An OB/GYN On The Maternal Health Disparities Black Women Face
Systemic racism not only limits Black communities' access to employment, housing, and education, but it also limits access to equal and appropriate health care. These inequities in the health care system are abundantly clear when it comes to Black maternal health.
After years of working as an OB/GYN, treating thousands of patients, and being a patient herself, Heather Irobunda, M.D., became aware of the discomfort many women—particularly women of color—face at doctor visits. She created an online platform to provide reliable and transparent information about women's health, and she believes it's her responsibility to remind the world that Black maternal lives matter, and Black babies matter, too.
In this Q&A with mbg, Irobunda discusses the health disparities between Black mothers and other women, the deep-rooted issues that cause them, and what needs to be done to change these outcomes.
We know Black women are disproportionately affected by maternal mortality, but what statistics are most shocking to you?
The U.S. has the worst maternal mortality rate among developed countries, and the rate has been rising since about 1990. According to the Centers for Disease Control (CDC), the current maternal mortality rate is 17.4 deaths per 100,000 moms. That means about 700 women die from a pregnancy-related death per year. To put it into some context, we rank right behind Russia in terms of maternal deaths worldwide.
In addition, the maternal mortality rate of Black mothers is much worse than the overall rate. According to the CDC, the Black maternal mortality rate is over three times the rate for white mothers (about 40 deaths per 100,000 moms in Black women). These statistics put the Black maternal mortality rate within the range of some developing countries.
Are these deaths preventable, and what can change the outcome going forward?
These deaths are largely preventable. One of the biggest ways to prevent these deaths is to listen to the issues that Black women present during pregnancy.
Many times, families and friends of women who have passed away say the mom had been voicing concerns about her health in the time leading up to her death. And oftentimes, there are accounts of the mom saying she felt unheard by her health care providers. We need to make a bigger effort to listen to these patients.
We also need to work on addressing implicit bias in members of the health care system. We need to invest in training to address these issues. There are larger societal discussions that need to be had about how our environmental factors and social factors affect the Black community because these larger issues are affecting the health of Black mothers.
Black women are also more likely to develop health complications while pregnant, compared to white women. Why is this?
Black women are more likely to develop a variety of health complications while pregnant. These complications include gestational diabetes, gestational hypertension, preeclampsia, and preterm labor. The reasons Black women are more likely to develop these complications are due to many societal factors, rooted in systemic racism and implicit bias.
Stereotypes about Black women's pain tolerance have been known to affect the care that Black women have received in health care settings. Black women are believed to have a higher pain tolerance than other women. It is thought that when Black women make health care providers aware of their pain, these health care providers may not take it as seriously. This has affected the way health care providers respond to Black women.
In addition, historical incidences of using Black people as unwitting research subjects in medicine have led to a distrust of the health care system by Black communities. Incidences like the Tuskegee syphilis trials and the painful experiments from OB/GYN J. Marion Sims lead to a lot of fear and can challenge an already fragile health care provider-patient relationship. These are just a few examples.
Why are women being blamed, and who should be held accountable?
Women are being blamed for these deaths and health complications. The argument is that if women engage in more unhealthy habits, they may end up with health problems that contribute to their deaths or health complications. Women are also being blamed for starting families later in life, which could cause them to have worse health outcomes.
It is damaging to make these claims because they do not take into account societal or environmental factors, which contribute to these increased health issues or behaviors.
For example, increasing studies show in both urban and rural regions in the U.S., there are areas where it's difficult to find fresh produce and healthier food options. These places are called food deserts and are believed to contribute to obesity. Women living in food deserts often have to buy less nutritious foods—due to lack of access and available options—contributing to worse health and health outcomes.
In terms of accountability, we need to hold our health care system and our government accountable. Many of the issues that cause these disparities in maternal health are systemic issues that are bigger than the individual. Not acknowledging these larger factors is damaging.
How else does systemic racism play a role in the death of Black mothers and babies?
Systemic racism, unfortunately, plays a huge role in the death of Black mothers and Black babies. It shows itself in medical education. Students are taught there is a genetic, instead of a societal, reason Black mothers and babies are more likely to have complications in pregnancy and childbirth.
It also shows itself in the communities that more Black women and babies live in. These communities tend to have a higher rate of unemployment, which directly affects access to health insurance and health care. As mentioned earlier, many of these areas also have less access to fresh and healthy foods.
In addition, there are not many Black physicians in medicine. Black physicians make up only 5% of all physicians in the U.S., and Black women only make up 2% of all physicians. Lack of representation causes a decrease in the Black perspective in health care. It also makes it hard for the health care system to recognize issues within the Black community and/or gain perspective on how to fix these issues.
What is reproductive justice, and why is it so important, especially for Black women?
Reproductive justice takes reproductive rights one step further. Reproductive rights ensure that women are able to have contraception and get proper health care when it comes to pregnancy and abortion care. Reproductive justice ensures that we use all of the tools available within our society to ensure that everyone gets equal access to reproductive rights, no matter the race or economic status.
It is born out of the concern that reproductive rights were only fully available to women of means and that women of lower socioeconomic status were not able to access all of their reproductive rights. This is so important, in general, but especially for Black women because, as shown by the differences in maternal mortality rates, there is an issue with Black women having proper access to all of the reproductive health care they should be getting.
What else should people know?
This is a huge topic that some scholars have dedicated their whole careers to studying. There are a lot of things that we know about health disparities and a lot that we still need to learn. It is wonderful that we are now starting to have a serious discussion about this because, through these discussions, we will find a path forward. All Americans have the right to be healthy, and taking these steps to work on improving health equity gets us closer to that goal.
For more resources, here are some organizations doing great work to support Black mothers.