We Can Save the Lives of Black and Indigenous Mothers
Assessing the High Maternal Mortality Rate within the United States and Methods for Addressing the Inequities
Photo Credit | Robin Eisenberg
Most generations make some progress. However, advancement is not guaranteed. Transformation takes recognition of society’s problems, surmising the best techniques for enacting structural change and committing to fixing them. For marginalized groups of people, the need for change is urgent. Stagnation only allows inequalities to fester, breeding contempt and disunity.
For women, giving birth is one of the most celebrated joys. However, in America, even that is not without inequities. Every group of women does not experience pregnancy and childbirth in the same way, with the same level of care, support, and dignity. Black and Indigenous women die from childbirth at an alarming rate.
“African-American, Native American and Alaska Native women die of pregnancy-related causes at a rate about three times higher than those of white women, the Centers for Disease Control and Prevention reported “(Rabin, 2019)
While the sheer number of deaths is appalling, the more poignant issue is that Doctors and medical specialists could prevent many of these maternity-related deaths. The disproportional number of fatalities suffered by Black and Indigenous women demonstrates the gravity of the problem. It highlights an American healthcare system that provides better care for white people across the board.
Every group of women does not experience pregnancy and childbirth in the same way, with the same level of care, support, and dignity. Black and Indigenous women die from childbirth at an alarming rate.
While most people would agree that change in the system is necessary, historically, there has been little appetite politically and within the medical community to make this a reality.
“The racial disparity has persisted, even grown, for years despite frequent calls to improve access to medical care for women of color” (Rabin, 2019).
It is time to evaluate the inequities that make childbearing more dangerous for women of color, assess the impact it has on families and communities, and make it a priority to remedy.
Access to Healthcare is Not Equal
Although America prides itself on being a powerful and prosperous country, many people fall through a fragmented healthcare system. Some Americans receive healthcare insurance through their employers or the Affordable Care Act, while others acquire it through the private market or Medicare (a government-subsidized plan). This swiss cheese approach does not provide healthcare to all people.
The number of uninsured Americans is on a steady four-year rise. As of 2018, before the pandemic, 13.7% of American adults were uninsured. The number of uninsured Americans is rising even higher since the onset of the virus. This increase is the direct result of people relying on their employer-based health insurance. With many Americans out of work, they lack the same level of access to care. While it is true that all Americans are facing a health care crisis, Black and Indigenous people were always at a disadvantage. The federal government even acknowledges systematic racism within the healthcare system.
“Racial and ethnic minorities face challenges in having access to medical care in the United States. When they receive it, their care may not be equivalent to that for other groups” (Bulatao, 1970).
Healthcare is a controversial issue in America since the two major political parties view the healthcare crisis using different ideologies. While some argue that healthcare should only be a product on the private market, others fight for a public option or Universal Healthcare implementation. While lively discourse is essential in a democracy, Americans should not choose an option that further marginalizes communities of color, locking them out of the healthcare system. In an inequitable healthcare system, Black and Indigenous mothers will continue to die disproportionately.
Having healthcare is not the holy grail. Even citizens with health insurance report high deductibles, prescription costs, and premiums. Many Americans left with no alternative options, dive deep into their pockets to pay for procedures not covered by their healthcare plans.
“More than one-third of women in the U.S. report skipping needed medical care because of costs, a far higher rate than the other countries included in the study” (Gunja, 2018)
If the healthcare system’s point is to keep people healthy, the high cost is counterproductive since its high price deters people from promptly seeking medical attention. Doctors recommend that expectant mothers make routine checkups. Women without substantial healthcare policies will be more likely to skip visits.
Percentage of uninsured Americans by ethnicity | Statista
In the first half of 2019, over 27 percent of the Hispanic population in the United States didn't have health…
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“U.S. women are less likely to rate their quality of care as excellent or very good compared to women in all other countries studied” (Gunja, 2018
While pointing out these inequities within the system is essential, it is also significant to note that white women also suffer from the American healthcare system’s ineptitude. So, this is an all-hands-on-deck call to action. Across the board, women are not satisfied with the care they receive by American health care providers, and inequities exacerbate the deaths in Black and indigenous women.
While maternal mortality is a global issue, most developed nations have addressed the problem more effectively. The United States lags behind its counterparts; this is not a new phenomenon.
“The United States has an abysmal record on maternal health, compared with other high-income countries. Even as maternal death rates fell by more than one-third from 2000 to 2015 across the world, outcomes for American mothers worsened, according to Unicef” (Rabin, 2019)
As Americans, the health and welfare of mothers should be a top priority. Within any prosperous society, mothers should have access to preventative healthcare. This investment in their healthcare will ensure that mothers receive equal access to care. While it is true that maternal mortality rates are impacted by the mothers’ inaccessibility to healthcare, providing healthcare to every American would not in of itself solve the problem because systematic racism creates inequities in quality of care.
Preventative Measures
The great news is that Americans can save the lives of many Black and Indigenous moms. While these moms do face unique health challenges, many doctors and healthcare providers want to change the system. This group of providers understands how to address the disparity.
“Sixty percent of all pregnancy-related deaths can be prevented with better health care, communication and support, as well as access to stable housing and transportation, the researchers concluded” (Rabin, 2019)
The research lays forward a path for Americans. Expecting mothers need consistent care and access to communicate with healthcare providers. Whether state or federal, the government must prioritize ensuring that mothers who face housing insecurity are housed and provided transportation to their doctor’s appointments.
While some Americans may be hesitant to invest in confronting the high maternal mortality rate, they should consider the alternative. The United States is losing money under the current system. These women are still receiving care, but the cost of care is exasperated because they do not receive consistent, preventative care.
“Each year an estimated 12001 women in the USA suffer complications during pregnancy or childbirth that prove fatal and 60 0003 suffer complications that are near-fatal — even though costs of maternity care in the USA in 2012 exceeded 60 billion United States dollars” (Agrawal, 2015).
Considerations As We Advance
Black and Indigenous mothers matter. The fact these moms die at approximately three times the rate as white women should send alarm bells in every American’s ear. While giving birth is no walk in the park, modern technological and medical advances significantly decreased maternal mortality in the twenty-first century. The problem is the inequitable application of these life-saving techniques.
“A new federal law, the Preventing Maternal Deaths Act, provides grants to states that investigate pregnancy-related deaths, including deaths occurring up to a year after the birth. The American College of Obstetricians and Gynecologists this week released new guidelines for treating heart disease during pregnancy” (Rabin, 2019)
While this law demonstrates progress on the issue, these federal grants are only one step in the right direction. This law encourages health care providers to study maternal mortality and, hopefully, decrease the number of fatalities. The successful implementation of this law depends on recommendations made in response to the studies conducted. However, inequities will continue to exist as long as implicit bias impacts the quality of care received. Women’s health advocates continue to fight to increase accessibility to health care for Black and Indigenous women. Acknowledging the problem is a healthy start but to save lives, the advocates must continue to push direct methods for addressing these inequities.
“To address the broad clinical and policy challenges that render U.S. mothers at growing risk of maternal mortality, and to specifically address the structural inequities that put black, indigenous, and rural families at disproportionate risk, further legislation is needed. For example, in August 2018, Sen. Kamala Harris (D-CA) introduced The Maternal Care Access and Reducing Emergencies (CARE) Act, which focuses squarely on dismantling structural racism by creating training programs to address implicit biasamong clinicians and encouraging integrated health care services that honor the strength of culture and support pregnant women with evidence-based care” (Chapple-McGruder, Mendez, Hernandez, & Kozhimannil, 2019)
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References:
Agrawal, P. (2015, May 20). Maternal mortality and morbidity in the United States of America. Retrieved August 21, 2020, from https://www.who.int/bulletin/volumes/93/3/14-148627/en/
Bulatao, R. (1970, January 01). Health Care. Retrieved August 21, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK24693/
Chapple-McGruder, T., Mendez, D. D., Hernandez, E., & Kozhimannil, K. B. (2019, February 04). Beyond The Preventing Maternal Deaths Act: Implementation And Further Policy Change. Retrieved August 21, 2020, from https://www.healthaffairs.org/do/10.1377/hblog20190130.914004/full/
Gunja, M. (2018, December 19). What Is the Status of Women’s Health and Health Care in the U.S. Compared to Ten Other Countries?: Commonwealth Fund. Retrieved August 21, 2020, from https://www.commonwealthfund.org/publications/issue-briefs/2018/dec/womens-health-us-compared-ten-other-countries
Rabin, R. (2019, May 07). Huge Racial Disparities Found in Deaths Linked to Pregnancy. Retrieved August 21, 2020, from https://www.nytimes.com/2019/05/07/health/pregnancy-deaths-.html