Is there a nurse in the 'House'?
Black maternal mortality rates and the implicit biases — how can we address them?
Maybe you've heard the story of Kira Johnson. In April 2016, Kira died from severe internal hemorrhaging, hours after giving birth by routine cesarean to her second son.
According to the Centers for Disease Control and Prevention, half of all maternal mortalities in the U.S. are preventable.
In Kira's case, her doctors cut her bladder during her cesarean - and then allegedly failed to act. For over 10 hours, Kira's family begged doctors to investigate visible signs of internal bleeding, which the doctors ignored until it was too late.
If you don't know Kira's story, you probably know someone like Kira who tragically lost their life while trying to bring a child into this world, or you know someone that came close to losing their lives during childbirth.
Although maternal mortality in the U.S. affects women from all places and all backgrounds at high rates, it disproportionately impacts women of color. Research also suggests women of color experience discrimination from their maternal care providers, and their birthing outcomes, particularly among Black women, correlate to their experience of racism. Most alarming is that Black women are 3 to 4 times more likely to die from pregnancy-related deaths than white women.
To combat rising maternal mortality rates and the implicit biases that affect them, we need to move forward on legislative action.
Several bills in Congress address the issue. Still, the Black Maternal Health Caucus' Momnibus and the Mothers and Offspring Mortality and Morbidity Awareness Act, or MOMMA's, would specifically address maternal health disparities through improving data collection and reporting on maternal mortality; improving maternal care; expanding Medicaid and CHIP coverage, and advancing respectful, equitable care.
Currently, the U.S. has no official maternal mortality rate because there is no standardized process for how states report and analyze deaths, nor is the data aggregated at the federal level. As a result, the CDC is unable to discern causes or establish preventative measures around maternal mortality. We need a reporting process that is uniform; we must put systems in place to regularly collect data at the federal level and share it with healthcare providers and researchers.
By streamlining the data collection process, we can also improve maternal care, including providers' ability to recognize maternal complications and signs of maternal distress that often result in infant and maternal mortality.
Another issue related to maternal care and mortality is the lack of insurance coverage in the months following delivery. In 2017, 43 percent of births were covered by Medicaid, mostly for women of color. Still, Medicaid coverage ends approximately 60 days postpartum, while half of the maternal deaths happen between 42 days and one year postpartum. To help prevent these deaths, the MOMMA's Act seeks to extend Medicaid coverage for pregnant women to one year after they give birth. We need to ensure that, even after their babies are born, mothers are still cared for.
Finally, we have to directly address the disproportionate impact of maternal mortality on women of color by training providers in offering care that is culturally competent and free of implicit bias. Health systems must be aware and respectful of cultural norms when providing care, and be mindful of buying into stereotypes based on race, ethnicity, and even underlying medical conditions like diabetes, which often lead to perceived discrimination and perpetuate systems of injustice. Finally, health systems must be accountable to mothers and families and have processes for listening to concerns about respectful care and addressing those concerns head-on.
The U.S. has the highest maternal mortality rates in the developed world. Behind every death is a tragic story like Kira's that is completely preventable. In our country, children are growing up motherless because our health care system has failed their families. Mothers should not die when we have all of the medical resources to save them. Congress must take action and pass the Momnibus and the MOMMAs Acts so that families have what they need to grow with dignity.
Katie Shea Barrett, MPH, is the executive director of March for Moms. This organization aligns the diverse voices of families, health care providers, policymakers, and partners to advocate for mothers' and families' health, well-being, and equal access to care.