WASHINGTON — The problem of higher morbidity and mortality among black mothers and their infants is one that can and must be solved, several speakers said here Wednesday.
“This is one of those truths that must be spoken,” Sen. Kamala Harris (D-Calif.) said at an event sponsored by the Center for American Progress (CAP), a left-leaning think tank here. “It is a truth that black women in America are three to four times more likely to die than white women because they choose to become mothers and want to raise those children to become productive members of society.”
CAP President Neera Tanden expressed similar sentiments. “Black mothers are 243% more likely to die from pregnancy or childbirth-related complications than white mothers, while African-American infants are more than 250% more likely to die before their first birthdays compared to white children; that is unacceptable,” she said. “A high-income black woman with an advanced degree is still more likely to die or experience the death of her child than a poor white woman who hasn’t graduated from high school. Think about that… We must take immediate action to end the rampant discrimination, deprivation, and neglect currently facing black mothers.”
Diversity Often Lacking
Their comments came in the wake of House passage on Tuesday of the Preventing Maternal Deaths Act of 2017, sponsored by Rep. Jaime Herrera Beutler (R-Wash.). That bill would give grants to states to establish maternal mortality review committees that would review all maternal deaths, and to develop a plan to educate healthcare providers on ways to improve the quality of maternal care.
The bill would also require the state to use the data collected “regarding pregnancy-related and pregnancy-associated deaths to identify trends, patterns, and disparities in adverse outcomes and address medical, non-medical, and system-related factors that may have contributed to such pregnancy-related and pregnancy-associated deaths and disparities.” A companion bill in the Senate, introduced by outgoing Sen. Heidi Heitkamp (D-N.D.) was passed out of the Senate Health, Education, Labor, & Pensions Committee in June but has not been acted on by the full chamber.
The bill requires that the members of the mortality review committees be “multidisciplinary and diverse” — a characteristic that Breana Lipscomb, U.S. maternal health and human rights campaign manager at the Center for Reproductive Rights, said was often lacking.
“What I’m finding is still missing is the inclusion of black women in the conversation… I think the first step is to make sure that as we have this heightened awareness of the issue, we’re holding systems and governments accountable to make sure black women are at the center of those conversations,” she said.
“We have a record number of states that have established maternal mortality review committees, yet a lot of those committees are not diverse. You don’t have a diverse representation of providers at the table to discuss it, and you have no community representation there, so you’re only looking at a very limited focus on the clinical outcomes of that pregnancy instead of really incorporating the social contextual issues surrounding why that mom lost her life.”
In addition, the problem also needs to be considered in a historical perspective, Lipscomb said. “We can’t talk about it without thinking about the historical traumas that black women have faced, the institution of slavery and the impact that has had on the devaluing of black bodies, and the pervasive discrimination and bias that has resulted in how black women are treated in medical institutions today.”
“When you think about it, from the beginning, black women were being sold, were being used to breed property for their owners, and the structure of the black family from the start was not valued,” she said. In addition, there are the more recent examples such as the syphilis study on black men at the Tuskegee Institution and the case of Henrietta Lax, whose genetic material was used without her permission to create lines of stem cells. “We still feel that in how we receive care today.”
Lack of respect for women is also part of the problem, according to Sen. Harris. She told a story about her mother, a breast cancer researcher. “One time she came home absolutely outraged,” Harris said. “She worked in a lab where she was one of very few women, much less women of color. She was walking through the halls and there was a doctor walking around with [an uncovered] plate, and on it was a breast, because a woman had just had a mastectomy… she said, ‘I wonder, if it had been a penis, would he have been walking around that way?’ It showed a lack of understanding about the dignity of a woman’s body and the need to treat it with dignity.”
The Value of a Safe Space
Just giving women a safe space can really help, according to Jennie Joseph, a licensed midwife who practices in Winter Garden, Florida, and serves patients regardless of their ability to pay. “We’ve tried to fill gaps [in care] and found that women, once they feel they’re safe, they thrive,” Joseph said. She cited a study showing that the methods used in her practice, which includes a lot of care and counseling from mid-level providers and peers, lowered infant morbidity, low birthweight, and prematurity.
“If something as simple as ‘come in, sit down, wipe your tears’ is that effective in eradicating prematurity — a $50,000 bill per baby — I just cannot understand [why it’s not easy] to embrace open access,” she said. “We find that women are more compliant and will [disclose more] when they work with women who look like them and do not judge them… This is a matter of life and death; I don’t know what we’ve got to wait for.”
Implicit bias among healthcare providers is another issue that needs to be addressed, said Nana Matoba, MD, MPH, a neonatologist and assistant professor of pediatrics at Northwestern University in Chicago. “The fact that healthcare providers have implicit bias should be surprising, but it was completely shocking when I first realized it,” she said. “We think as healthcare providers we treat everybody equally and want to do our best for everyone… [but in] subtle and not-so-subtle ways we treat families differently, and there is evidence this leads to different baby outcomes from the NICU [neonatal intensive care unit] in terms of going home with breastfeeding, and with hospital-acquired infection rates.” The hospital has started an educational program in implicit bias for residents coming through a neonatal rotation.
“I don’t know that there’s a solution, but the first step is to be aware,” she said. “Try to form a connection with families instead of judging them as neglectful families that can’t visit the babies because of transportation, childcare, and employment issues. Try to understand what it took for them to get to the NICU that particular day.”