Why Pregnancy Related Deaths In Missouri Are Four Times Higher For Black Mothers Than White Mothers
Bias in healthcare is a contributing factor in Black maternal mortality numbers, say leaders of organizations trying to reduce those statistics.
Daysha Lewis knew things were going wrong with her pregnancy. Still, she thought, “these are professionals. They must know what they’re doing.” So she followed the direction of her nurses and doctors.
But after the baby came the real harm. Lewis had what’s called a postpartum hemorrhage — serious bleeding after birth.
“I got up, went to the bathroom, and I just passed out,” Lewis said on Up To Date.
Lewis is one of many Black women in Missouri who have experienced dangerous pregnancies. According to a report from the Missouri Department of Health and Senior Services, Black women in Missouri died during pregnancy, or within one year of pregnancy, at four times the rate of white women in 2018. Infant mortality rates are higher for Black pregnancies as well.
One reason for this is racism inherent in medical spaces, said Hakima Payne, executive director of the nonprofit Uzazi Village, which works to increase maternal and infant health for Black and Brown communities. Uzazi Village employs doulas who offer psychosocial support and advocate for Black mothers in medical environments.
“Those biases carry into healthcare,” Payne said. “There’s nothing special about healthcare that keeps it from manifesting the bias that exists in our society in general.”
Nursing is a primarily white and middle class profession, she said, adding that Black mothers are often disbelieved by nurses because of racist assumptions that Black women are less educated or feel less pain.
“Medical schools, nursing schools, still teach racial differences that are false and based in unsubstantiated, biased beliefs,” Payne said. “You can still find textbooks that say things like, ‘African Americans have thicker skin, therefore their perception of pain is muted.’”
During her pregnancy, Lewis said, she also felt she wasn’t being taken seriously. Despite her protestations and her doctor’s advice, her delivery team decided to induce labor. She said the whole experience was “unnerving” and she felt “lots of confusion.”
Reporting from ProPublica shows postpartum hemorrhages like the one Lewis experienced are responsible for more life-threatening pregnancies than any other complication. Black women also disproportionately suffer these complications.
Payne said Lewis’ induced labor is a common experience for the mothers she’s spoken with.
“It’s very routine for me to hear from women who don’t know why they were induced, who don’t know why they had a C-section. A major abdominal surgery, and they don’t know why they had it,” Payne said.
According to Tracy Russell, executive director at Nurture KC, two-thirds of maternal deaths in the United States are preventable. Nurture KC connects health workers to mothers living in the 14 Kansas City ZIP codes with the highest pregnancy mortality rates.
The 2018 Missouri study found that 82% of pregnancy related deaths in Missouri are preventable, meaning there was at least some chance the death could have been averted if something had been done differently in the facility, the system, the provider or the community.
Some of the leading causes of preventable deaths in 2018 were substance abuse disorders, failure to properly assess the patient and a lack of adherence to protocol.
The Missouri DHSS recommended these deaths could be avoided through regular postpartum visits and childcare education, among other things. Through well visits after pregnancy and holistic services (such as providing food, diapers and car seats), Nurture KC hopes to avoid some of the most preventable pregnancy related deaths.
Russell said their outcomes defy the odds, though her organization is only able to serve 700 mothers per year.
“It’s not enough,” Russell said.
Payne said having more Black providers in the healthcare system will help build trust and lead to more culturally competent healthcare, though even Black clinicians are socialized in a racist system.
“Healthcare systems really need a major overhaul to adequately meet the needs of Black families today,” Payne said.
Better understanding of the actual reality of maternal mortality would also help, Payne said. She and Russell said state agencies need to publish better statistics, which Russell said are currently “fragmented.” Payne said statistics around maternal death are not often broken down by race, which could “hide” the deaths of Black women in the aggregate data.
Russell said another way to lower Black maternal mortality rates would be to expand Medicaid. She said some Missourians opposed expanding Medicaid for fear of covering certain contraceptives, though some Medicaid benefits, such as postpartum care, are crucial to preventing maternal deaths.