RIO DE JANEIRO, BRAZIL – AUGUST 13: Tori Bowie of the United States celebrates after the Women’s … [+]
The recent death of Olympian Tori Bowie due to pregnancy complications has once again thrust the plight of Black mothers into the media spotlight. Despite random coverage, these tragedies are not isolated incidents. They reflect the impact of ongoing medical and public health neglect. These deaths expose the cost of systemic inaction.
We raise our heads when visible people like Serena Williams or Allyson Felix share their maternal health struggles, but research shows maternal mortality is most associated with socioeconomic factors such as poverty and lower educational attainment. When the lights fade, these are the mothers we leave behind.
This problem is not a mystery. The most common causes of maternal death are known.
Causes of maternal and pregnancy-related deaths.
Furthermore, according to a CDC report, “Black women were more than three times more likely than white women to die from complications of pregnancy, childbirth, and the puerperium. Possible explanations include differences in pregnancy-related morbidity, access to and use of healthcare services, and content and quality of care.”
The problem is, this CDC excerpt is from 1990.
We have been discussing Black maternal health disparities for at least 30 years. The same trends have been described recently in academic systematic reviews, by policy institutions like the Kaiser Family Foundation, the Center for American Progress and the United States of Care. Even insurers have acknowledged the urgent need to address these disparities.
“Preexisting chronic conditions, such as hypertension and diabetes, strongly correlate with higher severe maternal mortality and worse pregnancy outcomes,” says Dr. Adam L. Myers, M.D., chief clinical transformation officer for the Blue Cross Blue Shield Association. “To achieve better outcomes, we need to make sure care before pregnancy is easily accessible and equitable for all women, in addition to robust prenatal care and ongoing postpartum care to ensure the safety of future pregnancies.”
After decades of data collection and oratory, Black mothers do not need more summits and convenings. We are saturated with data, declarations and theories regarding disparate outcomes, whether weathering, medical bias or the impact of social determinants of health. Simply attributing these deaths to racism is not enough. Black mothers need urgent intervention to address the drivers of maternal death. Black mothers need action.
I have interviewed dozens of pregnant and recently pregnant women to gain a deeper understanding of the social context and drivers of maternal mortality. I have also interviewed some of their doctors. These conversations revealed crucial insights beyond our failure to hear Black mothers.
Health education is inadequate. Mothers described knowledge gaps spanning all stages of pregnancy, including preconception. For example, some mothers were unaware of the impact of hypertension and anemia on pregnancy outcomes. One mother who delivered three weeks early due to preeclampsia expressed her frustration: “When I went for my first prenatal visit, they told me everything was fine. Nobody told me my numbers could change later in my pregnancy.”
Furthermore, mental health support throughout and beyond pregnancy is urgently needed. Mothers consistently cited mental health, particularly in the third trimester and postpartum period, as their highest priority for support. Neglecting the mental well-being of mothers puts them at risk of adverse outcomes. Mental health support for Black mothers is also essential because so many suffer from chronic, toxic stress and weathering—the cumulative effect of chronic stressors like poverty and discrimination on physical and mental health, which ultimately result in higher disease risk. Accessible behavioral health resources can offset the impact of these stressors during pregnancy.
Most healthcare providers acknowledged the clinical and social biases influencing the care delivered to Medicaid-insured mothers. “We get implicit bias training but that doesn’t fix the problem,” said Dr. Carrie Carda, an OB physician based in Southern Missouri.
When asked to explain the root causes of maternal health disparities, doctors emphasized the need for upstream prevention, education and social support, particularly for mothers from underserved and under-resourced communities. My conversation with a geographically diverse group of obstetricians from Georgia, Maryland and Colorado reinforced these perspectives. These doctors were also less enthralled with the impact of bias training and cited the need for training in motivational interviewing.
“Black mothers need social, clinical, and community support,” says Dr. Kameelah Phillips, a board-certified, practicing OB/GYN on the front lines of Black maternal mortality in New York City. Phillips contends with the needs of Black mothers daily and believes social support begins with pregnancy and birthing education, home visits and social connection with other families and others. “The need for consistent and easy access to education, community-based and clinical services cannot be underestimated,” she says.
Dr. Kameelah Phillips, named among The Root 100 Most Influential African Americans in 2020.
Dr. Phillips believes healthcare executives must be willing to listen and implement changes needed to attract mothers into care. “We need insurance companies to facilitate access to care for mothers without the roadblock of routine denials, referrals, and prior authorizations,” she says. She cites frequent inability to access basic and standard healthcare tools like blood pressure monitors, fetal monitoring and nutrition consults. Her philosophy for addressing the maternal health crisis revolves around enveloping mothers in a safety net during the third trimester and postpartum period, during which they receive the education and support needed to identify and manage the physical and mental complications of pregnancy.
Continuing to sensationalize the issue of Black maternal death without taking meaningful action guided by existing data is a glaring indictment of our healthcare system. Healthcare executives and policymakers must demonstrate curiosity, demand accountability and implement change regardless of the return on investment. Otherwise, people are dying in the name of profit.
We may never fully understand the circumstances and context leading to Tori Bowie’s death. Her story likely represents many unseen and unheard mothers struggling with no clear direction about where and when to turn for support. I hope this tragedy creates a sense of urgency among healthcare executives and policymakers to tackle root causes and take targeted action to eliminate maternal health disparities. As Dr. Phillips says, “Enough talk. When are we going to act?”
Sadly, after more than 30 years and given all we know, it is probably now or never.