How Do We Fight Black Maternal Mortality in Virginia?

Black mothers are three times more likely to die during pregnancy.

RICHMOND-In Virginia, mothers die in 29.5 out of every 100,000 live births. More than half of those women are Black, according to the World Health Organization. It’s a problem unique to this country, whose 29.6% rate is significantly higher than most of the developed world. In fact, fewer women die during pregnancy in more than 50 other nations.

The Virginia Maternal Mortality Review Team (VMMRT) told WTVR in Feb., “maternal mortality declined more than 40% worldwide between 1990 and 2014. However during the same time period, there was an approximately 26% increase in maternal mortality rates in the United States.”

Most of these numbers consist of Black women. From 2013-2017, 52.6% of people who died from pregnancy related complications were Black. In Virginia, Black women are also two to three times more likely to die from pregnancy related causes than white women.

But there are people trying to make the Commonwealth a safer place for mothers of color. Rep. Donald McEachin is one example. Since 2020 began, Rep. McEachin has introduced bills that would aid at-risk mothers before, during and after pregnancy. As the father to two young women, the situation hits particularly close to home.

“Our country is facing a crisis – Black women are dying from preventable, pregnancy-related causes at two to three times the rate of white women. This is unacceptable and we have to do something to fix this,” McEachin said in a statement.

Maternal Mortality Rate in Virginia

According to the World Health Organization, the term “maternal mortality” describes any kind of pregnancy related death. This includes death resulting from complications before, during or one-year after childbirth.

The WHO reports these complications cause 75% of maternal deaths:

• severe bleeding (mostly bleeding after childbirth)
• infections (usually after childbirth)
• high blood pressure during pregnancy (pre-eclampsia and eclampsia) 
• complications from delivery
• unsafe abortion.

According to a 2018 study, Black women are 60% more likely to develop pre-eclampsia than white women. Pre-eclampsia when left untreated is potentially fatal. Dr. Lauren Powell, the CEO of health equity consulting firm The Equitist, said that the core cause of this disparity is structural racism.

The medical field has a long history of mistreating Black communities in America. And while there’s been improvement, that mistreatment hasn’t completely gone away. A 2016 study from the University of Virginia revealed that doctors routinely undertreat Black people for pain in comparison to white people. The study suggests that racial bias in the medical field is to blame.

“Many previous studies have shown that black Americans are undertreated for pain compared to white Americans, because physicians might assume black patients might abuse the medications or because they might not recognize the pain of their black patients in the first place.” said Kelly Hoffman, a UVA psychology Ph.D. candidate who led the study. “Our findings show that beliefs about black-white differences in biology may contribute to this disparity.”

Old myths still plague healthcare system

In this study, researchers gave 222 participants two mock medical cases- one with a Black patient and one with a white patient. Both cases involved a ruptured kidney and a leg fracture. The students were then asked to recommend treatments based on the level of pain the patients might be experiencing.

Researchers also asked several questions about biological differences between white and Black people. While there were some true differences included (i.e. susceptibility to heart disease), researchers also offered untrue but commonly believed differences as well. Myths like Black people aging at a slower rate or having thicker skin have no scientific backing. However, a substantial number of participants still believed them.

The study showed that half of the sample believed at least one myth. And participants who did believe these myths were more likely to report lower pain levels for the Black patient. Even worse, these myths have racist origins. During the 1800s, many of these falsehoods arose from slave owners and doctors to justify enslaving Black people.

But what does this have to do with maternal mortality rate? This discrimination means that Black mothers with pregnancy complications are at risk of not receiving the medical treatment they need. This leads to Black women having a greater chance of dying due to these untreated complications.

“We still have a lot of racism in the healthcare system,” said Dr. Powell. “That results in Black people receiving unequal treatment and women being told they don’t know what’s going on in their bodies. And that results in death and several other complicated outcomes. We need to make sure that people in these positions of power, like doctors and nurses, are able to treat everyone fairly.” 

Structural racism also contributes

However, this problem doesn’t end with health care. Structural racism, no matter how subtle, shapes every facet of a Black person’s life. Experts say there are many other factors, besides healthcare, that play a role in the high death rate of Black mothers in the United States. For example, the wage gap between Black and white women. 

“Black and Latina women are paid at the lowest rate. They make the least to the dollar compared to white men and other women in similar categories,” said Dr. Powell. “Think about the implications of that when having time to take off of work to take care of yourself while you’re pregnant. Think also about access to maternity leave and being able to take care of your child once they’ve been born.”

Another large factor is access to health care. Having no access to internet or reliable transportation can make it even more difficult to get appropriate prenatal care, especially during the current pandemic.

“When we have women who are pregnant or post-partum but can’t get to a hospital, that is a major social detriment as well,” said Powell.

“Equality does not equal equity,” added Erica McAfee. She works as a grief and loss counselor, as well as the host of Sisters in Loss podcast. “We have work to do when it comes to our own biases and how we show up for Black women. We must trust Black women, listen to Black women and respect Black women when it comes to their own health.”

How are legislators helping? 

Other states and cities across the country help mothers before, during and after their pregnancies. The city of San Francisco, for example, just launched a pilot program, providing expectant mothers with $1000 a month.

Dr. Powell hopes something similar happens in Virginia.

“That is the kind of thinking we need that goes beyond just thinking about medical intervention,” said Dr. Powell. “We need to think about how to make the total life for mothers, particularly Black mothers, much better.”

Thanks to Congressman McEachin, that might be a reality in the near future.

With the help of members from the Black Maternal Health Caucus, McEachin co-introduced The Black Maternal Health Momnibus Act of 2020- a play on the word “omnibus bill.” This Momnibus Act is a legislative package with nine new bills to address every dimension of the Black maternal health crisis. This includes veteran and incarcerated mothers as well.

These bills direct the Department of Health and Human Services to establish task forces and award grants for maternal mortality review committees, innovative maternity care models and other purposes.

The WHO states that poor women in remote areas are less likely to receive adequate health care. This act would require the Dept. of Housing and Urban Development to report on the impact of housing during prenatal and postpartum periods. The Department of Transportation would also do the same for transportation.

Currently, these bills are stuck in the Senate. Due to the pandemic, other COVID-related bills have taken priority to the Momnibus bills. However, McEachin predicts more movement in the next congressional session.

Educating expectant mothers

While legislation is still underway, it’s very important that potentially at-risk mothers educate themselves on ways to stay safe. Stephanie Spencer, registered nurse and the Founder of Urban Baby Beginnings, says the most important thing is to stay calm.

“Right now there’s a lot of fear-based messaging. And with that fear based tactic, there are a lot of Black women who know that they’re at high risk for death during their pregnancy,” said Spencer. “So what happens is women walk around in high levels of anxiety because they think any day now something is going to happen.” And this added stress could actually bring more harm to the mother and unborn baby.

The March of Dimes warns that high levels of stress during pregnancy can cause heart problems, high blood pressure and premature birth.

Besides this, Spencer also encourages Black mothers and their families to speak up when they’re concerned. Spencer recommends having an advocate like a doula, who is a trained companion to support families during significant health-related life experiences-to help boost more confidence.

“One of the important things that we have to remember is that we have a voice. The voice of Black women has been suppressed for a very long time,” said Spencer. “And when a voice has been suppressed, we’re not used to using it in situations where there’s a hierarchy. Specifically, when we get in front of doctors.”

Dr. Powell hopes that people’s biggest take away is that this issue isn’t separate. It’s one part of a much larger issues.

“If you’re a small business owner, pay your employees well. Have maternity leave. Have paid sick time off,” said Powell. “All these small things can make a difference.”

For more information on how to be supported during pregnancy, visit Urban Baby Beginnings here.

Arianna Coghill is a content producer for Dogwood. You can reach her at [email protected].