forced sterilizations of Black women and the infamous Tuskegee syphilis study that withheld treatment from hundreds of Black men for decades to let doctors track the course of the disease” (Hostetter et. al 2021). In my work at the substance abuse treatment clinic in Schenectady, I heard from many people of color that they were less likely to trust medical advice or seek treatment because they feared retribution and being stereotyped or used as an example of “what is wrong with black people.” These generalizations are part of racist systems of oppression.
Socio-economic status must also be considered as an intersecting factor impacting these women. Black women in the United States consistently make less money than white women in the same jobs (CAP, 2021). They have to work harder to achieve the same level of economic success. Therefore, they are also exposed to higher levels of income-related stress. Furthermore, on top of the financial stress they are exposed to daily stress related to oppression, discrimination, and race-based violence that is imbedded in daily life in the US. Stress is unhealthy during pregnancy and so black women being exposed to more cumulative stress are already going to be at higher risk for health issues. Here we run into one final problem. Black women are less likely to hold positions of power in healthcare facilities and therefore black women lack advocates and peers to stand up for their medical rights and needs. They also lack representatives of their culture in their experience of the medical system. According to researchers from George Mason University “The mortality rate of Black newborns in hospital shrunk by between 39% and 58% when Black physicians took charge of the birth, according to the research, which laid bare how shocking racial disparities in human health can affect even the first hours of a person’s life” (Picheta, 2020). Statistics like this one show how much healthcare is impacted by the lack of adequate racially and culturally representative staff and practices.
I believe that reaching women of color in their communities and creating healthcare agencies led by black women for black women will help to begin creating safe spaces for pregnancy and birth-related care, and therefore help to alleviate some of the risks and challenges black women face that lead to higher maternal mortality. However, the structures must also change. Systemic racism creates undue stress for the black pregnant woman, setting her up to be at a disadvantage before she even steps into the inequitable healthcare system in the first place. We must begin to create an anti-racist policy that tackles systemic racism and re-writes race-based inequities in place. We must also find ways to incorporate culturally and ethnically inclusive birthing and pregnancy practices in both medical school education and health class education for young people in the United States. Creating better health outcomes starts with finding ways to level the playing field by re-working social structures that perpetuate white supremacy and oppression of minorities.
Bibliography:
Picheta, R. CNN. (2020). Black newborns more likely to die when looked after by White doctors. Retrieved from
Bowleg, L. (2012) “The Problem with the Phrase Women and Minorities: Intersectionality—an Important Theoretical Framework for Public Health” American Journal of Public Health. 102: 1267-1273.
CAP. (2021). Women of Color and The Wage Gap. Retrieved from https://www.americanprogress.org/article/women-of-color-and-the-wage-gap/
Hummer R. and E. Hamilton. (2020) Population health in America. Chapter 6 “Race, Ethnicity, Nativity and U.S. Population Health.”
Hostetter et al. (2021). Understanding and Ameliorating Medical Mistrust Among Black Americans. Retrieved from https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans
Petersen, E. Et Al. CDC. (2019) Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016. Retrieved from https://www.cdc.gov/mmwr/volumes/68/wr/mm6835a3.htm
