Maternal health is a crucial aspect of public health. It reflects a society's commitment to the well-being of its mothers and children. Unfortunately, racial disparities in maternal health persist as a significant challenge across many countries, including the United States. These disparities are deeply rooted in systemic and social factors, leading to alarming health outcomes for Black, Indigenous, and women of color (BIPOC). In this article, we will delve into the key issues surrounding maternal health racial disparities and inequities and explore potential solutions to address this pressing problem.
Understanding Racial Disparities in Maternal Health
Racial disparities in maternal health refer to a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. This means that BIPOC mothers may not have equitable access to culturally tailored healthcare or may experience provider bias leading to poor care, for example. Numerous studies have demonstrated the stark contrast in maternal health outcomes between white women and women of color, particularly Black/African-American, Indigenous, and Latina women. Some key data that highlight the extent of this issue are:
Access to Prenatal Care: Timely and adequate prenatal care is vital for a healthy pregnancy and childbirth. However, BIPOC women often face structural barriers such as poverty, discrimination, racism, sexism, and other societal ills to accessing quality care, leading to increased risks of preterm birth and other adverse outcomes. A report by the U.S. Department of Health and Human Services highlighted that Black and Latina women are less likely to receive early prenatal care compared to white women.
Maternal Morbidity: Women of color also experience higher rates of severe maternal morbidity. According to the World Health Organization (WHO), maternal morbidity is defined as adverse health conditions complicating pregnancy, and/or childbirth that has a negative impact on the woman, including complications such as hemorrhage, preeclampsia (persistent high blood pressure that develops during pregnancy and/or postpartum), and/or blood clots. A study published in the American Journal of Public Health found that Black women are 60% more likely to experience severe maternal morbidity than white women.
Maternal Mortality: Shockingly, Black women in the United States are two to three times more likely to die from pregnancy-related causes than white women, according to data from the Centers for Disease Control and Prevention (CDC). This alarming disparity remains consistent regardless of socioeconomic background or education, despite almost 60% of maternal deaths being preventable.
Factors Contributing to Maternal Health Inequities
Health inequities continue to persist for BIPOC mothers despite the U.S. spending more per capita on healthcare compared to other high-income countries. To truly address health inequities, we need to first call out the underlying systemic issues and then get to work breaking down these barriers to improve maternal health outcomes and support healthy births. Several Several key issues include:
Structural Racism: Systemic structural racism in healthcare perpetuates disparities. Women of color are more likely to encounter discriminatory practices, limited resources, and unequal treatment within the healthcare system. A study published in the Lancet emphasized the impact of historically rooted and culturally reinforced structural racism on health disparities, which ultimately results in adverse birth outcomes. One main example of structural racism is residential segregation of Black Americans which has systematically shaped the health-care system, provider, and quality of care in their neighborhood which impacts their ability to access quality health-care access.
Socioeconomic Factors: Socioeconomic status plays a significant role in maternal health outcomes. Black women are disproportionately affected by socioeconomic challenges, including poverty, limited access to healthcare, and inadequate health insurance coverage. These factors hinder their ability to access quality care during pregnancy and beyond.
Implicit Bias in the Healthcare System: Implicit biases held by healthcare providers can influence provider’s decision-making, communication, and the overall quality of care they provide for their patients. Such biases can lead to disparities in maternal health outcomes.
Tangible Solutions to Address Maternal Health Inequities
Confronting health inequities in maternal health requires collective efforts and evidence-based solutions. Below are key strategies that can be adapted to address this pressing issue:
Improving Access to Quality Care: Expanding access to comprehensive culturally tailored prenatal care, including early and regular prenatal visits, is crucial. Addressing barriers to healthcare access, such as increasing the availability of community-based healthcare services and affordable insurance options, is vital to improving maternal health outcomes for women of color. Mothers should also have access to doula and midwifery services to support healthy birth outcomes.
Culturally Competent Care: Healthcare providers must be trained to better understand cultural nuances and offer respectful, culturally competent care. Culturally tailored care ensures that women from diverse backgrounds receive equitable treatment and have their unique needs met, feel valued, respected, heard, and seen during their pregnancy and postpartum period.
Supportive Policies: Implementing policies that address social determinants of health, such as affordable housing, paid family leave (for both parents), and increasing wages to a living wage, can help alleviate some of the socioeconomic barriers faced by BIPOC women. Raising awareness about racial disparities in maternal health through public health, healthcare systems, and community-engaged approaches and advocating for policy changes can foster meaningful improvements in access to quality healthcare.
Research and Data Collection: Robust data collection and analysis are essential to identify disparities, understand their root causes, and develop effective equitable interventions. Research should prioritize investigating the underlying factors contributing to racial disparities and health inequities in maternal health and identifying evidence-based solutions.
Maternal health inequities are a deeply concerning issue that demands urgent attention and collective action. Achieving equitable maternal health outcomes requires a multi-faceted approach that addresses the structural, social, and healthcare-related factors contributing to these inequities. By understanding the magnitude of this crisis and addressing its root causes, we can work together to create a more equitable and just healthcare system for all mothers, regardless of their race or ethnicity. Empowering women of color with accessible and culturally competent care is not only an ethical imperative but also a critical step towards building a healthier and more inclusive society for generations to come.
To learn more, visit our Mamas 4 Life health education campaign webpage: https://www.beaconpublichealth.com/mamas4life.
Follow us on social media:
Instagram | Facebook | LinkedIn: @BeaconPublic Health
References
Bailey, Z. D. et al. (2017). Structural racism and health inequities in the USA: evidence and interventions. Lancet (London, England), 389(10077), 1453–1463. https://doi.org/10.1016/S0140-6736(17)30569-X
Howell, E. A., Egorova, N. N., Balbierz, A., Zeitlin, J., & Hebert, P. L. (2016). Site of delivery contribution to black-white severe maternal morbidity disparity. American journal of obstetrics and gynecology, 215(2), 143–152. https://doi.org/10.1016/j.ajog.2016.05.007
Taylor, J., Phadke, S., Novoa, C., & Hamm, K. (2019). Eliminating Racial Disparities in Maternal and Infant Mortality. https://www.americanprogress.org/article/eliminating-racial-disparities-maternal-infant-mortality/
Vanderkruik, R.C., Tunçalp, Ö., Chou, D. et al. Framing maternal morbidity: WHO scoping exercise. BMC Pregnancy Childbirth 13, 213 (2013). https://doi.org/10.1186/1471-2393-13-213
Centers for Disease Control and Prevention. (2020). Pregnancy Mortality Surveillance System. Retrieved from https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm
Chinn, J. J., Martin, I. K., & Redmond, N. (2021). Health Equity Among Black Women in the United States. Journal of women's health (2002), 30(2), 212–219. https://doi.org/10.1089/jwh.2020.8868
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O., 2nd (2003). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports (Washington, D.C. : 1974), 118(4), 293–302. https://doi.org/10.1093/phr/118.4.293
Njoku, A., Evans, M., Nimo-Sefah, L., & Bailey, J. (2023). Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States. Healthcare (Basel, Switzerland), 11(3), 438. https://doi.org/10.3390/healthcare11030438