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The recent, high-profile death of Erica Garner, a 27-year-old African-American mother of two — one of them a 4-month-old infant — is a tragic example of how racism and access to health care for black mothers is a national crisis.

Not long after the birth of her youngest child, Garner had a heart attack. Four months later, an asthma attack triggered another heart attack; she died not long afterward. According to news reports, Garner’s heart had been enlarged during her pregnancy, something she didn’t know before becoming pregnant.


Her death made headlines because she was the daughter of Eric Garner, who died in July 2014 after being placed in an illegal chokehold by a New York City police officer; she was also an outspoken activist against police brutality. But it should also have made headlines on its own, a grim reminder of an issue we must solve.

As a woman of color in the health care field with two daughters of childbearing age, I am as afraid for them today as my grandmother may have been for my mother in rural Mississippi in the 1950s. The issue of maternal health became an even more personal one in our family during the past six months. Two of my daughters’ friends barely survived childbirth. Both of these young African-American women, who were apparently healthy before their pregnancies, developed dangerously high blood pressure that took months to return to normal after the births of their children.

Because Garner died within a year of giving birth, her death is counted as a pregnancy-related death due to a complication of pregnancy. According to the Centers for Disease Control and Prevention, pregnancy complications include anemia, urinary tract infections, mental health conditions, high blood pressure, pregnancy-induced high blood sugar (gestational diabetes), severe morning sickness (hyperemesis gravidarum), and more.


As a nurse at a major Chicago hospital, I often care for infants in the nursery because their mothers are in the intensive care unit for complications experienced during or after their child’s delivery. One infant spent almost two weeks in the nursery while his mother was recovering from a heart attack due to a blood clot in her lungs (pulmonary embolism).

Maternal mortality in the United States is a scandal. A 2014 World Health Organization report indicates that our country has a higher maternal mortality rate than Iran, Libya, and Turkey, even though we spend vastly more money on health care than those countries do. Half of maternal deaths in this country are preventable.

The problem is worse for African-American women than white women. In New York state, for example, between 2013 and 2015, 54 black women died for every 100,000 births compared to 15 white women.

To be sure, the U.S. is making some progress in decreasing the leading causes of maternal death, including bleeding, infection, and high blood pressure. However, the number of mothers with cardiovascular disease and cardiomyopathy (enlarged, thickened, or stiff heart muscle) has risen to the point where heart conditions are the cause of more than one-fifth of pregnancy-related deaths.

What we are not as successful at reducing are the factors of racism that shorten a black mother’s life.

A 2016 research overview of maternal mortality and morbidity in the United States shows that maternal health and death are influenced by racism, discrimination, poverty, and poor or inadequate health care. Racism is entrenched oppression that places value on individuals based upon their race or ethnicity.

According to Dr. Camara Jones, research director on social determinants of health and equity in the Division of Adult and Community Health at the National Center for Chronic Disease Prevention and Health Promotion and a scholar at the Center for Health Policy at Meharry Medical College, three levels of racism influence individual health: institutional racism, personally mediated racism, and internalized racism. Contributing factors include societal indifference to racism and discrimination; unequal access to employment, housing, education, and pay; and perceptions that African-American women have not achieved success because they are not up to the task.

These influence the health experiences and health outcomes for African-American women, regardless of socioeconomic status and access to quality health care. According to the CDC, younger age, higher socioeconomic status, and more education do not mitigate the negative influence of racism and discrimination. On average, black women with higher incomes and college educations have worse health than white women who have not graduated from high school.

Medicaid finances nearly half of all U.S. births. That should provide many women with quality prenatal care. Yet many providers don’t accept Medicaid patients, which heightens the logistical challenges to prenatal care visits, such as difficulty getting time off work to attend prenatal care visits during traditional office hours, transportation, and child care.

African-American and poor women are more likely than other women to be treated at low-quality hospitals, increasing the chances they may experience serious complications during and after childbirth. Hospital quality can account for nearly 50 percent of the racial disparity in maternal illness.

There’s no question that some women at greatest risk for maternal death have lifestyle or behavioral risk factors that contribute to early disease and death, such as unhealthy diet, being overweight or obese, smoking, late or no prenatal care, living in substandard housing or dangerous neighborhoods, and living in communities fraught with environmental hazards.

We must do more than just point to this injustice. A first and necessary step is to call out institutional and interpersonal racism and discrimination when we see it. Then we must take action to make changes to improve the quality of maternity health care for all mothers. The Alliance for Innovation on Maternal Health is a collaboration of health care professionals affiliated with 19 major organizations that is taking steps to do just that.

Equally important are initiatives that improve cultural and ethnic diversity of providers so mothers are comfortable with their health care providers without fear of judgment, bias, and discrimination.

Efforts to reduce stress with techniques such as mindfulness-based meditation, to reduce poverty, and to support optimal health before pregnancy are other components that can make a difference in the lives of black mothers, children, families, and communities.

From my perspective, it sometimes feels that being a poor, black mother is akin to a diagnosis that increases the risk of dying during pregnancy or soon after giving birth. By fighting the racism that contributed to the deaths of Erica Garner and so many other American women, we can also stop the need for mourning.

Wrenetha Julion, Ph.D., is professor and chair of the Department of Women, Children, and Family Nursing at Rush University College of Nursing in Chicago, an NIH-funded researcher focused on the wellbeing of families, and a Public Voices Fellow through The OpEd Project.

  • Maybe it’s because She was a slave? I’m sick of the white = black BS we hear.
    I’m American Indian & a Christian. We were feed to lions. Almost all Indians were killed but you don’t hear US complain everyday of the White people and what they did.
    It wasn’t the USA. It was England. And it was 400 years ago.
    Washington and Jefferson never went out and took slaves home. They were born with them!

  • MEDICAID…designed as universal health for the poor…INFERIOR TO “MEDICARE” = free health insurance comprehensive coverage for disabled or anyone over 65 ( eg. over 50 % of Asian immigrants are over 65 who get in on relative visa’s so they can grow old with medicare, which they automatically qualify if have visa and age 65) meanwhile our own poor suffer with mediCAID…which any doctor who has to support his own practice, will NOT accept…eg. For 1 procedure example, medicare gives 28 dollars, medicaid? 2dollars and seventy cents…so the poor, especially poor minorities, get stuck in inner city understaffed public “clinics” whose only doctors are those who have not been able to find a real practice to join….MEDICAID is a bipartisan supported measure for when congress and their families get old or disabled. MEDICAID deliberately sounds like ‘medicare’ , same as SATAN and SATIN…,same difference…neither side will ever give the poor medicare…but legal immigrants who get in for the family visa get MEDICARE 1st day of arrival…medicaid? a govt scam on the poor supported by BOTH parties.

  • For two years I taught a class that was about addiction and over coming it/them. My heart goes out to those folks, because they are not in charge of their lives; their addictions are. My question: in addition to other problems, how many pregnant women use alcohol and/or tobacco, which contributes to low birth weight babies and other health problems? One cannot ignore this usage that causes so very many problems.

  • Unfortunately the ignorant, racist views that so many people hold actually hurts us instead of making things better. When you deny racism and its consequences, you are contributing to it. Please please try to educate yourself before you post such comments. We can do better.

    • You’re right, MD, we shouldn’t question such things. If someone claims that his problems are because of discrimination, we must assume that that is in fact the case, and then change things to make his life better.

    • MD – so you are saying that if someone disagrees with you or does not blindly blame every problem in the black community as racism, then that person is contributing to racism? That’s nonsense.

  • The article makes many valid points, but extremely overstates those points at the exclusion of terms like “personal responsibility.” For example, the issue of the harmful effects of stress from living in a tough neighborhood. Let’s talk about making good choices: work hard in school, get a college education or some type of vocational training, and most of all, fall in love, get married, save money toward a home–then have the babies. Far too many kids grow up in a culture of guns and gangs that are really surrogates for having a daddy. To have multiple kids out of wedlock when it’s hard to support yourself, and then to complain of “income disparity,” is bonkers. Racism does play a role in black mortality stats, but it’s just one of several factors.

    • you should read up on racial housing discrimination, redlining it’s called and then you might rethink your comment about how if you just study, get good grades, and a good job you can move your family out of the hood and into a wonderful majority white neighborhood with less crime and then you wouldn’t experience racism. Systemic and institutional racism makes all of these things possible. Have you ever heard of white flight? It’s not like black people could have just moved into white areas and lived peacefully.

    • I agree Joe. Chronic untreated HTN leads to Cardio and Kidney disease. High Schools try to educate these students but they don’t care or listen so they stay dumb adults, cry Racism and oppression.

    • Poverty is hard on people, no argument. Bad decisions only makes things worse, not better. When the #1 hobby is eating or watching TV, then obesity prevails – regardless of race. Do poor white women get a free ride? Never! Visit any metro area and discover poverty of all colors. The only racism I saw in this article was the authors.

  • Many doctors do not accept Medicaid because those patients take less responsibility for their general health and prenatal care. When there are complications they sue. So few premier physicians will accept Medicaid. They cause their own deaths by eating junk and becoming obese.

    • I feel that there is a huge lack of understanding and a huger lack of empathy in these comments – from men – and it is attitudes like these that help hold back positive progress in our country and world. Institutionalized racism is a big stress that adds to the health issues of African American women. You need to open your eyes, your minds and hearts so that you can be helpful to your fellow humans, instead of what you are doing now.

    • Ma’am,

      Salt, fried, fatty diets, and any calorie drinks, are holding people back. Working out inside the house and going out on weekends is possible. Opening eyes, minds, and hearts, to that message, true for every human, is fact.

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