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Maternal and Infant Health Disparities

Strategies for Reduction

By Ruth Richardson, JD and Alice Mann, MD, MPH

The committee’s first order of business was a focus on the persistent and unacceptable racial disparities in maternal and infant mortality and morbidity.

The data is disturbing

The United States has the highest maternal and infant mortality rate among comparable countries. A deeper look at the disturbing data uncovers a preventable public health crisis with profound racial disparities.

Black and Indigenous infants are twice as likely to die before their first birthday than White infants. The disparity between infant mortality rates for Black and White babies today is larger than the gap experienced under chattel slavery. However, when Black newborns are cared for by Black physicians, they are less likely to die in hospital settings and the excess mortality rate is cut almost in half.

Nationally, U.S.-born Black women have the worst maternal mortality and morbidity outcomes of any racial group; they are 3-4 times more likely to experience a pregnancy-related death than White women. Even when controlling for familial status, education, general nutrition, overall health, substance use disorder status, income, insurance and housing status, these stark disparities remain. The heartbreaking reality is that Black women are more likely to experience a preventable maternal death. The fact that 60 percent of the deaths are estimated to be preventable means that we can and must do better.

Wayside Recovery Center understands that the maternal and infant mortality crisis cannot be adequately addressed without understanding and dismantling racism and bias in our medical and behavioral health systems. We also understand that the complexities of the crisis require community-based responses and not only addressing the stigma associated with substance use disorders and mental illness but also recognizing the inequities and inequalities that persist across the behavioral health system.

Black and Indigenous infants are twice as likely to die before their first birthday than White infants.

Seen and not heard

The recent near-death experience of tennis star Serena Williams drew much-needed attention to the medical disparities Black women have experienced for decades. Williams made national news recounting her ordeal, which began when she found herself gasping for air after an emergency c-section. She had a history of blood clots and pulmonary embolism, but had stopped her regimen of anticoagulants in preparation for the surgery. Williams immediately recognized the symptoms of another embolism. She walked out of her hospital room to find the nearest nurse, and between gasps told her that she needed a CT scan and IV heparin right away. The nurse disregarded her request for medical attention, believing that she was confused from her medications. Eventually a doctor performed an ultrasound of her legs, which revealed nothing. When doctors finally complied with her repeated requests for a CT scan, they discovered several blood clots in her lungs and immediately began treatment. The delay in addressing her embolism and intense coughing led to a rip in her c-section wound. What followed was an emergency surgery, the discovery of an additional hematoma and a 6-day medical crisis. When Williams finally returned home, she needed six weeks of bed rest.

For every Serena Williams, there are countless stories of Black women that you do not hear about, the “hidden figures.” Women like Amber Rose Isaac, who pleaded for help from her maternal healthcare providers before her death. On April 17, 2020, Isaac tweeted that she should write a “tell all” about the incompetence of her medical team. Less than four days later, she was pronounced dead after a c-section that went wrong. Because her partner was not allowed into the hospital during the pandemic, she died alone. Isaac suffered from a treatable complication called HELLP syndrome. This condition typically proves fatal for only a small number of women who go without treatment. Her surviving family members describe a pregnancy riddled with neglect by rude and unprofessional staff that ignored her cries for help even as she repeatedly reached out to them in her last weeks.

Shalon Irving, a Lieutenant Commander in the U.S. Public Health Commissioned Corps and an epidemiologist at the Centers for Disease Control who had dedicated her career to eliminating health inequities, died 3 weeks after childbirth from complications of high blood pressure. After discharge, Irving had made visit after visit to her primary care providers because she knew something was wrong. First for a painful hematoma at her c-section incision site, then for spiking blood pressure, headaches, bladder issues, blurred vision, swelling legs and rapid weight gain. Doctors repeatedly assured her that the symptoms were normal. Hours after her last medical appointment, she collapsed. One week later she was removed from life support.

Twenty-six-year-old Sha-Asia Washington died during childbirth last July. Washington reported difficulty breathing shortly after receiving epidural anesthesia and other sedatives. Her cries for help went unheard, and providers did not appropriately administer oxygen. Washington went into cardiac arrest while doctors delivered her daughter Khloe via c-section. She was pronounced dead after doctors spent 45 minutes trying to revive her.

About 700 women die of pregnancy-related complications each year in the U.S., and the largest share are Black women. What these four stories – along with a growing body of academic research – tell us is that there is currently no protective factor against structural racism in the medical field. Advanced education, good nutrition, overall good health, stable housing, access to prenatal care, great personal wealth – none of it changes the risk for adverse outcomes if you are Black.

There is something deeply wrong with a healthcare system that fails to value Black women’s lives and voices equally to White women. The common thread in this deadly epidemic is a Black woman expressing concern, and her clinicians either disbelieving or delaying response. Not only is there a troubling pattern of Black women’s birthing concerns being dismissed, but traumatic birthing experiences are so common that one-quarter of Black women report disrespect and abuse from medical professionals in the hospital. At Wayside Recovery Center, we have heard too many stories of such mistreatment and the traumatic birthing experiences that have resulted in patients leaving the hospital early at great risk to escape such treatment.

We have the ability to change that reality.

It is possible to reduce these unacceptable disparities.

A long, foundational history of racism in the healthcare system

The disparities in maternal infant health in Minnesota and across the nation are the predictable outcomes of a healthcare system working just the way it was designed to work. There is a dark history associated with the origins of OB-GYN care in this country, and the legacy of that mistreatment continues down to the present day. The “father of modern gynecology,” J. Marion Sims, contributed revolutionary tools and techniques to the medical field. Many of Sims’ discoveries were made through horrific, painful experimentation on enslaved Black women without the use of anesthesia. Today these women are unknown and unnamed except for Anarcha, Betsey, and Lucy. Anarcha Westcott endured at least 30 procedures in the last 1800s. Sims’ decision not to use anesthesia on enslaved women was based in the racist belief that Black people do not feel pain in the same way as White people. Anarcha, Betsey, Lucy and the other unnamed enslaved women were not extended the same care, treatment or anesthesia of Sims’ White female patients.

These misguided beliefs and misconceptions about how Black people experience pain persist into the present day. Black patients receive less pain medication than White patients across age ranges and conditions. Disturbing beliefs that Black people’s nerve endings are less sensitive or that their skin is thicker is not a relic of the past. They are notions still held by some medical students, residents, and doctors today. The abuse of enslaved bodies as medical test subjects is just one example of a historical legacy of medical apartheid that also includes the atrocities of the Tuskegee Experiment and the exploitation of Henrietta Lacks. A long history of medical atrocities towards Black and Brown people in America contributes to the lingering distrust of a healthcare system that has not consistently recognized the humanity and value of Black lives. But it is important to note that our healthcare system also has a deeply embedded distrust of the Black community as well. That distrust becomes clear with the stark disparities in maternal healthcare where the voices of Black women are being ignored and dismissed with deadly consequences.