February 16th, 2021 BY HealthNetwork
Women of color experience life-threatening pregnancy complications more often than white women. And among Black women in particular, the rates are startlingly high.
Maternal death robs children of their mothers and leaves holes in communities. Families deserve better.
Experts are working to unpack the complex factors that contribute to higher complication rates among women of color. They hope that their efforts will contribute to systemic change and more equitable health outcomes for all women.
In the meantime, educating yourself on pregnancy concerns that disproportionately affect Black mothers can prepare you to advocate for your life and the lives of those you love.
Black Women and the Risk of Complications
For white women in the U.S., there are about 12.4 maternal deaths for every 100,000 live births. That’s a high death rate compared to other industrialized nations, but it pales in comparison to the maternal mortality rates that other American racial groups face.
Among non-Black women of color in the U.S., there are 17.8 pregnancy-related deaths for every 100,000 live births.
For Black women, though, that figure jumps to 40.0 deaths per 100,000 births.
Another set of figures shows that Black women are 243% more likely to die in pregnancy, childbirth or the postpartum period than white women.
Why are pregnancy-related deaths over three times higher among Black women? The reasons for this disparity are intertwined with the complex reality of systemic racism in America.
For some women, lack of access to quality healthcare services, whether in the early prenatal period or throughout the pregnancy, plays a part.
Black women often begin their pregnancies with a more vulnerable health status than their white counterparts. Again, for some women, this is a matter of inequitable healthcare access on account of socioeconomic status.
It’s not the only explanation, though.
The chronic stress of living in a society plagued by systemic racism takes its toll on Black women’s bodies. Researcher Arline Geronimus refers to this issue as “weathering.” As a result, pregnancy complications are more common among Black women in their 20s or 30s than those in their teens — even if older women have greater economic security.
To further exacerbate the problem, bias within the healthcare system means that Black women’s concerns aren’t always heard. Research shows that doctors and nurses tend to take white patients’ questions and complaints more seriously than those of people of color. That can have devastating consequences for Black mothers.
Pregnancy Complications to Watch For
In the face of clear disparities in outcomes for women of color, self-advocacy can be an indispensable tool. During your own pregnancy or that of someone you love, be on the lookout for signs of these complications that frequently affect Black mothers.
Also known as toxemia, preeclampsia is a condition that most often affects women during the second half of their pregnancies or even after childbirth. Symptoms include:
- High blood pressure
- Protein in the urine
- Swollen hands and feet
With an incidence rate of 70 cases for every 1,000 pregnancies, Black women are 60% more likely than white women to deal with preeclampsia. In one 2014 study, over 60% of Black mothers diagnosed with preeclampsia developed serious cases.
Bedrest and blood pressure medication are often recommended for women with preeclampsia. To save the mother or baby’s life, early induction is sometimes necessary. Doctors should continue monitoring the mother’s health for at least six weeks after childbirth.
Some cases of preeclampsia develop into eclampsia. Because Black women have a higher risk for severe preeclampsia than the general population, eclampsia is also a greater concern.
Eclampsia is characterized by seizures or loss of consciousness. Signs of eclampsia include:
- Double vision
- Swollen extremities
Intravenous magnesium sulfate can be used as an anti-seizure medication before or during labor. As with preeclampsia, inducing labor is sometimes essential.
Left untreated, eclampsia can be fatal for both mother and baby.
#3) Uterine Fibroids
The uterine wall sometimes develops noncancerous growths called fibroid tumors. These can affect women at any time, not just during pregnancy. But side effects during pregnancy may include placental abruption and preterm labor.
Nearly 25% of Black women between the ages of 18 and 30 have uterine fibroids. By contrast, just 6% of white women in this age group have them.
The incidence rate increases with age. Some estimates suggest that 60% of Black women over age 35 have uterine fibroids.
In addition to causing pregnancy problems, fibroids can also contribute to infertility, anemia and chronic pain.
#4) Gestational Diabetes
Even if you don’t have diabetes before pregnancy, you can develop a special form of this condition during pregnancy. Characterized by high blood sugar, gestational diabetes (GD) increases your risk of other conditions, such as:
- Preterm birth
- High blood pressure
Women of color, particularly those of Asian, Native American and Hispanic heritage, often face an increased risk of gestational diabetes. The risk of GD is comparable for both Black and white women.
That said, GD is a serious concern for Black women since this prenatal condition sometimes leads to type 2 diabetes down the road. And the risk for this is 52% higher among Black women than white women.
#5) Postpartum Hemorrhage
Some women experience a potentially fatal amount of blood loss after childbirth. This condition, known as postpartum hemorrhage, can occur right after delivery or weeks later. Symptoms include:
- Heavy vaginal bleeding
- Clammy skin
- Blurred vision
- Pale skin
- Elevated heart rate
These symptoms constitute an emergency. Don’t hesitate to call 911 or your doctor if you experience — or witness a friend experience — these symptoms. Without quick treatment, postpartum hemorrhage can lead to shock or even death.
Two factors that can contribute to postpartum hemorrhage are preeclampsia and fibroids.
Since Black women experience these conditions at higher rates than the general population, it’s not surprising that hemorrhaging is also more common among this group. Plus, among women who hemorrhage, Black women are more likely to die than white women.
Progress Towards a Healthier Future
While individual advocacy can be critical to saving one family at a time, mothers and babies will benefit most from system-wide improvements.
The United Nations Committee on the Elimination of Racial Discrimination (CERD) and Amnesty International have highlighted the effects that bias and systemic racism have on maternal outcomes.
Closer to home, Geronimus, the weathering researcher and a professor at the University of Michigan, advocates for Black mothers to receive high-risk pregnancy care at earlier ages than white women. And Ana Langer of Harvard T.H. Chan School of Public Health insists that maternal healthcare inequity should be considered a public health crisis.
Wanda Barfield, director of the CDC’s Division of Reproductive Health, encourages local jurisdictions to review instances of maternal death and submit the data to the CDC. Barfield and her colleagues hope that this data will provide life-saving insights for policymakers and practitioners.
You can stand up for maternal health equity, too.
To learn more about how you can get involved, check out the Black Mamas Matter Alliance and the Black Coalition for Safe Motherhood. These organizations offer resources and advocacy on behalf of mothers, babies and the people who love them.