April is recognized as National Minority Health Month – a month-long initiative to advance health equity across the country on behalf of all racial and ethnic minorities in the United States. Black Maternal Health Week takes place every year from April 11 to 17.
While there is a particular focus on Black maternal health during this time, African American obstetricians and gynecologists of the National Medical Association are concerned about the health of mothers and mothers-to-be every single day of the year, because we see first-hand the devastating impact that our community faces because of profound healthcare disparities. The National Medical Association is the largest and oldest organization of Black physicians in the United States, celebrating 125 years of advocating for patients of African descent.
Black women are 3-4 times more likely to die during pregnancy compared to white women in the United States, a health disparity that has been persistent for the past 50 years. We share here what the medical profession and patients need to do to improve these dismal statistics and overcome this unacceptable and long-standing racial inequity.
The responsibility of the medical profession is to have the will and passion to act. Start by educating all providers about best obstetrical practices before, during and after pregnancy and their role in reducing maternal mortality. Then insist that they use them. Most importantly, listen to the patient.
Every state has to have in place an emphasis on reducing this difference in maternal mortality by expanding Medicaid and collecting and reviewing why pregnant women die in their state, especially Black women. Also, putting in place the best obstetrical practices in prevention,counseling, treatment and management at every birthing hospital has to be a must. There is a lack of Black obstetricians and gynecologists in the pipeline to take care of our communities, organized to fight racism and bias – both overt and implicit, and to help combat Black maternal death. Black obstetrician-gynecologists can inform and educate patients wherever they work, worship and play about their role in reducing death during pregnancy through social media and social groups. They are partners with all Black birthing workers, including midwives, doulas, community health workers, and the community members themselves.
There are a number of medical, environmental and social conditions or risk factors that are known to increase the chance that pregnancy will cause a Black woman to die. Advocating for the end of systemic factors, such as institutional racism, barriers to adequate health care, unconscious biases held by health care providers, in addition to optimizing the health of Black women before, during and after pregnancy to best manage medical conditions, have been strategies used tolower the risk of a death related to the pregnancy.
When mothers see or experience bias or racism in the clinic or office or hospital, they should call it out. The American College of Obstetricians and Gynecologists (ACOG) has stated that they have acommitment to “eliminating racial disparities in women’s health and to confronting implicit and explicit bias and racism.” Hold them accountable to their word.
Before pregnancy, know the conditions that increase the risk for a pregnancy related death. Consider sharing this risk information with your relatives, friends, spiritual leaders, educators and employers. Work with your physician or health care provider to best manage and understand chronic conditions, such as past COVID-19 infection, diabetes, hypertension, heart disease, asthma, depression, HIV/AIDS, hepatitis C infection, or obesity.
Getting adequate prenatal care will reduce the risk. Less than four visits during the prenatal period is associated with a higher chance of maternal death during or immediately after pregnancy. However, only 1/3 of pregnant Black women get the recommended seven to ten prenatal care visits. These visits are critical not only for routine management of the pregnancy, but also to learn warning signs of when they need to alert their provider if something changes in their pregnancy. Now, because of COVID-19, some of these routine visits will be through telehealth – but they remain important and should be kept.
Breastfeeding decreases the amount of bleeding after having a baby, a leading cause of mother dying — so breastfeed if you can! It is good not only for a mother’s health, but also for the babies, as Black babies have more than twice the risk of dying before their 1st birthday than white babies. Receiving care after a delivery is a must. High blood pressure and heart failure are the leading cardiovascular causes of Black women dying within three months of having a baby. These conditions are increased by being obese or overweight, having a cesarean delivery, hypertension or diabetes—all conditions that affect black women more often than white women. Healthcare visits within days and weeks of delivery are important opportunities to identify and learn about the early postpartum warning signs.
By physicians, health care providers, and patients working together, we can and must reduce maternal death in our black mothers and improve maternal health. Black obstetrician-gynecologists play a pivotal role in demanding that institutional and structural racism continue to be addressed to ensure that health and birth equity are attained. We can mentor the next generations of African American high school, college and medical students and residents to become physicians and obstetricians and gynecologists.
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Authors:
Camille A. Clare, MD, MPH Washington Hill, MD
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