The alarming number of deaths of Black women during childbirth and soon afterward once gained little national attention. That changed, partly because of the high-profile deaths of Dr. Shalon Irving and Kira Johnson, and and the delayed response to Serena Williams’ request for treatment of a post-delivery complication.
In each of those cases, the woman or her family asked for help with one or more known warning signs of complications, like severe pain and difficulty breathing, and were not heard. Sadly, that happens all too often.
From the rich and famous to the less well-to-do, Black mothers are often not listened to when they report signs of possible complications of pregnancy and birth. Not only are their concerns dismissed, but traumatic birthing experiences are so common that one-quarter of Black women report disrespect and abuse from medical professionals in the hospital. Deaths and severe complications related to pregnancy and childbirth are the tip of the iceberg of medical harm experienced by Black birthing people, from rushed prenatal visits to unnecessary and unwanted cesarean births, which can cause postpartum infections and wound problems.
Childbirth is far more hazardous for Black women than white women. In New York state, the Department of Health found that three times more Black women died from pregnancy-related complications than white women, and this disparity persisted even when college-educated Black women were compared with non-Black women who did not finish high school. More than 60% of these deaths are preventable if appropriate care is given in a timely fashion.
In California, where improvements in care were implemented as soon as the crisis in maternal deaths was recognized in 2005, the overall maternal mortality rate dropped from 17 per 100,000 births to seven by 2013. Despite this improvement, the racial disparity of three times as many Black women dying around the time of childbirth persisted in California.
According to the Centers for Disease Control and Prevention, the majority of maternal deaths are preventable.
In an effort to reduce the number of maternal deaths in the United States, the CDC launched the Hear Her Campaign and, in conjunction with the CDC, the Council on Patient Safety in Women’s Health Care launched the Urgent Maternal Warning Signs tool. These join other warning-sign tools and video campaigns from the Association of Women’s Health, Obstetric, and Neonatal Nurses; the March of Dimes, and the Preeclampsia Foundation, to name a few. Even MTV has the Save Our Moms Campaign.
These efforts are welcome because of the lack of effective patient education for pregnant women. But they fail women in a crucial way: They blame mothers for their poor outcomes and fail to address providers’ tendencies to dismiss moms’ complaints.
The CDC’s Hear Her Campaign and the council’s Warning Signs tool tell mothers and their supporters that they are responsible for changing their behavior, improving their own outcomes, and preventing their own complications related to childbirth. These online and social media tools and videos do not address how racism affects providers’ communication and decision-making when Black mothers let them know that they are experiencing warning signs.
Will the nurses and doctors who are receiving announcements of these programs actually reflect on their racial biases and recognize that mothers should not be blamed for their poor outcomes when they are not heard or educated by their providers?
I do not expect that the CDC will declare racism a public health crisis, as many local and state departments of health have done, even though 1,200 employees of the CDC wrote a letter to Director Robert Redfield protesting a “toxic culture of exclusion and racial discrimination.” The first of their seven demands was to declare racism a public health crisis in the United States.
The Black Coalition for Safe Motherhood, an organization I co-founded, promotes health care advocacy and holistic support for Black moms through interactive community programs. The focus of our programming is overcoming the obstacles to obtaining safe, respectful, person-centered care that honors the values, preferences, and needs of Black moms and families is the focus of our programming.
The coalition’s ACTT Curriculum encourages Black women and their supporters to Ask questions, Claim your space, Trust your body, and Tell your story. It also takes advocacy a big step further: ACTT participants practice asserting themselves when they are not heard, or are dismissed or disrespected in medical settings.
The Hear Her Campaign puts providers last on the list of those encouraged to listen to mothers’ concerns and does little to address the problem of not hearing Black mothers. The Urgent Maternal Warning Signs tool lists symptoms to be recognized during and after childbirth as requiring care that Black women have recognized, asked for help with, and then been denied lifesaving treatment and care.
Black people have long suffered unequal treatment and poor communication with providers, despite alarms from the public health sector, including but not limited to the landmark report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.” The persistence of racial stereotypes in medicine and their impact on treatment was underscored by a study showing that 50% of physicians-in-training hold false beliefs about Black people’s bodies. Until racism in medicine and medical education is eliminated, the “care” of Black people will continue to be unequal, disrespectful, and often harmful.
Martin Luther King once wrote, “Whites, it must frankly be said, are not putting in a similar mass effort to re-educate themselves out of their racial ignorance. It is an aspect of their sense of superiority that the white people of America believe they have so little to learn.”
It’s time for medical professionals and professional organizations to “re-educate themselves” to recognize and eliminate racism, patriarchy, and elitism in medicine so all women can experience safe and effective and respectful maternity care, and we can close the shameful disparity in maternal deaths.
Leslie Farrington is an obstetrician-gynecologist and co-founder of the Black Coalition for Safe Motherhood.