With everything going on in the world today, we feel it is important to discuss how systemic racism in America affects the world of women’s health. Specifically, how it contributes to the rates of maternal mortality in the United States.
American females are 50% more likely to die in childbirth today than when our mothers gave birth. According to NIH, maternal mortality rates in the United States have increased in the last two decades, while the international trend is in the opposite direction. This is a big problem for the United States. Usually, these rates are used as indicators of the quality of a country’s healthcare system, not to mention the tragedy that the loss of a mother and partner creates for a family.
Unfortunately, the medical industry is also marred with the impact of systemic racism. Black females are 4 times more likely to die in childbirth than white women even if they have no previous health condition, putting them at greater risk during pregnancy, delivery and postpartum. The fact is, in some areas of the United States, pregnancy can be as risky as in some developing countries. Research also indicates that over half of life threatening pregnancy events and maternal deaths are preventable.
Why is this happening?
According to NIH, quality of care is key for determining the outcome of a pregnancy.
What are the problems?
There are three problem areas that feed into the issue of maternal mortality in the United States:
Underperforming hospitals serve a disproportionate number of racial and ethnic minority women. In conditions like this, women do not have proper access to quality prenatal care. According to NIH, among pregnancy related deaths, 24.5% had not started prenatal care until the 2nd or 3rd trimester, and 8.5% had not received any prenatal care. Access is a key issue. 31% of generalist OBGYNs were not satisfied with the maternal medicine services available to them for their patients.
2. Provider factors
In many cases, these deaths would have been preventable if not for a delay in diagnosis or treatment on the part of the healthcare provider. The role of implicit bias in the scope of maternal mortality rates in the US cannot be ignored. Research indicates that these biases impact how a healthcare professional assesses pain levels and administers treatment to his or her patients. A pro-white bias correlates with perceptions of poorer communication and quality of care for Black patients. Because these attitudes are implicit, meaning not consciously recognized, providers do not always realize the impact they have on their work. One study revealed that 84% of providers agreed disparities in care impact their practice, but only 29% believed personal biases affected how they care for their patients
3. Communication issues
The combination of a lack of access to quality care and the role that implicit biases play in influencing the behaviors of a healthcare provider creates communication barriers between doctors and patients. These lapses in understanding can then prevent providers from being able to intervene appropriately when an issue arises with a pregnancy, and patients from feeling properly understood and cared for.
There is a need for healthcare providers who are culturally competent and actively practice strategies to reduce implicit biases. Luckily, there has been a sizable amount of research performed on reducing implicit biases. In fact, simply increasing a physician’s awareness of his or her susceptibility to implicit bias changes behavior.
However, awareness is not enough to produce systemic change. Providers need specific strategies to reduce implicit biases. Two that have proven effective are:
- Individuating: The provider focuses on specific information about an individual, such as the names of their children or more information about their life story, which makes their individuality more salient in decision making, and stops the provider from filling in partial information with information based on stereotypes.
- Perspective-taking: the provider makes a conscious effort to envision the viewpoint of the patient, which can be helpful when trying to accurately assess pain levels.
A combination of education and practicing these two tactics is likely the best way for providers to address and minimize the impact of their implicit biases.
Medical racism is real. It manifests in the quality of care given to white versus black patients. It manifests in the racial breakdown of active physicians -- 56.2% white and 5.0% black in 2018. It manifests in a lack of access to quality medical care for racial and ethnic minority women, and thus higher rates of maternal mortality.
In a developed nation like the United States, pregnancy should not be dangerous. Here at Binto, we provide access to care for every female in the hopes of lifting up those who might not otherwise have access to quality prenatal care. It is our duty as providers to treat every human with respect. Every mama deserves a safe and healthy pregnancy, and it is our mission to do what we can to support you every step of the way.
Want to get more involved? Give back to your community through programs like the Maternity Care Coalition. As always, if you have any questions or comments, you can reach out to one of our healthcare professionals using the chat feature on our website.