A recent study from the National Bureau of Economic Research (NBER) found that the wealthiest women and their infants are more likely to have better childbirth outcomes than those who are not. Unless they’re Black, that is, where new statistics reveal a disproportionate impact on people of color, regardless of income level.
The study documents an unconscionable national health emergency. NBER’s analysis covered nearly 2 million childbirths in the state of California over a nine-year timeframe. And it found Black infant mortality at the top income bracket is nearly 23 percent higher than that of white infants at the bottom bracket. It also found the maternal mortality rate for Black mothers at top income levels is similar to that of white mothers at the lowest.
“This evidence,” the study’s authors noted, “implies that policies seeking to achieve racial health equity cannot succeed if they only target economic markers of disadvantage.”
We’ve known the obvious and egregious imbalance of maternal mortality among women of color, which should have already spurred a national call to action. Historically, limited access to healthcare, insurance, transportation and economic challenges have all played a role in marginalizing many Black women from receiving quality prenatal and postnatal care.
Now, the NBER study raises even larger concerns: Black families that can afford healthcare are experiencing higher rates of maternal mortality. Why?
Experts cite the effects of systemic racism regardless of economic status. Black women encounter “untoward experiences” and face bias by medical professionals, conscious or unconscious. Some of these patients express concerns that their pain won’t be taken seriously. Others fear hospital security may be called based simply on the color of their skin.
These experiences deny pregnant Black women — those able to pay — from receiving the care they deserve. We can’t ignore it; we must listen, learn and do the necessary work to minimize this community’s unacceptably high risk of pregnancy complications.
Tennis star Serena Williams said she wasn’t taken seriously when a near-death moment threatened her pregnancy. She lost feeling in both of her legs and began to experience pain. Hospital staff initially dismissed her, but she insisted on having an exam performed in light of her past history of blood clots. Her doctor eventually agreed, and the results showed the presence of dangerous clots that required immediate surgery to save her life.
“Being heard and appropriately treated was the difference between life and death for me,” Williams said at the time. “In the U.S., Black women are nearly three times more likely to die during or after childbirth than their white counterparts. … Many of these deaths are considered by experts to be preventable.”
Such statistics are likely to worsen. The U.S. Supreme Court’s decision to overturn Roe v. Wade will inevitably restrict OB-GYN access for all women in states where abortion is illegal. And new data shows rural hospitals are closing their maternity departments in record numbers. Between 2015 and 2019, nearly 90 of these divisions were shuttered across the country. By 2020, almost half of rural hospital centers didn’t even offer obstetrics care.
Nearly two years ago the Biden administration called maternal mortality a “crisis” and outlined a series of steps to try and address it. There’s been little action since to turn those ideas into action. We need leaders in Congress to respond with a sense of urgency and find solutions.
A collection of bills in Congress, known as the Black Maternal Health Momnibus Act, hopes to do just that by advancing initiatives to improve the health of Black women. Led by Rep. Lauren Underwood (D-Ill.), the expedient passage of these bills will help save countless human lives. Over 250 organizations have expressed support for the national legislative package, including CVS Health, the American Public Health Association, the National Medical Association, March of Dimes and Johnson & Johnson, among many others.
Robust funding is needed to recruit and train medical professionals too — especially those of color — so that Black women in need of OB-GYN support can plan for pregnancies without fear of potential bias. Yet nothing will change until we accept that Black maternal mortality statistics in America are inexcusable.
We have empirical proof that we are failing this community. The question lawmakers must ask themselves is: What are we going to do about it?
Lyndon Haviland, DrPH, MPH, is a distinguished scholar at the CUNY School of Public Health and Health Policy.