- Black and indigenous women are two to three times more likely than their white peers to die from pregnancy complications.
- Having a trained support person, like a doula, can help improve outcomes, but during the pandemic many hospitals are limiting support people.
- That makes it especially important for Black and indigenous women to be able to advocate for proper care.
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Compared to the rest of the developed world, the United States has a shockingly high maternal mortality rate. Each each, 700 American women die of pregnancy complications. The burden of maternal mortality isn't spread evenly: Black and indigenous women are two to three times more likely to die during the pregnancy or postpartum period than their white peers.
"It is often mistakenly attributed to socio-economic differences, but when you look at Black women with a college degree, the disparity is still present," said Lenorre Clarke, MD, an OB/GYN with Riverside University Health System in Moreno Valley, California. "Meaning, affluent Black women are still more likely to experience maternal mortality when compared to White women."
While it's clear that internal biases and systemic racism are at play, researchers can't pinpoint exactly why Black and Native American women are at increased risk.
"The causes of these differences are being studied, but at this time we don't have a definitive explanation for this disheartening disparity," Clarke said.
The pandemic makes advocacy even harder
While there aren't yet clear solutions for closing the maternal mortality gap, research has shown that having a support person like a doula can reduce risk for Black women, Clarke said.
During the pandemic, however, it's not always possible for women to have a support person with them.
"COVID brings extra challenges for women, as there are typically limitations for visitors and support personnel," Clarke said.
While some doulas are offering virtual support for laboring mothers, the role of advocacy often falls on pregnant and laboring women themselves.
"It is important for women to know that they can and should be active participants in their health care," Clarke said. "It is imperative to ask questions and ensure that your care plan is clear to you."
The language of advocacy
Clarke says it's important that Black and indigenous women are honest with themselves about the risks that they face.
"Pregnancy and childbirth are too often portrayed in a fantasized fashion, but people's lives are at stake," she said. "Find a physician who you can establish a good doctor-patient relationship with, get early and regular prenatal care, and never be afraid to speak up for yourself."
Here's how you can advocate for yourself:
- Early on, bring race into the conversation. A recent guide published by the New York Times urges women to speak up about race early on. The authors suggest saying something like, "I recently read that Black women like me have a much higher chance of death related to pregnancy and childbirth than white women. That's really scary. What do you think about these statistics, and how we can work together to prevent that from happening?"
- Trust your intuition. Even tennis great Serena Williams famously needed to advocate for her health after delivering her daughter, Olympia. Despite her expertise, and history of blood clots, a nurse initially dismissed her worries. Williams said that women need to be prepared to demand that their health care providers listen to their concerns. "I think it's important to speak up loud and clear and say: 'No, this isn't right. Treat me the same way that you're treating [someone else]," she told Essence.
- Consider a Black doctor. Recent research suggests that Black babies are less likely to experience health complications if they have a Black doctor. "Black doctors may be more in tune with the specific experience that black newborns are facing, [such as] more challenging births as the result of increased socioeconomic pressures," said study author Brad Greenwood, of George Mason University.
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