By Andrea King Collier
Black women in the United States suffer from maternal mortality that is 30% to 40% higher than that of their white counterparts, according to the federal Centers for Disease Control and Prevention. CDC data show that overall, women living in this country are more likely to die during childbirth or of complications from childbirth that other women in the developed world. The CDC definition of maternal mortality is death during pregnancy or 42 days after delivery, due to health complications.
Many health journalists who cover health disparities and women’s health issues have covered disparities in infant mortality, yet we don’t often do a deep dive into what happens to the survival of women of color during pregnancy, delivery and the year after giving birth.
It is important to note that maternal deaths are not common. There are around 700 maternal deaths out of 3.8 million live births. Approximately 13 white women die each year for every 100,000 live births. For Latinx women that number drops to 11.4. Yet the number jumps for black women to 42.8 for every 100,000 live births. Experts agree that 60% are preventable.
Legislators have taken notice through a focus on health policy, and health insurers and employers are taking steps to change payment models. All are taking steps to improve outcomes for all women.
High-profile cases
Sometimes it takes just one high-profile story to cast a new light.
Vogue magazine ran a revealing essay in 2018 from tennis superstar Serena Williams who nearly died of a pulmonary embolism (blood clots) in her lung and later from an abdominal hematoma (bruising). Williams has suffered from life-threatening pulmonary embolisms throughout her career and says she told her medical team that something wasn’t right but they didn’t believe her.
The Root.com covered the high profile maternal death of Kira Johnson, M.D., daughter-in-law of television personality Judge Glenda Hatchett. Johnson died after delivery from an untreated hemorrhage. Both stories are significant because they put the disparities in maternal death in the national spotlight and they belied the narrative – that this only happens to poor, obese women who cannot get access to care.
Linda Goler Blount, the President and CEO of the Black Women’s Health Imperative says, “educated, highly paid professional black women have maternal mortality rates worse than white women with less than an eighth-grade education.” She and many researchers and advocates believe that there is a “causal relationship between experiences of racial and gender discrimination and maternal mortality,” that goes beyond lack of access and economic factors.
NPR cast a spotlight on disparities in maternal mortality in its Shots series. In “Why Racial Gaps in Maternal Mortality Persist,” reporter Patti Neighmond says the CDC’s principal deputy director, Anne Schuchat, M.D., notes that every death reflects a web of lost opportunities including lack of access to health care, missed or delayed diagnoses, and failures by doctors or nurses to recognize warning signs. Women who died during childbirth itself typically suffered severe bleeding or an amniotic fluid embolism. After delivery, high blood pressure or infection are the leading causes and in the year after, hypertension, stroke or a weak heart muscle condition called cardiomyopathy.
“We are missing opportunities to identify risk factors prior to pregnancy, and there are often delays in recognizing symptoms during pregnancy and postpartum, particularly for black women,” Lisa Hollier, M.D., immediate past president of the American College of Obstetricians and Gynecologists, said in a statement.
In 2018, Linda Villarosa’s feature for The New York Times, “Why America’s Black Mothers and Babies are Facing a Life or Death Crisis,” follows the journey of a black woman who had complications in delivery that put her in a life-or-death fight. Her child did not survive. But the story also chronicles the challenges that women face in coming out of the birth process healthy and whole. Villarosa reports that “recently there has been growing acceptance of what has largely been, for the medical establishment, a shocking idea: For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions – including hypertension and pre-eclampsia – that lead directly to higher rates of infant and maternal death.”
Follow the laws and policies
The awareness of the disparities in pregnancy-related deaths for black women is bringing about change at the policy and legislative levels.
In 2018, the Preventing Maternal Deaths Act (HR 1318) was signed into law. It provides funding to states that investigate pregnancy-related deaths, including deaths occurring up to a year after birth. The Health Affairs team broke down the law and what the laws calls the state Maternal Mortality Review Committees (MMRC).
For journalists seeking insight into what is happening at the local and state levels, the MMRCs are a good place to start. A total of 46 states and the District of Columbia require some level of maternal death review, a steady increase from the 22 committees that existed in 2010.
For those looking for angles into maternal mortality among black women, consider looking into these topics:
- The links between stress, pregnancy outcomes and maternal mortality
- The role of midwives, doulas and community health workers in maternal care. Look at what initiatives in your communities are focusing on supporting pregnant women.
- What local and regional health systems are doing to improve access to clinical prenatal care for women in underserved communities.
- The links between access to sexual and reproductive health programs and maternal mortality.
- The phenomena of what medical experts call the “near miss,” which is when a woman suffers a medical incident such as a hemorrhage which could have resulted in death, but didn’t, as in the case of Serena Williams.
- What advocacy organizations are doing to create awareness and supports for black women during pregnancy and beyond.
Another way to cover maternal mortality is to focus on payment reform, as writers for the Health Affairs blog explained in July. The authors of an article, “To Help Fix The Maternal Health Crisis, Look To Value-Based Payment,” were Clare Pierce-Wrobel and Katie Green of the Health Care Transformation Task Force. They explained that the current payment structure is flawed because it does not cover high-value services adequately, does not hold providers accountable for overall cost and outcomes, and does not encourage coordination among providers. Instead, the health care system should use value-based payment models that would replace fee-for-service payment. Value-based payment would pay different rates for high-value versus low-value care, would link reimbursement to maternal outcomes and the total cost of care and would cover payments for mother and newborn that link reimbursement for both maternal and infant quality outcomes and total cost.
In July, the task force released a report that outlined many of the same ideas that Pierce-Wrobel and Green promoted in Health Affairs. In the report, “Expanding Access to Outcomes-Driven Maternity Care through Value-Based Payment,” the task force explained how changing how health insurers pay for maternity care would work in practice. Despite clear evidence about what works, efforts to transform maternity care payments have remained sluggish, the report added.
Here are other reports on how payment reform could reduce maternal mortality:
- The Rising U.S. Maternal Mortality Rate Demands Action from Employers, an article published in the Harvard Business Review in June.
- Medicaid Payment Initiatives to Improve Maternal and Birth Outcomes from the Medicaid and CHIP Payment and Access Commission.
- New Payment Models for Improving Maternal and Infant Health and Health Care (from the Network for Excellence in Health Innovation.
Andrea King Collier is an author and freelance journalist in Lansing, Mich., who writes about family and health care issues including illness prevention, women’s health and end-of-life issues.
