We generally think of childbirth as a routine occurrence, and while pregnancy can be a worrisome time for a number of reasons, maternal and infant mortality is rarely a top concern for parents-to-be.
But the truth is, the C.D.C. reports about 700 American women die each year in childbirth or due to pregnancy-related complications. Even more shockingly, each year more than 11,000 American infants die within 24 hours of their birth. This number comes from a 2015 report issued by Save the Children, which specifies that America has "50 percent more first-day deaths than all other industrialized countries combined.”
A closer look at these numbers reveals that one's likelihood of suffering these complications hinges on one factor: whether the mother and baby are black or white.
Black Infant Mortality Rates
While it is true that infant mortality rates are far lower than they were in the early 1900s, recent studies show that they are slowly on the rise. In recent years, the United States has fallen from the 12th lowest infant mortality rate to 32nd (out of 35 developed countries), and this figure is largely driven by the black infant mortality rate.
Black infants in America are now more than twice as likely to die as white infants — 11.3 per 1,000 black babies, compared with 4.9 per 1,000 white babies, according to the most recent government data. This racial disparity is wider than it was in 1850, 15 years before the end of slavery.
Black Maternal Mortality Rates
Black infant mortality is coupled with another glum statistic: the death and near death of black mothers. According to the C.D.C., black women are three to four times as likely to die from pregnancy-related causes as white women. This rate is higher than that of Mexico, where nearly half the population lives in poverty. As with infants, the high numbers for black women drive these national statistics.
The crisis of maternal mortality for black women crosses class lines as well, impacting black women above — even well above — the poverty line, as well as those below. The United States is one of only 13 countries in the world where the rate of maternal mortality is now worse than it was 25 years ago.
Serena Williams' Story
Serena Williams' recent near death experience after giving birth to her first child is a poignant example of this. While her pregnancy and the birth of her child were healthy and uneventful, she experienced near-fatal pulmonary blood clots immediately after giving birth. The medical team treating Williams did not believe she was in as much danger as she was, blaming her symptoms instead on the stress of childbirth and the pain medication prescribed after her c-section. Williams knew she needed a CT Scan to address what she knew to be clots, but the medical team refused and performed an ultrasound only, which did not reveal the clotting. Only after Williams lobbied hard for a CT Scan did the medical team concede.
Williams spoke openly about her experience, and stated that had she not advocated strongly for herself to receive the treatment she desperately needed, in all likelihood she would have died.
What Is Causing Higher Black Infant and Maternal Mortality Rates?
The reasons for the black/white disparity in both infant and maternal mortality have been debated by researchers and doctors for more than two decades. Recently, however, there has been growing acceptance of what has largely been a shocking idea: for black women in the United States, societal and systemic racism creates a kind of toxic physiological stress which leads to conditions — including hypertension and pre-eclampsia — that contribute to higher rates of infant and maternal death.This endemic racism is further expressed in a wide-spread, longstanding racial bias in health care. Dismissal of legitimate concerns and symptoms is one way this bias manifests itself, and it helps explain poor birth outcomes, even for wealthy, educated black women.
A 2012 psychological study showed that people assume that black people feel less pain than white people. The subjects —white, black, nurses, and nursing students — all demonstrated this bias, which professionals have termed the "racial empathy gap."
The disparity in perception of pain from medical professionals has implications for treatment across the medical spectrum. Other studies that investigate this bias have shown racial disparities in pain treatment for migraines and back issues, elder cancer care, and children suffering from bone fractures. A 2008 review of more than a decade of emergency room data showed that white patients complaining of pain were more likely to walk out with an opioid prescription than black patients with pain-related ER visits.
This may partially explain why black mothers and infants suffer higher mortality rates. Recently, black women have begun to come forward and share their stories of doctors disregarding their concerns.
In an April 2018 New York Times article, Simone Landrum shared her unsuccessful struggle to get her obstetrician to take her pain seriously in 2016. Her repeated complaints were routinely dismissed. “It was like he threw me away,” Landrum says angrily. A few weeks after her last visit with this OB, Landrum rushed to the hospital after she began to bleed. There, she gave birth to a stillborn daughter and came close to losing her own life. Once she recovered, she recalls, "The nurse told me: ‘You know, you been sick. You are very lucky to be alive.'"
What Can We Do?
Providing black mothers and their infants with continuous, proper care and dispelling the endemic racial biases are the keys to decreasing black infant and maternal mortality. Doulas can advocate for their patients when the patient herself isn't being heard or cannot advocate for herself.
One promising study revealed that receiving care from a doula has a positive outcome. A scientific examination of 26 studies of nearly 16,000 subjects first conducted in 2003 found that pregnant women who received the continuous support that doulas provide were 39% less likely to have C-sections. In general, women with continuous support tended to have babies who were healthier at birth. Last year, the American College of Obstetricians and Gynecologists released a statement noting that “evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor.”
Several organizations cater specifically to the needs of black mothers. The National Black Doulas Association keeps a directory of black doulas. The National Association to Advance Black Birth works to equip birth workers (doulas, midwives, nurses, and doctors) and maternity institutions with the practical tools and education they need to improve outcomes for Black women and persons. Health departments in Baltimore, New York, Tampa, and Chicago have attempted to combat high black infant mortality rates by training doulas who will work for low rates or pro bono to assist expectant mothers during pregnancy, delivery, and afterward.
Simone Landrum became pregnant again in 2017, but this time she connected with a doula from the Birthmark Doula Collective, an organization committed to birth justice in New Orleans. They ensure that anyone who needs their support can access it by providing their services on a sliding-scale for qualifying families. Birthmark has served 1,500 clients since their founding in 2011. Of these, only 10 infants have died, a lower rate than is typical in Louisiana and the United States at large. No mothers have died.
You can support this cause by donating directly to doula organizations that provide free or reduced services to women in need and by participating in Black Breastfeeding Week to raise awareness of and support for the particular challenges black mothers face.