And because Medicaid pays for nearly half of all births in the US (Medi-Cal pays for half of California births), telehealth should be covered by Medicaid, Zephyrin advised. That was fair enough, so I decided to look into this. Any pregnancy-related death within a year of delivery is counted as maternal mortality, and the difference in IHM rates suggests that in white hospitals black mothers die at high rates in the hospital, while in black hospitals they die at high rates after going home. Medically, the cause of the difference appears to be related to the circulatory system, which is sensitive to stress. Sign up for a webinar on April 30 to learn more. Combined, these factors help explain why states with large populations of black Americans register some of the highest rates of maternal mortality in the country. Young’s concern is not unique to the COVID-19 crisis. Medical facilities can also take action. After all, “we have spent a lot of time convincing Black women their link to survival in the health care system is their doula,” Kathryn Hall-Trujillo, founder of Birthing Project USA, told Guo. In fact, the United Nations initiated the Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016-2030. To start, here’s the basic problem we’re dealing with: Not only is the maternal mortality rate going up, but the difference between black and white mothers has been widening. According to the Centers for Disease Control and Prevention (CDC), between 800 and 900 women in the United States die each year from pregnancy-related complications, illnesses or events. The African Union conference in Kampala which started on July 19 and will end July 27, has been discussing strategies to reduce maternal mortality. Even California, which has cut its maternal mortality rate in half over the past ten years—mostly by reducing the use of cesarian sections—has cut it equally for both black and white mothers. More than 22,000 babies die before their first birthday each year in the U.S. and the infant mortality rate is twice as high among Black babies compared to white babies. However, this isn’t about the general fact that black mothers die at higher rates than white mothers. It’s also theoretically appealing, since there are known pathways for stress to affect pregnancy and childbirth. Black women are 3 to 4 times more likely to die a pregnancy-related death as compared with white women. Maternal Mortality in the U.S.: A Human Rights Crisis. Although the numbers are alarming, the disparity in mortality rates for minority women are even more devastating, with Black women being three to four times more likely to die from a pregnancy-related complication than their white counterparts. Because little is known about how the coronavirus affects pregnant women and their babies, research is needed to inform health care, policy, and personal decisions around labor and delivery. Medicaid coverage for pregnant women now lasts 60 days postpartum, but research suggests that extending postpartum coverage can benefit all women of color, who are burdened with maternal health disparities. ... talking about black maternal death rates. The timing of prenatal care doesn’t explain it. She was going to have the baby in Sacramento with community doula Joy Dean by her side. As a mother who has experienced the consequences of poor maternal health systems in Uganda, I thought it was time to tackle this crucial yet often neglected area of maternal health. To further complicate matters, the visitor restrictions “could change within hours of you getting to the hospital,” Erica Chidi Cohen, CEO of Loom, the Los Angeles sexual and reproductive health education center, told Sonja Sharp in the Los Angeles Times. Subscribe to the Mother Jones Daily to have our top stories delivered directly to your inbox. Is it because of a genuine difference, or simply due to better diagnostics? Then there’s the startlingly high in-hospital mortality rate in white hospitals vs. black hospitals. However, experts say many of these deaths are preventable, and prevention starts with taking care of expectant mothers and empowering them to deliver full-term, healthy babies. So lack of education isn’t the cause. She is the author of the weekly “Essential Coverage” column in The CHCF Blog. Instead, the NBEC is analyzing which large-scale issues are at the crux of black maternal mortality, then addressing them. First let me just say that, we know the best policies are data-informed, but I do believe that the best policies are advanced by leaning in and lifting up those who have been most personally impacted. Fighting the maternal mortality crisis ... the benefits of working with a doula but said there was no evidence showing they reduce mortality rates. Significant racial and ethnic disparities in maternal morbidity and mortality exist in the United States. Taking the average, this suggests that blacks have an AL about 0.2 SDs higher than whites—roughly the equivalent of three IQ points. In 2015, the maternal mortality rate increased from 17 deaths to 26 deaths per 100,000 live births. These abrupt changes to the birthing experience disproportionately harm some populations, including Black women and birthing people, “who are already vulnerable to disbelief and mistreatment by hospital staff — a situation that could potentially worsen without anyone there to advocate for them,” Monica McLemore, PhD, MPH, RN, associate professor at the UCSF School of Nursing, wrote on the Scientific American blog. They’re hard to come by, but Arline Geronimus, who originated the “weathering” theory to explain black-white differences, has studied the length of telomeres in black and white women. Some hospitals have implemented a one-visitor policy in birthing rooms, but that can create an impossible decision for women who must choose between a partner and a doula or midwife. The new aim is to reduce the global MMR to less than 70 by 2030. The reasons for both of these are unclear. Mother Jones was founded as a nonprofit in 1976 because we knew corporations and the wealthy wouldn't fund the type of hard-hitting journalism we set out to do. That changed a few months ago when Congress passed a bill that authorizes $58 million per year for the next four years to study maternal mortality. They’re truly large only for two: PCD (problems with blood vessels in the brain during the six weeks following delivery) and IHM, or in-hospital mortality. (3). Using a back-of-the-envelope look at patterns of racial bias vs. racial differences in maternal mortality, I found little reason to think that racism among delivery doctors was the likely cause of this. Because of the COVID-19 crisis, California has made emergency changes to increase Medi-Cal enrollees’ access to telehealth, including new coverage for phone visits and expanded coverage for video visits. Again, this suggests a fairly small difference between black and white women. Help Mother Jones' reporters dig deep with a tax-deductible donation. ¹California has recently added a specific program to look into the black-white gap, but it’s fairly new and hasn’t yet produced any results. The problem is that if you accept both the AL theory and the toxic stress hypothesis, they don’t seem to correlate well. When a woman dies from anything having to do with pregnancy, it is called maternal mortality or maternal death.1 Maternal death can happen while a woman is pregnant, during labor and delivery, or in the 42 days after childbirth or the termination of pregnancy. Although legislative efforts to address infant and maternal mortality have expanded since 1921, there is considerable room for improvement. Unfortunately, COVID-19 has necessitated physical distancing, and hospitals from San Francisco to New York have banned visitors from labor and delivery to protect patients and staff. Currently, with the U.S. ranking 47th out of 183 countries in maternal mortality, the stakes are high, and the pressure is intense. The first thing to look at is the causes of maternal mortality: The three causes with the biggest black-white differences are cardiomyopathy (heart disease), embolism (blood clots), and eclampsia (a pregnancy-related illness that produces swelling and high blood pressure). The November 2017 session, Meeting the Challenges of Measuring and Preventing Maternal Mortality in the United States, discusses efforts to analyze and prevent future deaths. “I’m not worried about the virus,” Young told Guo. Thus, an important intervention to reduce black maternal mortality rates is to subsidize and increase access to quality mental health treatment focused on … * We use the term “birthing people” to recognize that not all people who become pregnant and give birth identify as a woman or a mother. The Listening to Mothers in California survey, led by the National Partnership for Women and Families and funded by CHCF and the Yellow Chair Foundation, found that almost one-third of Black mothers (PDF) reported that they did not feel the delivery room staff encouraged them to make decisions about their birth progression. Other high-income countries with success in preventing maternal deaths offer potential lessons for the U.S. In the words of Senator Harris, “When we address both the systematic disparities and implicit bias in both our society and our health care system, we can get to the point where being Black and pregnant is full of joy and free from fear of preventable death.”. Listen on Apple Podcasts. 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, researchers from the Centers for Disease Control and Prevention (CDC) report today in the Morbidity and Mortality Weekly Report (MMWR).. It comes from a study that measured the average “allostatic load” for blacks, whites, and Hispanics. But that study doesn’t seem to exist. Both Zephyrin and McLemore emphasized the importance of increasing perinatal access to telehealth services, including doula care. How is COVID-19 affecting maternity care in your community? Issue: Most maternal deaths are preventable, but they have been increasing in the United States. During Black Maternal Health Week, which is led by the Black Mamas Matter Alliance and held every April, California senator Kamala Harris wrote in Essence, “We must speak the truth about America’s history of health disparities that existed long before the coronavirus pandemic, including the grave ongoing crisis of Black maternal mortality.”. Anne Sunderland Basketball Legend, Community Activist, Modernizing Payment to Community Health Centers, Listening to Mothers in California survey, extending postpartum coverage can benefit, UCSF Pregnancy Coronavirus Outcomes Registry, New Year Brings California No Pandemic Relief, Only Nine Months After the Pandemic Began, a Vaccine Is Delivered, COVID-19 Providers Hampered by Intense Psychological Burden. After receiving numerous requests from labor and delivery nurses who wanted to better support pregnant patients who could no longer have a doula with them, Porchia-Albert created a “crash” doula course for nurses. “First, we must review, report, and learn from every single maternal death,” he said when outlining his multipoint plan for reducing black maternal mortality. Consider the following chart. Here are results from a large-scale study using NHANES data: The differences in allostatic load are tiny—about the equivalent of one IQ point on an intelligence test—and Hispanics have a higher allostatic load than either blacks or whites but the lowest maternal mortality rate. It's us but for your ears. The following chart from a CDC study is complicated, so take a look at it and then read the explanation: In this study, the researchers grouped hospitals as those that primarily served whites and those that primarily served blacks. The reason we know so little is that there’s hardly any funding for research into the causes and prevention of maternal mortality. Using standard deviations to normalize them, the three measures showed that blacks had a mean allostatic load that was 0.1, 0.2, and 0.29 SDs higher than whites. join us with a tax-deductible donation today. © 2021 California Health Care Foundation. Finally, a fourth study in New Orleans found that black mothers had a lower allostatic load than white mothers. Despite high-tech medical advances of the last century, women around the world are still dying in pregnancy and childbirth from age-old scourges such as hemorrhage and pre-eclampsia and, increasingly, from complications related to chronic diseases, obesity, and advanced maternal age. Although the numbers are alarming, the disparity in mortality rates for minority women are even more devastating, with Black women being three to four times more likely to die from a pregnancy-related complication than their white counterparts. But in mid-March, when Young went into labor just as Governor Gavin Newsom ordered Californians to stay at home to avoid spreading the novel coronavirus, her plans went awry. The African Union conference in Kampala which started on July 19 and will end July 27, has been discussing strategies to reduce maternal mortality. The registry “will track participants for a year to learn how the virus impacts maternal health, fetal development, preterm delivery, newborn health and outcomes for underserved women at higher risk of mortality during pregnancy,” Feldberg wrote. All Rights Reserved. The complications associated with pregnancy are often preventable with the right tools, precautions, and training. What you’d really like to see is a study that measures allostatic load in individuals during pregnancy and then analyzes whether it’s predictive of later maternal mortality. The numbers clearly demonstrate that the U.S. is one of the most dangerous high-income countries for Black women to give birth. And that societal racism is further expressed in a pervasive, longstanding racial bias in health care — including the dismissal of legitimate concerns and symptoms — that can help explain poor birth outcomes even in the case of black women with the most advantages. Yet, between 2000 and 2013, high Black maternal death rates placed the United States second worst in maternal mortality among 31 Organisation for Economic Co-operation and Development nations. And so far there is no published literature demonstrating that doulas actually reduce maternal mortality. This is shocking: we still have almost no idea of what’s going on even though this has been a well-known problem for more than two decades. Put all this together and the toxic stress/weathering hypotheses look shaky. Read on at your own risk. Pressley: What am I trying to do specific to maternal mortality rates? To reduce maternal mortality disparities and birth-related complications experienced by Black women, hospitals and other medical facilities can address implicit biases and improve their quality of care: Educate … Almost all maternal deaths (99%) occur in developing countries. Prior to joining CHCF, Xenia was a research assistant at the Prevention Institute, where she wrote about nutrition policy. Black women specifically have the highest maternal mortality rate in the U.S. and are nearly four times more likely to die from pregnancy-related causes compared to White women. According to the Centers for Disease Control (CDC), the maternal mortality rate for Black women in 2018 was more than 2.5 times higher than the maternal mortality rate of white women, and the infant mortality rate of babies born to Black women is more than 2.3 times higher than the infant mortality rate of babies born to white women. More than 10% of Black mothers reported that they were treated unfairly during their hospital stay because of their race or ethnicity. Solutions to Reduce Maternal Mortality and Morbidity. - “Because some of our clients may not have access to smartphones, we work via phone, text message, Zoom, FaceTime, as well as WhatsApp.”. What we’re left with is this: Poverty, education level, drinking, smoking, and genetic causes don’t seem to explain the black-white difference in maternal mortality. What it seems to tell us is that there’s a difference in when black mothers die. We already know that. This mystery is what makes the toxic stress hypothesis appealing: it seems reasonable, since black women of all incomes and education experience stressful incidents of racism throughout their lives, and nothing else seems to account for their higher rate of maternal mortality. Dean drove them to the hospital only to discover that new restrictions on visitors in labor and delivery rooms meant that Young would have to labor alone, Eileen Guo reported in the New York Times. Solutions to Reduce Maternal Mortality. Copyright © 2021 Mother Jones and the Foundation for National Progress. During Black Maternal Health Week, which is led by the Black Mamas Matter Alliance and held every April, California senator Kamala Harris wrote in Essence, “We must speak the truth about America’s history of health disparities that existed long before the coronavirus pandemic, including the grave ongoing crisis of Black maternal mortality.” “We immediately switched over to be able to provide virtual doula services, offered to all of our clients,” Porchia-Albert told Nina Bahadur in Self. Today, reader support makes up about two-thirds of our budget, allows us to dig deep on stories that matter, and lets us keep our reporting free for everyone. With any luck, that’s the kind of study we’ll now be able to conduct. For instance, the NBEC provides racial equity training sessions to … Chan School of Public Health The racial differences are modest and don’t seem to correlate well with maternal mortality anyway. We can also look at black-white differences in diagnostic indicators during and after delivery. By reducing care variation in the highest risk areas, hospitals and providers can begin to change the narrative on maternal mortality. While many countries have made progress in reducing maternal mortality, progress has stagnated or been reversed in many of the countries with the highest burden of maternal mortality:12 Most parts of the world are off-track to meet the MDG target of reducing maternal mortality.13 Perhaps even more puzzling for the toxic stress hypothesis, self-reported stress among the poor is lower for blacks than for whites: Poor blacks report less stress and higher levels of optimism than both poor whites and poor Hispanics. But for all its length, the article provides no real evidence for it. The maternal mortality crisis in the U.S. has long been a raw issue and the data makes it clear that it impacts Black women at twice the rate of many other racial groups. What about other measures of stress? A third study, unfortunately, doesn’t report standard deviations, but the results that were reported are consistent with a black-white difference of perhaps one-quarter of a standard deviation. A national conversation about the United States’ indefensible Black maternal mortality problem is underway. But many developing countries still have extremely high MMRs, and some countries with advanced economies (like the U.S.) have seen their MMRs increase over the past few decades. Maternal Mortality in the U.S.: A Human Rights Crisis. The issue is critical — but it's also not new. It’s unclear, however, whether these changes will continue after the pandemic. Maternal mortality is higher in the U.S. than any other developed country. Midwives Can Significantly Reduce Maternal Mortality, But They Need Support Posted on May 5, 2016 May 4, 2018 By: Kayla McGowan , Project Coordinator, Women and Health Initiative , Harvard T.H. Women in the United States are more likely to die from childbirth or pregnancy-related causes than other women … “Growing acceptance” is correct, and the toxic stress hypothesis is intuitively appealing. To reduce the mortality and morbidity associated with preterm births, policymakers should make screening available to the full extent of current evidence-based … More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia. Save big on a full year of investigations, ideas, and insights. The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 … Inexpensive, too! I got some pushback about this on Twitter, mostly saying that the delivery room was too narrow a focus. None of them appear to be the answer. Coronavirus notwithstanding, CHCF supports a portfolio of birth equity projects by, with, and for Black mothers and birthing people in California. As a mother who has experienced the consequences of poor maternal health systems in Uganda, I thought it was time to tackle this crucial yet often neglected area of maternal health. Can you pitch in a few bucks to help fund Mother Jones' investigative journalism? Governor Ralph Northam today announced his proposed budget will include approximately $22 million to combat maternal and infant mortality and reduce the racial disparity in Virginia’s maternal mortality rate. Terms of Service apply. Highly-educated black women, for example, experience maternal mortality at much higher levels than highly-educated white women. We noticed you have an ad blocker on. One study—also with large sample sizes—reviewed three different measures of allostatic load. Most pregnancy-related deaths are preventable. This makes the toxic stress hypothesis intuitively appealing, but it has little rigorous evidence supporting it. There’s some modest evidence that wider use of doulas could reduce both infant and maternal mortality, but no evidence that it would reduce the black-white gap. Another possibility is the timing of prenatal care, which differs moderately between black and white mothers, but studies suggest that it doesn’t explain the difference in maternal mortality either. To eliminate racial disparities in maternal mortality in this country, we must make a commitment to learn from every single maternal … But if toxic stress turns out not to be the answer, what is? Instead, she was worried that without her doula by her side, the delivery room staff would not listen to her. Can you pitch in a few bucks to help fund Mother Jones' investigative journalism? The enormous difference in black-white maternal mortality persists even in the state with by far the most success at addressing it.¹. First, pregnant individuals should be prioritized for COVID-19 testing, Laurie Zephyrin, MD, vice president of health care delivery system reform at the Commonwealth Fund, wrote in Stat. And last year, UNICEF reported that compared to other high-income countries, American women experience the highest rate of maternal mortality … The Preventing Maternal Deaths Act, signed in 2018, funds states to create committees to examine maternal mortality and morbidity rates. There’s no firmly accepted definition of allostatic load, but generally speaking it’s a combination of factors like high blood pressure, high cholesterol, and inflammation that are thought to be strongly influenced by long-term stress. The hospitals follow the lead of the California Maternal Quality Care Collaborative, an organization that has helped California dramatically reduce maternal death in a short amount of time and serves as an example of success. Hopefully a portion of this funding will be used specifically to study the black-white gap. As you can see, the black-white differences (black bars) are fairly small for most indicators. By signing up, you agree to our privacy policy and terms of use, and to receive messages from Mother Jones and our partners. At the very least I needed to look at the entirety of prenatal care, and beyond that the differences in black-white lifetime medical care. Data from the Centers for Disease Control and Prevention (CDC) on births between 2011 and 2014 revealed rates of 12.4 deaths per 100,000 live births for white women and 40.0 deaths per 100,000 live births for black women. Black women specifically have the highest maternal mortality rate in the U.S. and are nearly four times more likely to die from pregnancy-related causes compared to White women. 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