‘A critical emergency’: America’s Black maternal mortality crisis

America is facing an intensified push to pass stalled federal legislation to address the US’s alarming maternal mortality rates and glaring racial disparities which have led to especially soaring death rates among Black women giving birth.

Maternal mortality rates in the US far outpace rates in other industrialized nations, with rates more than double those of countries such as France, Canada, the UK, Australia, Germany. Moms in the US are dying at the highest rates in the developed world.

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Overall maternal mortality rates in the US spiked during the pandemic. Maternal deaths in the US rose 40% from 861 in 2020 to 1,205 in 2021, a rate of 32.9 deaths per 100,000 live births. For Black women, these maternal mortality rates were significantly higher, at 69.9 deaths per 100,000 live births in 2021.

These racial disparities in maternal health outcomes have persisted and worsened for years as the number of women who die giving birth in the US has more than doubled in the last two decades.

A major hospital in Los Angeles, Cedars-Sinai, is currently facing a federal civil rights investigation for how the hospital treats Black women after years of allegation of racism and discrimination since the 2016 death of Kira Johnson.

The issue and glaring racial disparities have received significant attention as high-profile celebrities such as Beyoncé and Serena Williams have shared their life-threatening experiences with childbirth and the recent death during childbirth of the US Olympic track runner Tori Bowie, highlighting the lack of support for Black maternal health in the US.

The CDC noted in a review of maternal mortalities in the US from 2017 to 2019, that 84% of the recorded maternal deaths were preventable.

“These are preventable, which means that we know what to do, for these deaths not to happen,” said Monifa Bandele of MomsRising, an advocacy group.

Bandele backs the Black Maternal Health Momnibus Act, a package of 13 bills aimed at confronting the maternal mortality crisis in the US. The bills include funding for community-based organizations working on maternal health, improving data collection and research on social determinants, support and services for maternal mental healthcare, and improving maternal healthcare for incarcerated mothers.

A package of federal bills was developed and introduced by the Black Maternal Health Caucus in 2020, the Black Maternal Health Momnibus Act, to address the pervasive racial inequities in US maternal healthcare.

The bill package was included in the Build Back Better Act which fell short by one vote of being passed in the Senate.

“The health and vitality of mothers is a litmus test for us as a society. It’s a lens into our culture, so the fact that the Momnibus has still yet to be passed is an unfortunate statement on how our country and current legislative body views and values mothers and birthing people in this country,” said Kimberly Seals Allers of Narrative Nation, a non-profit that creates technology and multimedia products to address racial disparities in maternal and infant health.

Certainly, the need for political action is there. Danielle Wilson was pregnant with her third child in the midst of the pandemic in spring 2021.

She wanted a VBAC (vaginal birth after cesarean) after undergoing an emergency C-section for her second child, but was denied by her doctors who cited her chronic illness and insisted she undergo another C-section.

Wilson said that when she saw a maternal fetal medicine doctor before her scheduled C-section, she was told she would make a great candidate for VBAC, but cited studies that have found racial bias negatively affects the calculation of how that candidacy is determined by clinicians.

As her pregnancy progressed, her doctors kept canceling appointments, and when she expressed concerns about swelling and tingling in her legs and arms, she said her concerns were dismissed and she was assured it was because she was having a girl.

“Later, to no surprise to me, I ended up being induced at 37.5 weeks because of a sudden onset of pre-eclampsia,” said Wilson. “With that sudden onset, it just became a matter of no one was really listening to me.”

She said she had to be on top of trying to enforce basic medical care, like her medications being given to her when they were supposed to. She said hospital staff would frequently deflect authority or responsibility for administering them to a different doctor or nurse.

Ten days after the induced birth of her daughter, Wilson was re-hospitalized with sepsis due to endometritis, where she was alone, isolated in the emergency room due to Covid restrictions. Even after recovering from sepsis, Wilson said she received no postpartum care aside from an automated text message a year later to wish her a happy birthday.

“For all they know I could have died,” added Wilson. “We just want to be heard. Who knows my body better than me? Especially because I’m someone with a chronic illness who has been hospitalized multiple times.”

She recounted a doctor in the ER telling her “that’s not my job,” when she was suffering from sepsis and requested her medications, with the doctor deflecting responsibility because her medical file had been moved from the ER to the OB [obstetrics] department, though she was still in the ER at the time.

“I thought that was wild. So, it would be OK for me to die here in the ER because my file has now moved from the ER to the OB department, so you can’t care for any more because I’m no longer under your watch so to speak, but I’m still sitting here in the ER. That’s how it felt. They were just going to let me sit here and die because files didn’t get moved over quickly and I am not in the bed upstairs on the OB floor, which didn’t make any sense to me,” she added.

Wilson criticized the role economics plays in determining and driving care, such as the overuse of cesarean sections, burnout and understaffing of the healthcare workforce, that exacerbates the quality of medical care in addition to racial biases affecting treatment.

Shocking attitudes can still be found in US medicine. A 2016 study on racial pain assessment found 12% of medical students surveyed believe Black people have less sensitive nerve endings and 58% believe Black people have thicker skin than white people.

To help combat these issues, Allers created an app, called Irth, a play on the word “birth” but dropping the B because of “bias”, as a crowdsourced app where users can submit and read peer reviews on OB-GYNs, pediatricians and birthing hospitals, as protection to use these experiences to work with hospitals and providers on improvements.

“The reality is people are not being treated the same way even at the same place,” said Allers. “I created Irth because I wish I had it when I was giving birth. I went to a hospital in New York City that was very highly rated on all of the media lists, and was highly touted as one of the ‘best of’ in my city. But I walked out feeling disrespected, unseen, traumatized and ignored.”

Allers emphasized the lack of solutions being provided by healthcare systems in the US as many anti-bias trainings offered to healthcare employees don’t work.

“We don’t think that we should try to solve this problem from the grave,” she added. “We all work this focus on how do we drive transparency and accountability within health systems, with people who are being paid to keep us alive, and to make sure we go home to our families, that’s their job. So we’re holding them accountable to that to provide equitable and respectful care.”

The package of 13 bills that comprise the Momnibus was reintroduced in May with 187 co-sponsors in the House. But it has only received support along partisan lines, with all co-sponsors being Democratic party members, though one of the bills in the package, the Moms Matter Act which address maternal mental healthcare, has received some bipartisan support.

“This is not just a crisis. We’re in a critical emergency. We need to act swiftly because we are losing people,” said Latham Thomas, a maternal health advocate and founder of Mama Glow. “It’s important we pass the Momnibus.

“We want people to have a transcendent, joyful, beautiful, sacred and health transformative birth. That’s what people deserve. They deserve to not worry about their safety leading up to their birth, they need to not feel like something is going to happen or be afraid or terrified to have a child or get pregnant.”