The Black Maternal Health Crisis

By: Kayla Robinson

The violence in healthcare suffered by Black women is only paralleled by the state-imposed violence suffered by Black men at the hands of the police.

The centuries-long dehumanization of Black individuals has worked its way into multiple systems, including the healthcare industry. A longitudinal case study conducted by Roosa Tikkanen, M.P.H (2020) found that the United States is the leading country among ten other industrialized nations in maternal mortality rates. Approximately 17.4 women die per 100,000 births. This number nearly triples for Black women at 44 deaths per 100,000 live births with data collected between 2007-2016 (Hoyert, 2019).

Figure 1. Maternal mortality rates compared across races in the United States between 2007-2016. Image from Peterson et. al 2019.

Figure 2. Maternal mortality ratios in ten industrialized countries. Image from Tikkanen et al 2020.

While alarming, this is not new information; it is simply a gap in the medical field that has been neglected in research for decades. Race-based maternal health disparities appeared as early as the origins of gynecology in 1844 through the unethical surgical experimentation on enslaved Black women without anesthesia by Dr. J. Marion Sims (Zellars 2018). Simmons justified his experimentation through popular medical myths that were based on non-scientific assumptions about Black patients. These notions included: “Black people do not feel pain” because “they have thicker skin.” These myths have become a part of his legacy, persisting in modern medical cases such as the Tuskegee syphilis trials and the nonconsensual use of Henrietta Lacks’ immortal cervical cells for polio vaccine creation (Holland, n.d.). There is an abundance of anecdotal accounts from Black mothers describing the postpartum neglect that they received, despite reporting pain which can be attributed to the lower rate at which these women are prescribed medicine for their pain (Badreldin et. al 2019). While there is not a uniform experience for Black women, all of these women experience neglect from staff when they are facing life-threatening complications. In one of these cases, Bianca Davidson was dismissed despite hemorrhaging after prematurely delivering her son. Davidson’s birthing experience was far more positive twelve years later with the addition of a doula. DONA International describes doulas as “a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible” (DONA, n.d.)This doula’s support extended outside of the delivery room, helping level socioeconomic barriers between Davidson and aiding her in receiving the postpartum care that she needed (Rab 2019).

 The causative factor for these accounts are directly correlated with J. Marion Sims’ influence, and they have been researched as recently as 2016. Researchers found that nearly 40% of M1 and M2 students at the University of Virginia School of Medicine believed at least one of the 15 held race-based implicit biases (Hoffman et al. 2016). These notions are the basis for the treatment of Black women in maternal wards across the nation. The experimentation on bodies that were considered genetically and societally inferior has contributed to pivotal points in medicine but at the cost of the humanity of Black individuals. 

The lack of systemic support in maternal matters has led to these marginalized communities pioneering grassroots activist solutions. There has been a shift in women taking control of their birthing journey through the use of at-home births and midwives, but doulas have been increasing in popularity in the Black community and may be the key to increasing birth equity in the United States. Karla Papagni, RN (2006) notes that “Doulas gained popularity during the 1980s when women became distressed at the ever-increasing rate of cesarean sections.” Doulas’ impact as birth advocates––as opposed to the medical advisor role of midwives––has been correlated with the decrease in unnecessary cesarean sections in the 1980s. Doulas uphold their duties to provide women with an ideal birthing experience (Papagni 2006). Doulas’ childbirth support was quantified in a 1997 meta-analysis where 11 childbirth trials were randomized and evaluated upon the presence or absence of a doula. The presence of a doula was correlated with higher regard for their babies, self-esteem, and happiness (Klaus et al 1997). The current body of knowledge supports the consensus that doulas improve the birth experience: shorter labor, higher APGAR scores infants, and an overall higher degree of satisfaction associated with the presence of birthing advocates in the delivery room (Sauls 2002). These positive effects have been echoed by multiple Black women across the nation in search of a better birthing experience, and it deserves the attention of researchers. The benefits of this practice are too large to remain inaccessible to the majority of women affected by this maternal mortality crisis. The Doula Medicaid Project aims to include doula services in Medicaid insurance to increase its accessibility to Black women in the United States. The bill holds different statuses across states, but the nationwide passing of this bill would be a monumental step in remedying the Black maternal health crisis.

The movement’s support stems from anecdotal accounts that compare Black women’s birthing experiences with and without the help of Doulas, like Bianca Davidson. Passing the Doula Medicaid Bill would improve the quality of women like Bianca who have experienced medical neglect as a result of implicit biases in medicine. Twenty-eight out of fifty states have proposed this bill before the legislature, and there are thirteen existing bills passed across ten states to provide insurance support for doula services. An increase in legislative support would contribute greatly to the decrease in maternal mortality in the United States, making postpartum care more accessible to low-income mothers. This would become a key component in the Black Maternal Health Crisis, giving these women the same attention as their counterparts, and the same humane treatment too.

References

About DONA International. (n.d.). DONA International. from https://www.dona.org/the-dona-advantage/about/

Badreldin, N., Grobman, W. A., & Yee, L. M. (2019). Racial Disparities in Postpartum Pain Management. Obstetrics and Gynecology, 134(6), 1147–1153. https://doi.org/10.1097/AOG.0000000000003561

Chen, A. (n.d.). Doula Medicaid Project. National Health Law Program., https://healthlaw.org/doulamedicaidproject/

Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences, 113(16), 4296–4301. https://doi.org/10.1073/pnas.1516047113

Holland, B. (n.d.). The ‘Father of Modern Gynecology’ Performed Shocking Experiments on Enslaved Women. HISTORY.  https://www.history.com/news/the-father-of-modern-gynecology-performed-shocking-experiments-on-slaves

Hoyert, D. L., & Miniño, A. M. (2020). Maternal Mortality in the United States: Changes in Coding, Publication, and Data Release, 2018. National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 69(2), 1–18.

Klaus, M. H., & Kennell, J. H. (1997). The doula: An essential ingredient of childbirth rediscovered. Acta Paediatrica (Oslo, Norway: 1992), 86(10), 1034–1036. https://doi.org/10.1111/j.1651-2227.1997.tb14800.x

Papagni, K., & Buckner, E. (2006). Doula Support and Attitudes of Intrapartum Nurses: A Qualitative Study from the Patient’s Perspective. The Journal of Perinatal Education, 15(1), 11–18. https://doi.org/10.1624/105812406X92949

Rab, L. (n.d.). The Secret to Saving the Lives of Black Mothers and Babies. POLITICO. 

https://www.politico.com/news/magazine/2019/12/15/black-mothers-matter-079532

Sauls D. J. (2002). Effects of labor support on mothers, babies, and birth outcomes. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 31(6), 733–741. 

https://doi.org/10.1177/0884217502239209

Tikkanen, R., Gunja, M., Fitzgerald, M., & Zephyrin, L. (2020). Maternal Mortality Maternity Care US Compared 10 Other Countries | Commonwealth Fund. The Commonwealth Fund. https://doi.org/10.26099/411v-9255

Zellars, R. (2018, May 31). Black Subjectivity and the Origins of American Gynecology | AAIHS.https://www.aaihs.org/black-subjectivity-and-the-origins-of-american-gynecology/

Images

Tikkanen, R., Gunja, M., Fitzgerald, M., & Zephyrin, L. (2020). Maternal Mortality Maternity Care US Compared 10 Other Countries | Commonwealth Fund. The Commonwealth Fund. https://doi.org/10.26099/411v-9255