Updated: Jul 6, 2020
Black women in the United States are at a disadvantage when they become pregnant. Even before their baby comes into the world, Black mothers have to overcome glaring racial disparities and odds in the healthcare system that are stacked against them. Black American women are at a much greater risk for preterm and low-birthweight deliveries and are three times more likely to die from pregnancy or childbirth complications than their white counterparts.
Dr. Joia Adele Crear-Perry champions the view that it is not race, but racial bias that persistently leads to poor maternal health outcomes for Black women. Inspired partly by her own experiences as a Black mother, Dr. Crear-Perry is on a crusade to eliminate racial disparities in maternal health. In addition to being a board-certified OB/Gyn, she is the founder and president of the National Birth Equity Collaborative, a non-governmental organization that strives to bridge the gaps between communities, hospitals, and governmental systems and to eradicate racial biases in health care. Also a member of EmmaWell’s Advisory Board, Dr. Crear-Perry sat down with us to discuss why we need to value all women to achieve maternal health equity, how maternal care in the U.S. has been colored by the color of a mother’s skin, and why these issues are so important right now.
How does racism impact Black women’s health?
Firstly, you need to understand what racism really means because people in general tend to have a misunderstanding of the term. It’s not something that only evil, mean-spirited people do to other people. Racism is a belief in a hierarchy of human value based on skin color that has become embedded in our policies and in our healthcare system. Both historically and currently, it has found its way into our laws, our social world (e.g. movies and TV shows), and our value systems, which dictate how we see people.
Because of this deeply embedded bias in our culture, we’ve lately been seeing many cases of reaction without thinking. A policeman believing that he can put his knee on the back of George Floyd’s neck for 8.5 minutes because he didn’t value him fully as a human being is in many ways analogous to what is happening to Black birthing women inside hospitals.
What are some examples of racism you’ve come across in your research on Black birthing mothers?
A recurring issue is when Black birthing mothers tell their provider that they are having pain (e.g. headache, chest pain, etc) or some other kind of physical or emotional complaint, their complaints are frequently dismissed. Sometimes the symptoms aren’t serious, but other times they could be the difference between life or death. It's important for providers to listen to the needs of all patients in order to care for them. When a person's chest pain or bleeding is not taken seriously, it can lead to deadly consequences. [Serena Williams’ birth story is one example of this issue that resonated for Black women and crossed over into the “mainstream” thanks to her celebrity.]
“Disrespect can turn into death really quickly.”
Many women end up in the ICU or with long-term complications because they are not heard and believed throughout childbirth. Studies have shown quantitatively that Black women are not getting pain medications at the same rate during or after delivery as their white counterparts. We’ve also heard reports of patients having an episiotomy or another surgical procedure performed without permission or anesthesia. [In a 2019 study, WHO researchers found that women of color reported far higher rates of mistreatment than the broader population, causing them to feel as if their provider was not listening to them, leaving them out of decision making, or refusing their requests for help.]
How does the rate of death during and after childbirth in Black women compare to that of white women?
In the past decade, there was no official count of maternal deaths in the U.S. until 2018. The last one before that was in 2007. We don’t have accurate figures for maternal morbidity simply because our country has disinvested in public health. One of the ways to calculate maternal morbidity is to match all the death certificates to all the births that have happened in the country, and we haven’t invested in the infrastructure to do that counting. In 2018, I testified in front of Congress to incentivize the states to invest in public health for counting maternal deaths, which they are already required to do with clear metrics for infant mortalities. Since we haven’t valued birthing women, we haven’t been keeping track of official numbers of their deaths.
“You don’t count what you don’t value.”
When the study came out in 2018, it showed that the U.S. has the worst maternal mortality rate in the industrialized world. It also showed findings like Black women who have an education higher than a college degree were five times more likely than white women with no high school education to die in childbirth. This large gap exists despite income and education, which is so important because it contradicts the historical myth of blaming and shaming Black birthing mothers.
The myth that has been perpetuated in our country holds that the reason Black women are more likely to die in childbirth is that they are less educated, less compliant, or overweight. When you pull and analyze the data, even when a Black pregnant woman is none of those things, she is still more likely to die. There is no biological difference between Black women and white women. Therefore, it is how Black women are seen and treated in the hospital system that has a huge impact on their ability to thrive during and after pregnancy.
What are the most common causes of death in Black mothers?
Currently, for Black women, the most common cause of death is cardiovascular dis