Racial Discrepancies in Maternal Care

Black women are three to four times more likely to die from preventable maternal death than white women in the USA. This unfortunate statistic encompasses the disparity in access and quality of care that women, especially those of black and minority backgrounds, face in today’s society. This heightened risk of death during and following pregnancy spans all incomes, educations and socioeconomic backgrounds for Black women, and despite being the cause of media interest for many years, this trend still continues to be seen.

All women and their pregnancy experiences are unique, and a major cause of disparity between racial groups is a failure to understand different women’s predispositions to complications in pregnancy. This is particularly observed in gestational periods, where Black and Asian women are more likely to have premature births, and White European women have the highest incidence of overdue and induced births (in the UK).

Black women are also more prone to suffer complications during pregnancy and childbirth. Studies showed that black women are three times more likely to have fibroids which grow faster and occur at younger ages than other women, which can cause postpartum haemorrhaging if not detected or monitored.

Black women are also 60% more likely than white women to suffer from pre-eclampsia (a severe and often fatal rise in blood pressure) and eclampsia (seizures that develop after pre-eclampsia). Black women make up the highest risk group in mature pregnancies, a condition which has been linked to greater instances of chronic stress and cases of socioeconomic disadvantage.

Access to reproductive health specialists and reproductive education disproportionately affects Black communities, meaning that complications such as fibroids, tumours and problems in fertility are often missed, only being detected when they present a fatal risk to the mother.

The complications suffered by these women do not need to result in death. They are entirely preventable with proper monitoring and care. Increasing the accessibility and the quality of reproductive health care as well as increased education about early symptoms for women across all demographics, especially those at higher risk of complications, could actively reduce this disparity in maternal care.

More needs to be done to improve the accessibility to adequate reproductive and maternal health for women of colour. Historically, these women have been exposed to forced sterilization, coerced birth control and unsafe drug trials, which has naturally created medical mistrust. During the contraceptive CHOICE cohort study, women of colour were found to rely more upon less-effective methods (such as withdrawal), opting against the use of medical contraceptives. This has resulted in women of colour experiencing the highest rate of unintended pregnancies.

Medical insurance also creates a barrier for women of colour. Women often avoid any medical intervention (such as ultrasounds) until the second or third trimester, falling into a coverage gap with no financial aid. This poses a large risk to both mother and child and poorly equips medical staff to deal with any complications that may have worsened over the course of the pregnancy. Expanding medical coverage and providing better quality services to all women would prevent unnecessary surgery, complications and death.

Complications prior to birth are often made worse by unconscious biases in the healthcare system. ProPublica and NPR collected over 200 stories from African American mothers, finding that most, if not all reported feeling “devalued” or “disrespected” by medical providers. More must be done in the healthcare field to provide safe, culturally respective care for any patient. Social factors, such as poverty, impact maternal stress and overall health dramatically, as well as other factors such as financial aid and access to mental health care, must be addressed in order to tackle the healthcare disparity.

Mothers must be able to trust their doctors to provide them with the best possible standard of care, without the fear of debt deception and indifference to their needs. Laws need to protect mothers with increased maternity leave and job security to make changes possible. Above all else, systemic change needs to happen to protect all women equally pre, during and post-childbirth so women can confidently choose to become parents, trusting that healthcare professionals will keep them safe.