The Dismal State of Maternal Wholistic Health for Women of Color

This article was originally published in Ellen's Interprofessional Insights, and appears with permission

April 11-17^th marks annual Black Maternal Health Week. There will most likely be a flurry of well-intended articles, blog posts and announcements focused on legislation, funding of initiatives and programs, and advocacy. But here’s the lowdown: Black mothers have had higher mortality than White mothers for well over 100 years. They are > 3X more likely to die from pregnancy-related complications and 2X as likely to suffer from mental health issues than their White counterparts. The impact of historical, intergenerational, medical, racial trauma is invasive and enduring. Change is long overdue for this massive maternal health chasm of wholistic health disparities, transcending physical, behavioral, and psychosocial health, and particularly for women of color (WOC)

The recent Commonwealth Fund report on women’s reproductive health reveals how severe the issue remains:

• U.S. women have the highest rate of maternal deaths among high-income countries. The current maternal mortality ratio of 17.4 per 100,000 pregnancies, equals roughly 660 maternal deaths. This earns the U.S. last place standing overall among all industrialized countries.
• A woman’s chance of dying in southern states is 2X greater than those in the north:
  • Alabama, Arkansas, Kentucky, and Oklahoma report death ratios of greater than 30:100,000 live births
  • California, Illinois, Ohio, and Pennsylvania reported death ratios less than half the figures in those states, <15 deaths: 100,000 live births

Data for WOC is beyond alarming:

• The maternal death ratio for Black women is 37.1:100,000 pregnancies. The number is 2.5X the ratio for white women (14.7) and three times the ratio for Hispanic women (11.8).
• Hispanic mothers were 80% as likely to receive late or no prenatal care as compared to non-Hispanic white mothers.
• A Black mother with a college education is at 60% greater risk for a maternal death than a White or Hispanic woman with less than a high school education.
• Even when WOC verbalize health and mental health concerns to providers, their voice is disregarded:
  • WOC are more likely than White women to express their concerns and preferences regarding births though more frequently ignored
  • Pain management is dismissed, minimized, or totally ignored
  • Women with Medicaid report inadequate postpartum care and support, where they are:
    • Pressured to have C-sections
    • Not scheduled for postpartum visits
    • Disrespected by providers due to insurance
• Pregnancy-related mortality rates vary across ethnic groups, yet show a constant disturbing trend:
  • Black (40.8%), American Indian/Alaska Native (29.7%), Asian Pacific Islander (13.5%), and Hispanic (11.5%) compared to Whites (12.7%).
  • Upwards of 60% of these deaths are preventable. A CDC report, reveals the often avoidable causes:
    • Infection (13%)
    • Postpartum bleeding (11%)
    • Cardiovascular conditions such as Cardiomyopathy (11%),
    • Blood clots (9%),
    • High blood pressure (8%),
    • Stroke (7%), and a category combining other cardiac conditions (15%).

Maternal Mental Health Awareness Week is scheduled annually for the first week in May, though bears mention. Not treating maternal mental health conditionscosts $32,000 per mother-infant pair, totaling $14.2 billion nationally

• Black women are twice as likely as Whites to suffer from perinatal mood and anxiety disorders, and less likely to receive treatment: 40% compared to 20-25%
• Indigenous women have a higher incidence of depression, anxiety, and substance misuse during the perinatal period from 17-47%; Indigenous identity increased the likelihood by 62%
• Migrant WOC are at greater risk for behavioral health issues during pregnancies (e.g., depression, schizophrenia, post-traumatic stress) from the interaction of psychosocial determinants as forced migration plus generalized insecurity associated with experiences as refugees, asylum seekers, and human trafficking victims

Endless data validates WOC’s maternal health mandates. Recent years have witnessed robust action courtesy of fierce voices and tireless work of many entities in the US and around the globe. Their agendas serve as a clearinghouse of efforts. The list below is a starting point of resources:

• Black Mamas Matter Alliance
• Equitable Maternal Health Coalition
• Every Mother Counts
• Homeless Prenatal Program
• National Birth Equity Collaborative
• Sista Midwife Productions and the Sista Midwife Directory
• Mama Glow.
• Maternal Mental Health Alliance (UK)
• Maternal Mental Health Leadership Alliance (US)
• Moms Rising
• Perinatal Mental Health Alliance for Women of Color
• The Black Maternal Health Caucus
• The Blavatnik Family Women’s Health Research Institute
• The Shades of Blue Project
• Sésé Doula Services

The “honorary” annual week is valued, but a wholistic health crisis of this magnitude mandates far more than 7 days of attention. Distinct legislation, dedicated and substantial funding at federal, state and local levels is vital. Yet, these efforts are for naught unless the systemic racism and implicit bias that perpetuate this reality are equally addressed. We must:

• Identify, call out, and dismantle systemic racism across macro, meso, and micro spaces
• Develop and implement population-inclusive clinical predictive analytics and algorithms
• Ensure dedicated quality metrics that report the necessary outcomes to drive clinical programming, treatment, and concordant practices
• Shift the academic curriculum to better prepare the interprofessional workforce to provide population-specific care without bias
• Continue to advance the concordant provider-base
• Expand ethnic, racial, and cultural programming, such as reimbursement of community-based Doulas, especially in medically underserved areas.
• Expand access to fertility treatments and address racial disparities in outcomes for IVF. Black women are more likely to have infertility compared to other races, yet the access to treatment is minimal

Data has long validated this epidemic’s emergent state, which has continued to escalate. Maternal wholistic health is a public health emergency of the highest priority. This article is just the tip of the iceberg. I invite those in this care space to post additional resources and information.