Earlier this year, Shalon Irving, a 36-year-old high ranking African American public health official at the Centers for Disease Control (CDC), died, just weeks after giving birth. In a dark twist of fate, Irving’s professional mission focused on addressing racial health disparities. Yet even she could not be protected.
The United States has the highest rate of maternal mortality of any industrialized country in the world (despite spending more money on healthcare than most countries). Between 700 and 1,200 women die every year from complications of pregnancy and childbirth—and another 60,000 come close to death.
Black women in the U.S., regardless of income level or education level, are three to four times more likely to die from pregnancy and childbirth complications than white women. According to the World Health Organization, black expectant and new mothers in the U.S. die at about the same rate as women in countries such as Mexico and Uzbekistan.
There isn’t one single factor that explains the disparity in death rates. But there is a lot we do know. We know that half of all maternal deaths in the United States could be prevented with better access to prenatal care, postpartum care, and skilled care during childbirth. We know that the most common causes of maternal death are heart conditions, hemorrhage, infection, pregnancy-induced high blood pressure, blood clots, and stroke. We also know that black women are not more likely to experience these complications during pregnancy or childbirth — but they are less likely to receive treatment for the conditions that could prevent them.
In a series by ProPublica and NPR, “Lost Mothers”, black women who survived “near death” experiences during pregnancy or childbirth share their stories. Reading through the accounts, it’s hard not to feel overwhelmed by what these women experienced. Although they survived, not all of their babies did — and their lives have been forever impacted by complications that may have been preventable.
According to a report on maternal mortality in the United States by the Center for Reproductive Rights:
Racial disparities in health are closely linked to economic disadvantage, reflecting systemic obstacles to health that disproportionately affect women of color. Factors such as poverty, lack of access to health care, social inequality, and exposure to racism all undermine health, and may contribute to the elevated number of Black maternal deaths.
Poverty and lack of access to healthcare clearly impact the health and lives of black women. Black women are more than twice as likely to live in poverty as white women. Black women make only 63 cents for every dollar a white man makes, for doing the same work. Black women are more likely to lack health insurance or even Medicaid coverage (because they tend to live in states that did not expand Medicaid under the Affordable Care Act). All of these are obstacles to receiving the prenatal and postpartum care, and access to skilled birth attendants, that all women need to protect their health and lives.
But if poverty plays a large role, why are black women like Shalon Irving and so many others dying, or nearly dying, at higher rates than white women regardless of income or education level? One of Irving’s closest friends, Raegan McDonald-Mosley, the chief medical officer for Planned Parenthood Federation of America, tells ProPublica:
It tells you that you can’t educate your way out of this problem. You can’t health-care-access your way out of this problem. There’s something inherently wrong with the system that’s not valuing the lives of black women equally to white women.
A system that does not value the lives of black women as it does white women is a racist system. And racism contributes to the care black women receive. Black women feel disrespected by their healthcare providers and develop a sense of mistrust for the healthcare system. Studies confirm that black patients receive unequal treatment compared to white patients.
For example, as Quartz reports, the most recent CDC data show that more than half of maternal deaths occur in the postpartum period, and one-third happen seven or more days after delivery. However, black women are twice as likely as white women to have postpartum depression and, notes Quartz, “much less likely to receive mental health treatment. If they experience discrimination or disrespect during pregnancy or childbirth, they may be more likely to skip postpartum visits to check on their own health (they do keep pediatrician appointments for their babies).”
But racism may also cause disease. Over time, racism contributes to stress and can compromise black women’s health and well-being. According to the CRR, “In the absence of sufficient resources to cope with the stress of racism, physiological responses may weather the Black body, leading to poor maternal health outcomes.”
What are we doing to protect black women’s health and lives? The question is best pointed at mainstream reproductive health and rights organizations, mainstream medical groups, health care providers, and other health advocates. Public health communities and black women have been fighting this battle for many years. The Black Mamas Matter Alliance was recently co-founded by SisterSong Reproductive Justice Collective and Center for Reproductive Rights to address the deep and abiding disparities between black mothers and white mothers.
Shalon Irving’s story is one of the thousands of black women in the U.S. who have died, despite having access to resources, information, and quality care. But unlike so many black women over the decades whose stories have suffered under the weight of silence, Irving’s death can be the alarm that sets off a more widespread and strategic set of solutions. We must do more to protect the lives of black mothers.