Each year in the U.S., hundreds of women die either during pregnancy or in the year after, while thousands more suffer unexpected outcomes of labor and delivery that result in serious health consequences – some short-term and others that continue for years.
But as the Centers for Disease Control emphasize, because more than 80% of pregnancy-related deaths in the U.S. are preventable, every pregnancy-related death is tragic.
Among the CDC’s recommendations to reduce many pregnancy-related deaths: recognizing urgent maternal warning signs; providing timely treatment; and delivering respectful, quality care.
Global view poses poorly for U.S.
According to the World Health Organization, in 2020, approximately 800 women died from preventable causes related to pregnancy and childbirth – meaning that a woman died around every two minutes.
Now, as nations across the globe continue to recover from the COVID pandemic, maternal mortality rates worldwide have dropped by almost 44% over the last 15 years, according to a new report released July 12 by the United Nations.
The report, published by the United Nations, UN News, global perspective human stories, indicates maternal deaths around the world dropped from about 532,000 in 1990, to an estimated 303,000 this year (http://news.un.org). But in the same United Nations report, the gap between those who live and those who die is especially wide in the world’s richest nation: the United States.
It further determined that Black women in the Americas remain subject to a heavier burden of maternal mortality than their peers.
The UNFPA, UNICEF, UN-Women, PAHO and NBEC Maternal Health Analysis of Women and Girls of African Descent in the Americas (https://www.unfpa.org/publications/maternal-health-analysis-women-and-girls-african-descent-americas) brings together for the first time, comparative data across the Americas on the situation of Afro-descendant women’s maternal health. It finds that Afro-descendant women and girls are disadvantaged before, during and after pregnancy.
Between 2016 and 2020, maternal death rates increased 15% in Latin America and the Caribbean, and by 17% in North America, according to the report from the U.N Population Fund – the United Nations’ sexual and reproductive health agency. And while the U.S. had the lowest overall maternal mortality rate among four nations that publish data by race – Brazil, Columbia, Suriname, and the U.S. – the report said Black women and girls were three times more likely than their peers in the U.S. to die while giving birth or in the six weeks afterward.
But why are African American women three times more likely to die from a pregnancy-related cause than white women?
The CDC points to a variety of factors that account for the disparities: quality healthcare, underlying chronic conditions, structural racism, and implicit bias. Simply stated, maternal mortality is on the rise in the U.S. and it disproportionately affects Black women.
A disturbing view of the numbers in New Jersey
Closer to home, here in the Garden State, the Network for Public Health currently ranks New Jersey 47th in the U.S. for its high maternal infant mortality rate, with 46.5 fatalities per 100,000 live births while the state’s Black maternal and infant mortality rates among the worst disparities in the U.S.
In response, the New Jersey Legislature continues to consider a bill in the 2022-23 session that would serve as a statewide resolution, declaring racism as a public health crisis in the State. But the data seems to suggest that far more than a declaration will be required to effectively reduce the disparities.
Consider the following facts related to Black women as reported by and last updated in March 2023 in The Network for Public Health Law’s Maternal Health Fact Sheet.
In New Jersey, a Black infant is more than three times more likely than a white infant to die before their first birthday.
Black women die from pregnancy-related causes at 7.6 times the rate of white women.
Black women in New Jersey experience preterm births at a rate of nearly 14% compared to white women whose preterm birth rates were closer to 8% in 2019.
As of 2019, Black infants (13%) were more than twice as likely to have a low birth weight compared to white infants (6%).
Approximately 61% of Black women in New Jersey receive early and consistent prenatal care compared to 83% of white women.
Finally, and for some, most disturbing, Black women in New Jersey reported that health care providers failed to listen to their pregnancy-related needs and concerns.
Tragic statistics based on real life-or-death situations
Two cases of high-profile African American women illustrate how the maternal mortality crisis continues to disproportionately affect the Black community, despite their access to health care and financial resources.
In June, three-time Olympic medalist, Tori Bowie, 32, died from complications of childbirth. Bowie was found dead in bed while eight months pregnant. The Orange County Medical Examiner’s Office in Florida, which determined the manner of her death as “natural,” confirmed she had been in labor. Unconfirmed reports suggest that she experienced complications including respiratory distress and eclampsia which is related to high blood pressure during pregnancy.
Tragically, three of the four women on Bowie’s 4×100 relay team nearly died or did die in childbirth.
In comments to Time magazine, Allyson Felix, one of the members of the relay team and the most decorated American and woman in Olympic track and field history, said, “We’re dealing with a Black maternal health crisis. Here you have three Olympic champions and we’re still at risk.” She demanded that the medical community “do its part.”
Tennis superstar Serena Williams, 41, in her book “Arrival Stories: Women Share Their Experiences of Becoming Mothers,” described the life-threatening complications she faced during childbirth in September 2017, while undergoing an emergency cesarean section.
In her own words, she said, “Giving birth to my baby, it turned out, was a test for how loud and how often I would have to call out before I was finally heard … No one was really listening to what I was saying.”
After her C-section, she required three surgeries due to complications that included an embolism (clot) in one of her arteries, and a hematoma, a collection of blood, in her abdomen.
Considering the reasons behind the disparities
One reason for the disparity is that more Black women of childbearing age have chronic diseases, such as high blood pressure and diabetes, which increase the risk of pregnancy-related complications like preeclampsia and possibly the need for emergency C-sections, according to the Centers for Disease Control and Prevention.
But there are socioeconomic circumstances and structural inequities that put Black women at greater risk for those chronic conditions. And Black women often have inadequate access to care throughout pregnancy, which can further complicate their conditions, according to a 2013 study published in the American Journal of Obstetrics and Gynecology.
In 2021, when the Biden administration issued a “nationwide call to action” on the maternal health crisis in the U.S., Vice President Kamala Harris called the “systemic inequities” that affect pregnant people of color a “matter of life and death.”
“Regardless of income level, regardless of education level, Black women, Native women, women who live in rural areas, are more likely to die or be left scared or scarred from an experience that should be safe and should be a joyful one,” Harris said. “And we know a primary reason why this is true – systemic inequities, those differences in how people are treated based on who they are, and they create significant disparities in our health care system.”
However, the team of health advocates responsible for the Network for Public Health report offered several recommendations including: learn the issues and risks that women face like the availability of clinical care, access to treatment before and after birth, the effects of structural racism, and social determinants of health to achieve complete equity; become an advocate while declaring in New Jersey that racism is a public health crisis; and demand statewide improvements by encouraging officials to implement racial equity/implicit bias training for health care providers and to reduce or eliminate discrimination and bias.
In January 2021, Tammy Murphy, New Jersey’s first lady, unveiled the Nurture NJ Maternal and Infant Health Strategic Plan – a blueprint to reduce New Jersey’s maternal mortality by 50% over five years and eliminate racial disparities in birth outcomes. The plan was the culmination of over a year of in-person and virtual meetings with hundreds of critical stakeholders, including national public health experts, New Jersey state departments and agencies, health systems, physicians, doulas, community organizations, and mothers and families.
“Without reliable data, we cannot fully understand and address New Jersey’s maternal health crisis or its causes,” Murphy said. “While our data continues to show improvement in areas of Cesarean sections, New Jersey still has much work to do to improve maternal and infant health outcomes for our mothers and babies of color. Our mission is to make New Jersey the safest place in the nation to delivery and raise a baby.”
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