The Black Maternal Health Crisis, Black Women Are Not Broken

The Black Maternal Health Crisis, Black Women Are Not Broken

The United States has the highest maternal mortality rate of industrialized nations. In 2020, the U.S. reported 23.8 deaths per 100,000 live births compared to Italy with a low of 2.7 and Canada at 8.4 deaths per 100,000 live births [1]. In addition to poor maternal outcomes, the U.S. has disparate outcomes amongst races. In 2020, the non-Hispanic Black maternal mortality rate (MMR) was 55.3 and in non-Hispanic White birthing persons it was 19.1 [2]. Racial maternal health disparities widened during COVID-19, as the MMR among non-Hispanic Black birthing persons increased 32.6% from 2018 to 2021 [3]. Within the same time frame, the MMR for non-Hispanic White birthing persons rose 11.7% [3].

In the state of Massachusetts, severe maternal morbidity (SMM) almost doubled from 2011 to 2020 at a rate of 52.3 to 100.4 deaths per 10,000 deliveries, with non-Hispanic Black birthing people dying at a rate of 2.5-fold of their non-Hispanic White counterparts [4]. In Massachusetts, as with many states attempting to address maternity care and disparate outcomes, there are many legislative, community, and private foundation initiatives to support efforts to address severe maternal morbidity.

In December of 2023, MassHealth announced that doula care would be a covered benefit. With this resolution, Massachusetts became the 10th state to implement doula coverage for birthing persons with Medicaid. The express purpose of MassHealth’s doula services program is to eliminate health inequities and promote positive outcomes and experiences for all birthing families. A doula is a non-medical support person who provides physical, emotional, and informational support to birthing people [5]. Doula care is associated with lower cesarean section rates and decreased preterm birth rates and other complications [6]. For many families, the out-of-pocket expense of doula care, which can run between $1,0003,000 in addition to preparing for a baby, is prohibitive.

In the early 1800s, birth was attended uniformly by women without degrees. Though women were barred from a formal education, they passed down knowledge and experiences from neighbors and through mother to daughter relationships [7] .“Granny midwives” were enslaved Black women who delivered babies on their plantations and in the surrounding communities. After emancipation, granny midwives continued to work with Black and White women in the rural South. As medicine and hospitals formalized, and birth became medicalized, the tides changed from almost all births in the country being at home to only 40% of births occurring at home by 1940 [8]. Granny midwives were forced out of the perinatal workforce through regulation and legislation, despite no evidence of superior outcomes.

Source: Johnson-Agbakwu CE. The Impact of Racism and the Sociopolitical Climate on the Birth Outcomes of Migrant Women, Mothers, and Birthing People in the United States. Medical Care. 2022.

How did Black women go from being the most experienced and well-trained hands, serving at home births, to being the people group with the worst obstetric outcomes? How is it that today only 7% of midwives [9] and 10.7% of ObGyns [10] are Black? Racism is the tie that binds.

Racial health disparities, as well as the lack of diversity in medicine are a result of racism. However, Black women are not broken, and the media should not continually plant seeds of fear in the minds of birthing persons with gruesome statistics. Instead, racism should be recognized at various levels –whether individual, interpersonal, community, or societal levels – as the root cause for racial health disparities to take an important step toward building a more equitable health landscape. We should focus our efforts on positive Black birthing experiences and showcase how having a positive culturally adept birth can affirm Black joy, culture, resilience, and strength so our country can mimic those standards of care. When we acknowledge that racism is pervasive in society, as well as in medicine, we can make targeted solutions that address the root causes and yield results.

Cherise Hamblin, MD, Assistant Professor, Obstetrics & Gynecology Medical Director, UMass Memorial Doula Program Director, URiM Community Workforce Development and Capacity Building Collaborative in Health Equity UMass Chan Medical School

Ahnyia Sanders, MS UMass Memorial Doula Program Coordinator