Black Maternal Health Week is recognized each year from April 11-17 to raise awareness and inspire action for improving Black maternal health outcomes. Dr. Methodius Tuuli, chief of the Department of Obstetrics and Gynecology at both Women & Infants Hospital and Brown University’s Warren Alpert Medical School and who is also a Chace-Joukowsky professor, spoke with Providence Business News about Black maternal health challenges and outcomes.
PBN: What unique maternal health challenges do Black women face and why?
TUULI: Black women in the U.S. bear a disproportionate burden of maternal mortality and morbidity. A recent report from the CDC [Centers for Disease Control and Prevention] shows that Black women have a two- to three-fold higher risk of pregnancy-related mortality than their white counterparts.
Black communities are also more likely to experience discrimination and poor experiences during pregnancy and delivery. The are several interrelated reasons for this.
First, there is a long history of structural racism against Black women. This means that the structures of human value, and access and quality of maternity care disadvantages Black women. There is a phenomenon called “weathering”, which refers to the effects that adverse life experiences, including racism and stress, have on Black women, increasing their vulnerability to chronic medical conditions and priming them for adverse pregnancy outcomes. As a result, Black women are more likely to enter pregnancy with conditions such as diabetes and hypertension that increase their risk for complications.
Second, access to quality maternity care is a challenge for many Black women. For example, they are more likely to be on Medicaid, which may not even be accepted by some maternity care providers. Moreover, due to the history of redlining and other factors, Black women are more likely to live in areas where there is either limited access to maternity care or the birthing facilities in those areas may be of lower quality.
Third, implicit and explicit bias among health workers may result in differential care and discrimination. There is the well-publicized lived experience by Black women showing that they are not listened to, and their complaints are often dismissed. As a result, there is mistrust of health systems by Black women, which leads to less engagement with the health system.
Fourth, a large proportion of health, including maternal health, is determined by factors outside of health care. Social determinants of health – the conditions in which people are born, grow and live – have an important impact on their health. These adverse social determinants of health, including lack of stable housing, nutritional food, transportation, social support and paid maternity leave, disproportionately affect Black women, contributing to an increased risk of maternal mortality and morbidity.
PBN: How have you seen these challenges evolve over the past several years?
TUULI: The challenges in maternal health faced by Black women have been long-standing. However, it has become more prominent in the public domain in recent years. The data shows that overall maternal mortality in the U.S. has increased over the years, and the two- to three-fold higher risk among Black women has persisted.
Mental health conditions now contribute to over 20% of maternal deaths in the U.S. It is also now recognized that the leading causes of maternal mortality differ by race and ethnicity. For example, while mental health conditions are the leading cause of mortality among Hispanic women, cardiovascular disease is the leading cause among Black women.
PBN: What can be done to improve maternal health outcomes for Black women?
TUULI: Just as the contributing factors to adverse maternal outcomes among Black women are many, approaches to addressing them must be multipronged.
First, health systems must work with communities to design maternity care that is patient-centered, coordinated, of high quality, and centered on the dignity and individuality of each pregnant person.
Second, efforts are needed to address systemic racism, as well as implicit and explicit bias in maternity care. While anti-racism training alone may not be effective, designing equity-centered policies and procedures, and holding maternity care providers accountable for suboptimal behavior may help.
Third, there is a need to address adverse social determinants of perinatal health. This requires universal screening during pregnancy and postpartum for these drivers and the development of effective systems to effectively address them. Policies that increase access to support persons such as doulas during pregnancy and delivery would help Black women advocate for their care.
Fourth, there is an urgent need at the societal and policy level to advance policies that prioritize maternal health by facilitating access to high-quality, respectful maternity care. Policies that ensure that pregnant people have competitive health insurance up to at least 12 months postpartum are in the right direction.
Policy changes are also needed to increase and diversify the maternity care workforce, including certified nurse midwives and providers of color. A policy for paid maternity leave in the U.S. would promote maternal health in general, and in Black women in particular.
Finally, there is the need for research to better understand the causes and develop and test innovative approaches to improve Black maternal health.
PBN: What is being done to improve Black maternal health and prevent pregnancy-related deaths?
TUULI: Several initiatives are underway to improve Black maternal health and prevent pregnancy-related deaths. Several states, including Rhode Island, have maternal mortality review committees that review maternal deaths to identify gaps that inform recommendations toward prevention.
Many health systems, including Care New England [ Health System], have programs aimed at promoting equity. The NIH [National Institutes of Health], Office of Minority Health [at the U.S. Department of Health and Human Services] and foundations are funding research and programs in collaboration with communities to design and implement programs to improve maternal health and reduce disparities in maternal mortality and morbidity.
Health systems are also developing programs to systematically screen for and attempt to address adverse social determinants of health. These all constitute an important start, but much more concerted efforts are needed.
PBN: How was Black Maternal Health Week founded?
TUULI: Black Maternal Health Week was founded by the Black Mamas Matter Alliance with the goal of raising awareness, promoting activism and fostering community-building to address the health disparities faced by Black mothers.
The first Black Maternal Health Week took place in 2018. This annual weeklong event is meant to amplify the voices, perspectives and lived experiences of Black mothers and birthing people. The week intentionally coincides with National Minority Health Month and begins on April 11 annually. This date is also recognized as International Day for Maternal Health and Rights, which advocates for the elimination of maternal mortality worldwide. The theme for the 2024 Black Maternal Health Week is: “Our Bodies STILL Belong to Us: Reproductive Justice NOW!”
Katie Castellani is a PBN staff writer. You may contact her at Castellani@PBN.com.
