It is a sobering statistic. A Black woman living in the United States is three times more likely to die from a pregnancy-related cause than a White woman. Even more alarming, the United States has the worst maternal mortality rate of all high-income countries.
Black Maternal Health Week, which takes place every April, is an important opportunity to raise awareness about these health inequities—differences in health status, available resources, or access among different races, genders, ages, sexual orientations, or other groups—and discuss ways to reduce the disparities that exist.
While progress has been made, experts say there is still a tremendous amount of work that needs to be done to narrow these gaps. “A lot of people are unaware of how huge the discrepancy is with Black maternal health care,” says Bernice Adu-Amankwa, MD, an obstetrician and gynecologist at Summit Health. “The country, as a whole, has done a better job of highlighting and discussing this important topic over the last few years. But we can do more.”
The first step in reducing these health disparities, she explains, is to identify and understand what causes these inequities to exist. In Black maternal health, the reasons are multifactorial and interrelated.
Access to Care and Socioeconomic Status
One of the largest determinants is access to care. The ability to obtain preventive, primary, or routine care is more difficult for individuals of a lower socioeconomic status.
In the United States, Black individuals are twice as likely as Whites to live in poverty. This creates a significant barrier to care as more Black women are uninsured, on Medicaid, or unable to afford quality health care when compared with Caucasian women.
“Lack of access to care has a domino effect on our health that ultimately leads to higher rates of Black maternal mortality,” explains Dr. Adu-Amankwa.
Chronic Conditions and Preventive Care
Black people suffer from disproportionately higher rates of obesity, diabetes, and high blood pressure. These chronic conditions have a negative impact on maternal health, including pregnancy and childbirth.
Maintaining a healthy lifestyle is key to controlling many of these diseases and conditions. Individuals of lower socioeconomic status are less likely to have access to fresh, nutritious foods or have as much leisure time to exercise regularly.
Discrimination, Bias, and Distrust
While socioeconomic status, insurance, and related access to care explain part of the difference in Black maternal mortality, research shows that racial disparity exists at every education and socioeconomic level.
Prejudice, discrimination, stereotypes, and implicit bias exist in health care just as they do in the larger society, and even unintentional behavior can prove harmful. Implicit bias refers to the unconscious prejudice individuals might feel about another group or person. In a 2016 study, oncology physicians whose implicit bias tests showed greater bias, had shorter interactions with their black patients, and their patients rated the interactions as less supportive and had less confidence in the recommended treatments.
Distrust of the system can lead to delays in care, an increase in chronic health conditions, and ultimately higher rates of maternal mortality for Black women.
The Path Forward
At Summit Health, Black Maternal Health Week is an opportunity for leadership, providers, and staff to focus on ways they can reduce these gaps in care. Dr. Adu-Amankwa’s colleagues often ask her what they can do to help in their own practices. Here are three suggestions that can have a big impact.
- Raise Awareness. “The first step to solving any problem is knowing what the problem is,” she says. “We need to bring more awareness and attention to the fact that this inequality exists. This will help improve access and early intervention for Black women.” Therefore, this spring, Summit Health will offer in-person workshops for all our maternal health practitioners titled, “Understanding Unconscious Bias for Reproductive Health Clinicians.”
- Identify Your Own Biases. “Everyone should take time for introspection,” advises Dr. Adu-Amankwa. “If you really look with careful consideration, you will probably realize there are areas where you have intrinsic biases.” A very widely referenced tool is the self-test administered by Project Implicit found here. We all need to be aware of our biases and the impact they have on people in order to deliver high-quality, connected care, to every patient, every time. Summit Health is currently offering classes to targeted groups and plans to launch organization-wide classes in the second half of the year.
- Listen Carefully. “Pay attention to what your patients are telling you and understand the roadblocks that exist in their care. There are many layers. They may have health insurance but be unable to afford transportation to the office or a certain medication,” she says. As part of our Summit Health Care Coordination team, our Social Work Care Managers are able to address some of these barriers to care by providing community resource information and special assistance to patients, and, when necessary, acting as the link between the patient and the community resource provider. This assistance may include coordination of transportation, scheduling of home health aides, senior center or daycare services, set up of personal safety devices and home medical equipment, home meal delivery, and more.
Summit Health has made health equity a focus and encourages you to let us know if there are ways in which we can continue to offer ever better care to our patients.