Why are so many African American women dying related to pregnancy complications?America ranks last.

The long over due House OverSight Hearing: Birthing While Black: Examining America’s Black Maternal Health Crisis

May 06, 2021

In advance of the long awaited House OverSight Hearing. And with Mother’s Day soon on the horizon, I thought it would be time well served by researching and then pointing you to relevant reports, facts within the reports and other germane data. Admittedly this article was difficult to write and at times I had to check the data-set numerous times. Because I wasn’t sure that I was reading the data correctly. This article might be difficult for some readers, however I genuinely think this topic is occasionally covered but it hasn’t truly seeped into the conscious of most Americans. Our sisters in the African American community need to know that they matter and the pregnancy related mortality is a crisis unique to them but as women we need to advocate for them.

Why? Well about six moths ago like many, I watched this press conference. Where Doc Rivers - said (as the tears flowed); “we keep loving this Country and it doesn’t love us back”

Doc Rivers rawness truly encapsulated the deep pain within our African American community. The reality is “black lives matter” too. And while most will (correctly) argue that social-justice-reform primarily focuses on law enforcement and our judicial system. I’d like to pull the aperture back and focus on the alarming increase in African American women pregnancy related mortality. And how structural racism is disproportionately impacting women of color. It is literally killing them. And it’s our turn to advocate and support them.

America ranks LAST in maternal mortality:

Back in November 2020, the Commonwealth Fund published a report - the Report is based on a large data set. The United States has the highest maternal mortality rate among other developed countries, 17.4 deaths per 100,000 births.

Black & Brown pregnant American Women mortality rate. The data doesn’t lie and it’s awful

The growing data suggest that pregnant non-Caucasian American woman are at an alarming and often times face a disproportionate risk of death and other adverse health outcomes before, during, and after pregnancy. Recent data also suggest that this impact is across the socioeconomic and educational spectrum. Meaning even educated and/or highly educated non-Caucasian women also experience higher rates of pregnancy complications, infant loss, and miscarriage across the socioeconomic board.

When you blend the educational achievement data, with specific age groups - you’ll note that a subset of women, specific African American women pregnant related mortality inexplicably increases.

For Example; the pink highlights specifically for African American women. The data shows that the mortality rate is (on average) 3.2 times higher than their Caucasian counterparts. As you’ll note - the data shows a precipitous uptick in mortality in age groups 25-29, 30-34 and then in age groups 35 thru 39, the pregnancy relate mortality rate just sky rockets.

When you compare the education level - this is where the data presents a difficult challenge. Meaning one could argue better educated equals lower mortality but as you’ll note the CDC data suggests the opposite. Which is why it is paramount to uncover the contributing factors that are leading to higher mortality rates among African American women.

Blending data and factors such as predisposition to hypertension which ultimately leads to higher stroke incidents is only a tiny fraction of contributing factors.

But other more complicated health related issues such as:

Cardiomyopathy, thrombotic pulmonary embolism, and hypertensive disorders of pregnancy contributed to a significantly higher proportion of pregnancy-related deaths among black women than among white women. Hemorrhage and hypertensive disorders of pregnancy contributed to a higher proportion of pregnancy-related deaths among AI/AN women than among white women.

Notwithstanding addressing better access to prenatal care and healthcare in general would likely help. Because preventative care is a far better return on investment. We should be advocating for better access to “quality healthcare” for preconception, pregnancy, and postpartum periods. Moreover it would allow the pregnant mother to work with her healthcare provider to potentially stabilize other chronic disease(s). As the data further suggest, appears to be a contributing factor to higher pregnancy mortality rates in the non-Caucasian.

The sad part is the data suggests that the vast majority of pregnancy-related deaths can be prevented, and significant racial/ethnic disparities in pregnancy-related deaths really need to be addressed. Meaning Congressional Lawmakers need to pass bipartisan legislation that will not only fund access to pre/post-natal care. Lawmakers need to help fund States. Who would arguably expand Medicaid, potentially open up additional healthcare clinics and/or stop the closure of rural hospitals and/or clinics. These closures likely exasperate the increased pregnancy-mortality.

In layman terms and generally speaking;

… it is as if we do not value the lives of African American, American Indian/Alaska Native women and the life of their unborn child(ren). And that’s part of the current argument of Institutional Racism. The paradigm here is we are talking about mothers and the babies in-utero1.

This isn’t a “right to life argument” nor is this a “birth control argument” what this is about is, America of all other industrialized nations has one of the worst, if not the worst mortality rates. In short we as a county are failing non-Caucasian pregnant mothers. And yes I’ll repeat it’s institutional racism is a factor - this is also known as Structural racism - which is is defined as “a system where public policies, institutional practices, and cultural representations work to reinforce and perpetuate racial inequity” 2

CDC Racial/Ethnic Disparities in Pregnancy-Related Deaths -2007–2016

In September 2019 the CDC released the Morbidity and Mortality Weekly Report (MMWR)3. Researchers goal(s) was to understand why, statistically speaking, why the mortality rate in: “Black, American Indian, and Alaska Native (AI/AN) women are two to three times more likely to die from pregnancy-related causes than white women – and this disparity increases with age..” Key findings: 2007-2016 national data on pregnancy-related mortality

https://www.cdc.gov/mmwr/volumes/68/wr/social-media/mm6835a3_DisparitiesInMaternalMortality_06Sept19_Image_1200x675_border-medium.jpg — CDC MMWR Report -

Based on an analysis of national data from 2007-thru 2016 - the CDC Study found the following datapoints;

Overall PRMRs increased from 15.0 to 17.0 pregnancy-related deaths per 100,000 births.
Non-Hispanic black (black) and non-Hispanic American Indian/Alaska Native (AI/AN) women experienced higher PRMRs (40.8 and 29.7, respectively) than all other racial/ethnic populations (white PRMR was 12.7, Asian/ Pacific Islander PRMR was 13.5 and Hispanic PRMR was 11.5). This was 3.2 and 2.3 times higher than the PRMR for white women – and the gap widened among older age groups.
For women over the age of 30, PRMR for black and AI/AN women was four to five times higher than it was for white women.
The PRMR for black women with at least a college degree was 5.2 times that of their white counterparts.
Cardiomyopathy, thrombotic pulmonary embolism, and hypertensive disorders of pregnancy contributed more to pregnancy-related deaths among black women than among white women.
Hemorrhage and hypertensive disorders of pregnancy contributed more to pregnancy-related deaths among AI/AN women than white women.
Disparities were persistent and did not change significantly between 2007-2008 and 2015-2016.
This report’s findings demonstrate that black and AI/AN women have a more accelerated trajectory in age-specific PRMRs compared with white women

The issue of African American women dying during pregnancy isn’t new. I would argue that upon reading a fuller dataset, you can observe the mortality rate’s upward trajectory is quickly approaching critical mass. It is both untenable and unsustainable. And I’m glad that Congress will hold a hearing on this growing public health issue. For context of the recent CDC WWMR Report, I would recommend that you see below - data concerning 2011 thru 2013

Pregnancy-Related Mortality in the United States, 2011-2013;

Objective: To update national population-level pregnancy-related mortality estimates and examine characteristics and causes of pregnancy-related deaths in the United States during 2011-2013.

Methods: We conducted an observational study using population-based data from the Pregnancy Mortality Surveillance System to calculate pregnancy-related mortality ratios by year, age group, and race-ethnicity groups. We explored 10 cause-of-death categories by pregnancy outcome during 2011-2013 and compared their distribution with those in our earlier reports since 1987.

Results: The 2011-2013 pregnancy-related mortality ratio was 17.0 deaths per 100,000 live births. Pregnancy-related mortality ratios increased with maternal age, and racial-ethnic disparities persisted with non-Hispanic black women having a 3.4 times higher mortality ratio than non-Hispanic white women.

Among the leading causes of pregnancy-related deaths (contributing factor of greater than 10%); cardiovascular conditions = 15.5%, other medical conditions, pre-existing illnesses = 14.5%, post delivery infection = 12.7%, hemorrhage 11.4%, and cardiomyopathy = 11.0%

Relative to the most recent report of Pregnancy Mortality Surveillance System data for 2006-2010 - the data - first the good news: when compared with serial reports before 2006-2010, the contribution of hemorrhage, hypertensive disorders of pregnancy, and anesthesia complications declined.

Now for the concerning data - However cardiovascular and other medical conditions increased, which presents an interesting dichotomy. Specifically would better preventative, pre/post-natal care could drive those numbers down. But relative to the 2011-2013 data juxtaposition with 2006-2016 data, this presents a conundrum. Meaning more data allows for a wider view but the aggregate subset data creates a bit of a truncated impression.

Pregnancy-related mortality ratios increased with maternal age, and racial–ethnic disparities persisted with non-Hispanic black women having a 3.4 times higher mortality ratio than non-Hispanic white women.

Trend of pregnancy related deaths:

In the abstract and confirmed by the data, which confirms significantly higher pregnancy-related mortality ratios among Black and American Indian/Alaskan Native women4. Shockingly these gaps did not change over time. Which sets forth a paradox - meaning with the advancement of healthcare and diagnostics the assumption would be that pregnancy related mortality should decrease. The data confirms the opposite. And that’s problematic and worrisome.

Recently (as in) April 15m2020 - the AMA president penned this well articulated and formulative OpEd/statement to AMA members. ,

At 17.4 deaths per 100,000 live births, our nation suffers from a higher rate of maternal mortality than any other developed country. The gap is immense; our rate of maternal death is more than twice as high as it is in nations of comparable wealth. What is even more disturbing is that, according to the Centers for Disease Control and Prevention, nearly 60% of these deaths are preventable.

House Oversight Hybrid Hearing - May 6, 2021

Purpose of House Oversight Hearing:

An examination of how America’s historical and ongoing structural racism against Black people is one of many root causes of African American maternal-mortality crisis5. Not to belabor the point but if you’re an African American woman, ages 35-39 there is a substantial likelihood that pregnancy could result in death. Lawmakers are committed to evaluate the need for comprehensive reforms. Make the necessary investments (on a federal level) to ensure the health and prosperity of Black mothers and more broadly African American families in the United States.

At any rate I hope this article is informative. Apologies for the extreme data dump. I felt that my readers should have access to the same underlying documents that helped formulate this article. The reality is this a growing public health crisis and it truly needs as much sunlight as possible. In some ways America has continued to fail African American women. And that needs to be remedied, forthwith.
Also the level of self restraint as to not castigate the predominantly white hypocrisy of some Christians who espouse “every life matters” —YES looking at you Cruz, Hawley, McConnell et al, apparently the accurate statement is; ”only white pregnant mothers and white babies matter” to the evangelical “christians” -there I said it because someone needed to say it.

I need a favor - please and thank you;

And lastly I rarely ask my readers to do something on my behalf - I would genuinely appreciate it if you could please share this article. Our African American sisters need us to help amplify the health crisis that is truly unique to them. Time and time again they have literally saved and defended our Democracy. With that in mind, it is certainly long past time for us to rally behind them, to act with purpose and affirm that they truly matter.

-Filey

ps - I’m going dark for the rest of the week. I’m in the final push to get the house projects done before high season begins. I might pop back up sooner but I want to set your expectations.

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