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Racial Maternal Health Disparity: 'We Need to Address Racism in All Forms'

Analysis  |  By Christopher Cheney  
   April 25, 2023

The maternal mortality rate for Black women is nearly three times higher than the maternal mortality rate for White women, according to federal statistics.

Addressing racism is crucial in addressing the high rate of maternal mortality among Black mothers, says Terri-Ann Bennett, MD, the new chief of Maternal-Fetal Medicine at Memorial Healthcare System.

The United States has one of the highest maternal mortality rates among industrialized countries. The maternal mortality rate for Black women in 2021 was 69.9 deaths per 100,000 live births, or 2.6 times the rate for White women, according to the U.S. Centers for Disease Control and Prevention.

In the racial maternal healthcare disparity, racism is "the elephant in the room," Bennett says. "The only way that we are truly going to impact significantly the maternal mortality crisis in the United States and the alarming disparities that affect Black pregnant women regardless of their education level and socioeconomic status is to first and foremost address racism. We need to address racism in all forms, including institutionally, systemic racism, and implicit bias."

This healthcare disparity needs to be approached from a multi-faceted level, including policy changes that address the historical racism within our healthcare system, she says. "Some of that has already started. Race has been removed from the Vaginal Birth After Cesarian Delivery calculator. That calculator helps to guide how patients are counseled about their success rate of being able to successfully have a vaginal delivery after they have had a Cesarian delivery. Historically, these kinds of tools have not had an equity lens, and unfortunately there has been underlying racism."

Racism has played a role in maternal care, Bennett says. "Racism affects how, when, and with whom Black pregnant people initiate and maintain prenatal care, the quality of that care, access to medications, medical and ancillary services, understanding and adherence to medical recommendations, and the necessary care required before, during, and after pregnancy. This affects the outcome of that person's pregnancy and the quality of the remainder of their and their baby's life."

Physicians have a role to play in addressing the healthcare disparity that is impacting Black mothers, she says. "Historical and modern renditions of racism have eroded the trust of physicians and healthcare systems at large, and it is up to us, currently practicing physicians, to correct this wrong and rebuild trust by re-imagining the physician-patient partnership."

Physicians need to address racism in their ranks, Bennett says. "There are physicians … that have racist practices and thoughts. Though implicit bias is defined as unconscious and unintentional, it is yet and still simply another form of racism. Taking an implicit bias course is merely a first step, an introduction; it is neither comprehensive nor a game changer. Racism can only be addressed by being antiracist. Much like love, antiracism is an action word. It takes intention, thoughtfulness, and deliberate and persistent action every day, with each patient encounter, every clinical impression, and every management decision."

Factors beyond racism in Black maternal mortality and morbidity

Beyond racism, maternal mortality and morbidity among Black mothers can be addressed in the pre-conception period, she says. "We can partner with people in the community so that we can ensure that we are addressing comorbidities such as hypertension, diabetes, and obesity—these are things we know are more prominent in the Black population. Once we can connect with the community, and we can make sure we are providing care that encourages people to enter into pregnancy in a more healthy way, that will allow for better pregnancy outcomes."

During pregnancy, establishing best practices and evidence-based protocols to ensure that equitable care is being provided across the maternal healthcare spectrum is extremely important, Bennett says. "Where you deliver your baby and who delivers your baby—down to the hospital and Zip Code—can impact your outcome. What that means to us as a health system is we need to be better—we need to make sure that every patient is being taken care of to our best ability. We need to minimize implicit biases that are definitely playing a role in how mothers are getting differential care. We also need to make sure as a community that we are elevating our standards and providing higher quality care, especially in our hospital systems that serve minority patients."

Memorial Healthcare System is committed to addressing the racial healthcare disparity in maternal care, she says. "What we can do specifically as a health system is create policies to make sure we are up-to-date on the most evidence-based medicine. We can also make sure through peer reviews and reviewing cases that not only ended in a poor outcome but also with near misses that we can go back and change our policies to ensure that we are addressing every single element that could have impacted care."

Related: Addressing Maternal Mortality Through Cardiovascular Care

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Racism is "the elephant in the room" in the racial maternal health disparity, says Terri-Ann Bennett, MD, the new chief of Maternal-Fetal Medicine at Memorial Healthcare System.

Racism has eroded trust in physicians and the healthcare system in general, and currently practicing physicians can help to repair the damage, she says.

Maternal mortality and morbidity among Black mothers can be reduced in the pre-conception period by addressing co-morbidities such as hypertension, diabetes, and obesity, she says.


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