Maternal Morality

My godmother’s sister – a woman whom I called my Aunt – died in childbirth at University Hospital in Newark. And though it was the same hospital in which she worked as a nurse, when she said something felt wrong, no one listened.

Having one’s health concerns fall upon deaf ears is a common plight amongst women; and, when that woman is black, her odds of receiving appropriate treatment are stacked even higher.

According to the Centers for Disease Control and Prevention (CDC), nearly 700 women die yearly in the U.S. due to pregnancy and birth complications – more than in any other industrialized country.

Additionally, the data shows that black mothers are up to four times more likely to die from pregnancy-related causes or in childbirth than their white, non-Hispanic counterparts.

New Jersey doubles that national average. In the state ranked fifth in the country for having the highest maternal mortality rate, black mothers become five times more likely to die here than white women from pregnancy or birth complications.

Therefore, we cannot talk about maternal mortality in New Jersey without also discussing structural and systemic racism.

While much work already has centered around the social determinants of health – where one lives, what one eats, how one travels and more – these serve little purpose in discovering why maternal mortality rates are so high.

That is because even accounting for education and socioeconomic status, which often may improve one’s access to healthcare, mortality rates are still worse amongst black women.

Instead, we must look toward the “weathering,” a term coined in the early 1990s by Arline T. Geronimus, a public health researcher and professor at the University of Michigan’s Population Studies Center.

Geronimus stipulated that the health of non-white Americans would rapidly deteriorate due to the chronic stress of being exposed to lifelong racism.

That has not improved. Furthermore, today’s 24-hour-news cycle constantly delivers fresh horrors to our televisions, radios, mobile phones and social media accounts.

It is no wonder then that my friends, regardless of their income, their careers, their locations or their degrees, say they worry their children might become a victim of a crime due to their race every time they leave the home.

And it is certainly no surprise that since the 2016 election, pre-term labor among Latina women in New York has skyrocketed due to mothers’ increased concerns for their families.

Because when a mother is about to bring a child into this world, the concern for their current and future safety is significant. It is a worry that weathers on one all of the time, and one which will continue to weather on mothers across the nation.

As a black woman with nine godchildren, I cannot separate myself from this reality.

And yet, couple this stress with the fact that medical professionals often decline to believe us when we do share our symptoms, leading to an underdiagnosis of disease and the denial of appropriate treatment.

Even Serena Williams, a top athlete in tune with her body, said she was forced to complain multiple times regarding her discomfort, until she was diagnosed with a life-threatening pulmonary embolism in her right lung after giving birth via Caesarean section to her daughter last year.

Then there was Sonya, my aunt, who already had a child. She knew what everything was supposed to feel like and she knew something had gone wrong. But instead of listening to her, everyone seemed to know better than her about her own body. In fact, in her final hours, she was told she was fine.

Just recently did the CDC release a study stating that three of every five pregnancy-related deaths are preventable, with continued monitoring helping to thwart many causes such as cardiopulmonary changes, stroke, high blood pressure, severe bleeding and infection.

It’s a start. Because the numbers have grown worse, the good news is that more attention is being paid. Maternal mortality is even showing up in popular television series such as “Grey’s Anatomy” and “The Resident,” with the issue being so pervasive that people have begun to question why pregnant black women in other countries are not dying at the rate they are in the U.S.

New Jersey Senator and 2020 presidential candidate Cory Booker and Massachusetts Rep. Ayanna Pressley have taken notice, too. On May 8, the duo introduced legislation in the Senate and House to address maternal mortality in the U.S., co-sponsored by other 2020 presidential candidates New York Senator Kirsten Gillibrand, California Senator Kamala Harris and Massachusetts Senator Elizabeth Warren.

The MOMMIES (Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services) Act seeks to extend the time period in which Medicaid covers postpartum women from two months to a year after having given birth, while embracing services such as the use of midwives, doulas and holistic birth workers to drastically improve maternal health.

New Jersey Governor Murphy followed suit not one day later, signing bills that would require Medicaid to cover the services of a doula; reduce the number of Cesarean sections by blocking insurance coverage for procedures scheduled before a woman is at full-term; and establishing a Maternal Mortality Review Committee to annually review and recommend improvements in which to decrease the rates and causes of maternity mortality.

While admirable, New Jersey is late to the game in this space. There already have been open and adamant discussions in other states regarding the reduction of maternal mortality, amongst other health care disparities.

This is because across the U.S., there is an increased demand for transparency. Health care institutions now often have methodology frameworks in which to check everything they do against institutional and structural racism so that it is not proliferated moving forward.

If we do not talk about that, we are only having half of the discussion.

But in healthcare, much like in many other industries, when someone is introduced to the idea of implicit bias, they often are afraid to be called racist.

That is not what any of this means. In fact, if we are living and we are breathing, each and every one of us has some sort of implicit bias.

And the data shows that when it comes to the treatment of patients, medical professionals may unintentionally act more empathetic or pay more attention toward those who fit the demographic of their implicit bias.

It is simply human nature. But there is a way healthcare facilities can actively begin to address this issue in both their processes and procedures and with their medical teams:

Encourage everyone to take the appropriate Implicit Association Test offered by Project Implicit at Harvard University.

This online questionnaire allows test takers to become aware of what their own intrinsic biases are and can educate them on how to better identify and respond accordingly in order to create greater equity in health care.

Even if all of the physicians and nurses are busy, administrators can help by putting every policy and practice that an institution is going to follow through such a racial equity assessment as if they were developing a strategic plan.

For example, one might say, as we go about this process, what is it that we need to be aware of that perhaps we are not? Or, before we have any discussions, how can we become more mindful of who is not yet in the room?

A reduction of the maternal mortality rate via systemic change is entirely possible, if we as individuals realize that the system itself is one that has been built upon decades of inequity.

Then and only then will we truly be able to do something about it.