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An Update on the Nationwide Black Maternal Health Crisis

Written by Vaishnavi Peyyety, Red & Black Current Events Staff Writer  

Dr. Charvonne Holliday'08 speaks at Dieter-Porter in 2019 about the extensive work she has done in the field of social determinants of health and intimate partner violence. (Courtesy W&J College)
FEB. 15, 2023 - Disparities in patientprovider communication within the first prenatal visit for patients of various racial backgrounds are ever-present and alarming. Washington & Jefferson College graduate Arabella Thompson studied this research subject at UPMC Magee-Women’s-Hospital under the guidance of Dr. Judy Chang, M.D. and Dr. Abisola Olaniyan, PhD, MBBS, MPH. The research teaanalyzed 468 recorded first obstetric conversations between pregnant patients and their OBGYN and found various racial and social stressors in these conversations.

Unfortunately, the issue does not just lie in first prenatal visits. It stems from the era of slavery when the “father of gynecology” Dr. John Sims, pioneer of the Vescio-vaginal fistulae in the 1840s, relied on Black enslaved women to be his patients and surgical assistants for various gynecological procedures. Black women (without consent) underwent the painful Vescio-vaginal fistulae procedure and supported Dr. Sims in carrying out this same procedure on other Black women. Not only was this unjustified, but also these Black women are rarely given credit for their help in perfecting the procedure.

This malpractice also bolstered the idea that Black individuals were “immune to pain,” a notion that is still present in our society as evidenced by a study published in 2015 in the Proceedings of the National
Academies of Science where 40 percent of medical trainees believing that “Black
people’s skin is thicker than white people’s” Additionally, the baseless belief that Black women are less sensitive to pain than white women can be seen through a study published in 2012 at the NIH that indicated Black people are 22 percent less likely to receive pain medications than White people.

Even more alarming are the statistics on maternal and fetal death rates between Black individuals and their counterparts The pregnancy-related mortality rate in Black individuals is over three times that
of their White counterparts (41.4 per 100,000 versus 13.7 per 100,000). So, what do we know about the causes of this crisis? Fifty-nine percent of the maternal mortality disparity is due to four
conditions (eclampsia and preeclampsia, postpartum cardiomyopathy, obstetric embolism and obstetric hemorrhage). Although the rates of these conditions vary between different populations of women, Black individuals are 2.3 to 5 times more likely to suffer from these conditions.

During COVID-19, this death rate increased while socioeconomic and racial disparities widened for underprivileged communities. Furthermore, a study published in the National Vital Statistics Report found that the infant mortality rate in Black women is 2.3 times that of White women (10.4 per 1,000 versus 4.4 per 1,000).

“The pregnancy-related mortality rate in Black women is over three times that of White women”

In terms of the Black maternal death rate, the only statistically significant contributor is the cortisol effect which explains how day-to-day stressors that Black women face raise levels of cortisol (chronic stress hormone) in their bodies. These stressors can range from small microaggressions to large acts of discrimination. A heightened cortisol level throughout their lives may lead to inflammation tha restricts blood flow to the placenta which in turn slows infant growth. Increased levels of this stress hormone can also trigger preterm labor, leading to the low birth weight seen among Black infants.

Greater awareness of maternal and infant mortality rates in Black women has led to an increase in efforts to improve health outcomes and reduce disparities, including the introduction of the Black
Maternal Health Momnibus Act of 2021 to the House of Congress.
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