Systemic racism and relentless stress heighten Black women’s risk of life-threatening complications—and death—during and after pregnancy.
About a year ago, I was among some public health professionals talking about the recent election when the conversation inevitably turned to race. One population health researcher, a Black woman, took a deep, ragged breath. Her tears spilled over almost immediately as she talked about her constant worry for herself, her family and her friends. She paused now and again to try to collect herself. Her whole body shook as she wondered aloud whether any of the rest of us realized that, for her, a Saturday night out with a male friend meant being afraid the whole time that they might be pulled over.
“I know my PhD won’t mean anything then,” she said. “I know it won’t save us.”
I don’t really know this woman personally but I occasionally cross paths with her professionally. She is poised and witty and warm. She is still early in her career, but she has already dedicated her professional life to understanding why members of her community are dying from manageable conditions at extraordinary rates and alarmingly young ages. That day, she made clear that the anguish we were witnessing was something she almost never shows. She was exhausted, she said, and angry, and she didn’t know what to do about it.
I thought of that moment when I read about 36-year-old Shalon Irving, an epidemiologist at the Centers for Disease Control who died three weeks after giving birth of complications arising from high blood pressure. Lieutenant Commander Irving—she was a commissioned officer of the U.S. Public Health Service—had, like my colleague, dedicated her career as a researcher to eliminating disparities in healthcare access and health outcomes. And, like my colleague, she was Black.
Shalon Irving’s story was reported as part of the Lost Mothers series, a joint investigative effort by NPR and Pro Publica into maternal mortality in the United States. The authors of the article noted two significant factors that increase the risks faced by Black women during and after pregnancy: Racial bias in the healthcare system and the chronic stress of facing racism on an individual and systemic level in the larger society. It was the latter that brought me back to that day listening to my colleague struggle to maintain her composure as she talked about the fear that never, ever goes away.
The United States’ overall record on maternal deaths is abysmal. It’s even worse for Black women.
Among industrialized nations, the United States has the highest rate of maternal deaths due to pregnancy—defined as not only deaths during childbirth, but also during pregnancy itself, and after the baby is born if the cause of death is linked to the pregnancy. As maternal mortality rates decline in other countries, ours continues to rise.
Maternal mortality affects women of all races, income levels, and levels of education. NPR and Pro Publica found that for all women some key causes lie in the healthcare system itself. Most hospitals are much more prepared to respond to a fetus or infant in crisis than they are to respond to a mother in crisis. Hospital protocols for dealing with maternal complications are often dangerously unclear, and doctors and other medical staff aren’t always properly trained to recognize and respond to maternal emergencies. The postnatal care that most new mothers receive is often insufficient—a critical factor given that, according to the CDC, half of all maternal deaths occur in the days and weeks after the woman has given birth.
For Black women, race is the compounding factor that amplifies the crisis. Black women are 243% more likely than white women to die due to pregnancy-related complications. The maternal mortality rate for Black women in the United States—44 maternal deaths per every 100,000 live births—is about the same as the rate for women in Uzbekistan.
We have a tendency as a society to assume that when people of color experience poor health, it is due to lower socioeconomic status. We’re so accustomed to using race as a proxy for class that when people of color are in poorer health than white people, we tend to think it’s because people of color are poor. The reality is more complex.
Within any racial category, mothers with higher incomes and those who have gotten farther in their educations are at less risk than those who have lower incomes or lower levels of education—so Black women with advanced degrees suffer life-threatening complications less frequently than Black women without a high school diploma. But college-educated, upper middle class Black women still experience heightened risk. In 2016, the New York City Department of Health and Mental Hygiene analyzed four years’ worth of data (2008 to 2012) focusing solely on life-threatening complications during delivery among women having their babies in New York City’s public hospitals. The rates of “severe maternal morbidities,” as these complications are called, were so high among Black women that those who had earned a college degree or beyond still experienced significantly more complications during delivery than women of any other race who had not graduated from high school. Nationally, financially well-off Black women die at rates nearly equal to white women of all classes combined.
What puts Black women in such danger?
For one thing, racial bias continues to permeate every institution in our country, including our healthcare system. As part of their investigation, Pro Publica and NPR collected the stories of over 200 Black new mothers. “Over and over, black women told of medical providers who equated being African-American with being poor, uneducated, noncompliant and unworthy,” they reported in the Lost Mothers series. The women who shared their stories said their doctors and nurses didn’t seem to respect them, didn’t listen to their concerns, and didn’t take their pain seriously. One woman said her doctor made assumptions about her lifestyle based on the way she wore her hair. A Black woman in Brooklyn, NY, started bringing her white husband or white in-laws along to every single prenatal appointment because she felt like her doctor “felt contempt for [her] based on [her] race.” This bias keeps providers from really seeing their patients and honestly assessing—and managing—their risks.
And then there is the stress of being a Black woman in the United States.
Lost Mothers cites a 2010 National Institutes of Health study that found Black women living in the United States experience such consistently overwhelming day-to-day stress they literally age faster than white women physiologically. Because their internal organs are constantly bathed in stress hormones, Black women develop chronic conditions like diabetes, heart disease and high blood pressure at a higher rate and much earlier in life than white women—all of which can lead to serious complications during pregnancy. Therefore, although we consider a pregnancy high-risk for a white woman if she is over 40, the threshold age for high risk for a Black woman would be much younger, given that she is likely to be physiologically older than her age in years. Yet, virtually no one is doing this in practice.
We are talking here about something beyond ensuring access to care. We can and should make sure that every hospital in the country institutes all the right protocols for responding to maternal emergencies in the delivery room and we should train doctors and nurses to pay as much attention to the wellbeing of mothers as they do the wellbeing of infants. We can and should train OB/GYNs to provide comprehensive postnatal care and to educate new mothers on the importance of tending to their own health with the same commitment as they do their babies’. We can and should take on racism in the healthcare system, working to root out the conscious and unconscious bias of providers so they see their patients as individuals not stereotypes and develop greater empathy and the capacity to fully listen.
But after we did all of these things, we would still be left with this: Black women’s everyday lives are so relentlessly stressful that they are literally aging on fast forward, which erodes their health and makes their pregnancies more dangerous, even fatal.
According to a 2013 post on The Root, this stress comes from a combination of pressures at home and pressures from the outside world. And for women working in environments where they are one of only a few Black employees, particularly women working in professional positions—as up and coming young health researchers, for example—the stress can be even worse.
Achieving health equity—or social justice for that matter—isn’t just about making sure that everyone has access to the same resources. Yes, we must continue to work hard for universal access to high quality care. But we must also aim for a fundamental shift in our culture. We must center the voices and experiences of those who have been for too long ignored and we must seek change in a way that benefits everyone.
Health professionals must be made more aware of the stressors that Black women face. As for the rest of us, if you are a non-Black person, educate yourself about the issues that affect Black women, in healthcare and outside of it. Seek out the voices of Black women in journalism, on social media, in literature, and elsewhere. Give the Black women in your life the space to speak their truth.
Amplify Black women’s voices. Educate others in your circle. Figure out how you can help address the issues that impose such an emotional, and ultimately physical, burden on Black women—as well as how you need to change your behavior or your mindset to stop contributing to the problem.
It’s horrifying that any woman should experience so much stress from living her life in her own skin that it ages her cells faster and leaves her more vulnerable to life-threatening disease. It is horrifying that any woman should experience so much stress that she dies while giving birth to her child.
It is even more horrifying if, knowing about it, we continue to allow it to happen.
Photo Credit: © Can Stock Photo / gregory21