Black Maternal Health Week: Why We Need to Do Better for Black Women in the United States
By Elizabeth Dawes Gay
On April 11, 2018, the Black Mamas Matter Alliance is launching the first national Black Maternal Health Week, coinciding with both the US National Minority Health Month (April) and International Day for Maternal Health and Rights (April 11). Black Maternal Health Week seeks to bring attention to racial disparities in maternal health in the US and amplify the voices, expertise, and leadership of Black women on this important topic. Black women are three times more likely than white women to die from pregnancy-related causes and two times more likely to suffer pregnancy-related illnesses known as maternal morbidity. These disparities exist regardless of age, income, or education.
Black Maternal Health Week offers an opportunity to revisit Every Mother Counts’ Giving Birth in America series, which explores the variety of maternal health experiences of women across the US. Giving Birth in America: Louisiana looks at the unique experiences of Black mothers who face racial, gender, economic, and social barriers to good health. In this latest installment in the series, Brianna — an expecting first-time mother and young Black woman living in Baton Rouge, Louisiana — shares her concerns about avoiding a cesarean section and her desire to give birth as naturally as possible.
“I’m really excited to become a mom,” Brianna says through a smile. She goes on to admit, “I’m kind of scared of the actual birthing process. I really want to feel like I made the decision of how I wanted to proceed through my labor.” Brianna says she seeks out information to increase her knowledge about prenatal care and the birthing process. She also spoke to her mom about her own birthing experiences years before and decided that a vaginal birth was the right thing for her. “I wasn’t really afraid of giving birth in a hospital. What I was more afraid of was being forced into a cesarean section. That’s my biggest fear with giving birth — being induced.”
Brianna’s concerns are warranted. Louisiana has the second highest c-section delivery rate in the nation — 37.5% percent of infants are delivered by c-section. Louisiana’s neighbor Mississippi has the highest rate — 38.2% of deliveries there occur via c-section. The World Health Organization cautions that when cesareans rise higher than 10–15%, there is no evidence that c-section improves population-level maternal and infant mortality rates.
“Unfortunately, in our state we have a culture of providers — largely for convenience, either for the patients’ convenience or their convenience — doing inductions,” says Dr. Rebekah Gee MD, MPH, secretary of Louisiana’s Department of Health. “We know that [unless the circumstances are right], the inductions are more than twice as likely to lead to a cesarean section. And we know that cesarean sections have had major impacts on women’s health and are a contributor to death of moms, or maternal mortality.”
Maternal mortality is a growing concern for the United States overall and in the state of Louisiana, where mothers experience some of the worst outcomes in the nation. Available evidence indicates that Louisiana has one of the highest rates of maternal mortality in the nation and that Black women in the state are over three times more likely to die from pregnancy-related causes than white women, reflecting national racial disparity data.
This racial disparity in maternal death is likely caused by a variety of factors including lack of physical and financial access to high-quality health care, disproportionately higher rates of poverty and economic insecurity, social injustice and racial discrimination that causes stress, discrimination within the health care setting, and other social factors like education, housing, and transportation that all ultimately influence health.
Black women are already at greater risk of having unhealthy pregnancy outcomes. Unnecessary medical interventions, often the case with c-sections, only add to the risk that something could go wrong.
Women like Brianna must be supported, through helpful public policy and by medical practitioners, to have the births they want. For Brianna, that meant avoiding an induction and c-section. Fortunately, her hopes for a vaginal delivery became a reality and she gave birth to a healthy baby girl.
Nationally, the US Department of Health and Human Services wants to reduce the c-section rate for low-risk pregnancies to under 24% by 2020. As of 2016, one in three births occurred via c-section. The US has a long way to go. National policymakers, local leaders, and hospital management must give this issue more attention to reach national goals and help women have the births they want.