Although many people in the United States would like to believe that they live in a “post-racial” society in which ethnicity plays no role, the reality is that what color your skin is does impact the kind of health care you receive. The quality of care that you obtain is closely tied to race, but there are complicating factors like economic status and racial predisposition for certain health conditions. All of these circumstances play a role in why women of color are more likely to die while giving birth.
Annually, from 700 to 1,200 women in the U.S. die due to pregnancy or childbirth, but African American women are three to four times more likely to die than Caucasian women. This statistic is shocking for a number of reasons; a higher percentage of American women die while carrying or delivering a child than in most other developed nations. Furthermore, it is absolutely astounding that one ethnic population is 300 to 400 percent more likely to die than another—in a health care system that is supposed to be blind to race.
Why is Maternal Mortality So High in the U.S.?
Currently in the United States, about 17 to 28 mothers in 100,000 die during pregnancy or childbirth. That is actually almost twice the rate from 30 years ago. It is also about three times the rate in the U.K. or Canada.
This steep rise in maternal deaths is largely related to a fractured health care system that partitions off primary care from maternity care. Many women in the U.S. lack access to the most basic of health care that would effectively treat health conditions like obesity, diabetes or high blood pressure that can make pregnancy or childbirth more dangerous. Because these conditions are becoming more prevalent in the U.S., the risk of maternal death is also on the rise. This is especially true for women of color in lower socioeconomic classes that may not have health coverage.
Unlike many other developed nations that provide universal health care that could manage these and other chronic health conditions, the U.S. does not guarantee access to health care. Although there are more resources like Medicaid for pregnant women, without more primary care to manage the health of the mother, there is a much higher risk of complications due to poor health.
Unfortunately, the American medical community prioritizes the life of the fetus or infant over that of the mother. This often means that obstetricians receive more training on fetal health than on maternal health, making them less prepared for any complications that threaten the mother.
There are also some trends in our culture that may be putting more women at risk. First of all, more women are waiting until a later age to get pregnant, whether through natural means or fertilization techniques. Older women face greater risks if they bear a child, and artificial reproduction often produces twins or triplets which can put additional strain on the mother. Finally, more women are opting for a Caesarian section which if performed multiple times can pose a fatal bleeding risk.
Finally, there is quite a disparity in health care quality between the financially well off and the poor. Unlike other countries that impose universal care standards throughout all regions, there is a sharp distinction between urban areas that have many more medical resources and rural areas that lack physicians and medical facilities.
Why Women of Color Are at Risk
Many of the reasons why maternity mortality is so high in the United States is even more applicable to African American women. Many African American women are uninsured or underinsured making getting appropriate health care difficult. Lower income African American women in urban or rural areas often go without treatment for dangerous chronic health conditions like high blood pressure or diabetes, putting them at greater risk if they become pregnant. Furthermore, many of these African American women may not have access to medical resources even if they can afford it as more medical maternity facilities are disappearing across the country. A report in the American Journal of Obstetrics and Gynecology found that 63 percent of white mothers gave birth in the highest rated hospitals compared to only 23 percent of African American women.
Lack of health care is complicated by other factors like a genetic predisposition for certain ailments like high blood pressure. Studies show that African Americans are more likely to develop high blood pressure at a younger age than other ethnic groups in the U.S. More than 40 percent of African Americans have high blood pressure compared to 27 percent among whites.
There are likely hereditary influences as well as cultural ones that make some conditions more prevalent in the African American community. Studies show that African Americans are 51 percent more likely to be obese than whites, and obesity is a major risk factor for high blood pressure, diabetes, and heart disease. Furthermore, there is often a cultural bias against the medical establishment in African American communities that may prevent them from seeking appropriate care for these conditions.
This cultural bias may also extend to pregnancy care. There are fewer African American women obstetricians in the U.S., which may pose a challenge for engendering strong doctor-patient relationships. This has prompted more medical organizations to use midwives and doulas of similar background throughout the pregnancy and post-delivery.
Although these factors do explain some of the disparity between white mothers and African American mothers, they do explain all of it. Among white women, maternal mortality is 12.7 per 100,000, but among African American women this reaches 43.5 per 100,000. Researchers admit that issues like income inequality, genetic predisposition and cultural resistance should account for some of this difference, but it is insufficient to justify all of it. This suggests that additional research is needed to fully understand the racial disparity in maternal mortality.
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