Why Black Women Are At High Risk of Dying From Pregnancy Complications

Why Black Women Are At High Risk of Dying From Pregnancy Complications

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Why Black Women Are At High Risk of Dying From Pregnancy Complications

 Black women are subjected to disproportionate maternal health outcomes leading to high death rates related to pregnancy complications. Health system and societal factors contribute to maternal mortality and poor health outcomes among African American women. These women are more likely to experience racial discrimination and other barriers while accessing health care services (Taylor et al., 2019). Structural racism in social service and healthcare delivery results in African American women accessing poor care quality than their white counterparts. Additionally, they are not treated with respect and dignity and are denied necessary care when in pain.  Institutional racism places black women at high risk of dying from pregnancy complications. 

Background of the Issue

The United States considers high maternal mortality rates a significant public health issue. Although the government has channeled adequate resources to improve hospital-based maternity care, United States is ranked among the worst industrialized nations for pregnancy-related mortality rates (Madeline, 2020). However, from a global perspective, the country’s maternal mortality rates are low but are increasing rapidly among African American women. These women face disparity in accessing maternal care resulting in poor health outcomes. Historically, African American populations have been denied opportunities for quality and safe care.  As a result, African American women receive reduced healthcare quality and are given less attention while accessing care. The inequality is prevalent among pregnant African American women who are four times likely to succumb to pregnancy-related complications (CDC, 2019). Healthcare disparities contribute to poor quality of care and pregnancy-related complications among African American pregnant women.

System barriers, including sexism and racism, contribute to income inequality and poor health outcomes among African American women. According to the National Partnership for Women & Families (2018), Black women’s median wages are $36,227 annually. The amount is $21,698 less than white, non-Hispanic men’s median wages. Because of these income differences, African American Women and their dependents have inadequate finances to support their households. Additionally, they are forced to choose between healthcare, food, childcare, and housing because of their inadequate income. Thus, African Americans’ poor economic status affects their use of healthcare services and health outcomes.

 Limited access to insurance coverage undermines African American women’s access to quality and safe care. According to National Partnership for Women & Families (2018), African American women are underinsured because of their socioeconomic status.  These financial barriers limit African Americans’ access to necessary care, including prenatal care. Consequently, African American women suffer from preventable chronic health illnesses and medical conditions like cardiovascular disease, hypertension, and diabetes. These health conditions affect pregnant women‘s health outcomes. Lack of adequate finances causes African American women to remain underinsured and suffer from preventable medical conditions that influence their pregnancy outcomes.

 Risk Factors Contributing to Black Women Disparity in Healthcare

 Pregnant black women are exposed to multiple risk factors like low socioeconomic status, poverty, poor physical health, and restricted to prenatal care access. According to American progress, these disparities emerge from African American’s women gender and racial discrimination in their lives. The disparities are as described:

Socioeconomic and Poverty Status

Despite controlling socio-economic status and education, black women are still at increased risk for infant and maternal mortality. Also, after controlling for health status, maternal age, and gestational age, the likelihood of dying from delivery or pregnancy complications are three times higher than non-Hispanic women(Novoa & Taylor, 2018). The authors also indicate that college-educated black women are likely to lose their babies than non-Hispanic white peers with the same level of education. These analyses suggest that both educated and non-educated African American women face disparities in accessing healthcare services. Black women, whether educated or undereducated are undervalued by the healthcare system. They are not monitored as their white counterparts. According to American Heart Association News (2019), healthcare workers tend to dismiss African American women’s symptoms, as in Serena Williams’ case. After delivering her baby, William experienced a pulmonary embolism but medics dismissed her concerns and took time to diagnose and treat her.  Thus, structural racism contributes to poor healthcare outcomes among African American women and their socioeconomic and poverty status.

Prenatal Care

Early and sufficient prenatal care reduces infant and maternal deaths and promotes healthy pregnancies. Prenatal care is characterized by counseling on healthy living, parent education, maternal health screening.  Despite the benefits of prenatal care, few black women have access to this essential care compared to their white counterparts. However, Novoa & Taylor(2018) state that black women who accessed prenatal care still recorded higher infant  death rates than non-Hispanic white women with no or late prenatal care. The disparities might be attributed to the differences in the quality of prenatal care accessed by black and non-Hispanic white women. Madeline (2020) substantiates the claim that the quality of prenatal care accessed by African American women is of poor quality than that of their counterparts. The poor quality results in pregnancy complications among African-American women. Therefore, poor quality of prenatal care accessed by African-American women contributes to their pregnancy-related complications.

Physical Health 

Pregnancy complications like preeclampsia are caused by obesity, a condition that is common among black women. However, Novoa & Taylor (2018) state that black women with normal weight are likely to die in their perinatal period than their counterparts who are obese. Accordingly, obese non-Hispanic whites experience a low-risk of pregnancy complications than their black counterparts.  Although obesity increases the risk of pregnancy complications, racial disparity in the healthcare systems worsens African American condition. This is because non- Hispanic white women are also obese but at a lower risk of pregnancy-complications (Novoa & Taylor, 2018). From the discussions, physical health, socio-economic status, poverty, and prenatal care access are not adequate to explain the disparity in pregnancy outcomes between white and black women. Policymakers should not ignore these factors while addressing African Americans lack of quality care and their discrimination in the healthcare sector.

African American Maternal Disparities

Most African American women are dying in childbirth and pregnancy.  Compared to women in other race/ethic groups, African American women are likely to die from pregnancy-related complications. According to Novoa & Taylor (2018), black women are at increased risk of experiencing preventable maternal deaths regardless of their education and income levels. Some of the most common medical complications that African Americans suffer during pregnancy include eclampsia, preeclampsia, postpartum hemorrhage, placenta previa, and abruptio placentae (Madeline, 2020).  African American women with these complications are likely to die than their white counterparts with identical medical conditions. Healthcare disparity is a factor that increases African-Americans risk of dying from pregnancy-related complications.

  Although there are hospitals that serve African American patients, the quality of care accessed is poor. According to National Partnership for Women & Families (2018), 75% of black women access maternal services from hospitals that primarily serve African American patients.  However, these hospitals’ maternal care quality is low, resulting in increased rates of complications for non-elective C-sections, elective deliveries, and high maternal mortality rates.  Howell et al. (2016) support the findings claiming that African American pregnant women accessing care in Black-serving hospitals report poor health outcomes. Since these women are less likely to access care in other facilities, they are compelled to tolerate life-threatening care.  Therefore, inaccessible options and inequitable care affects pregnancy health outcomes among black women. The disparities affect their delivery, regular check-ups, and prenatal care.

Addressing African American Maternal Disparities from a Nursing Leadership Perspective

 The increased maternal deaths and pregnancy complication among African American women are considered a human rights and public health emergency.  According to American Heart Association’s News (2019), most pregnancy-related deaths among black women are preventable. Therefore, nurse leaders can collaborate with communities, other healthcare providers, and policymakers to enhance African Women’s maternal health outcomes. They can advocate for the following strategies to reduce the likelihood of black women dying from pregnancy complications.

Expanding and maintaining their access to health coverage

 According to National Partnership for Women & Families (2018), 87% of African American Women of reproductive age are insured, while many remain uninsured throughout their lives. Therefore, nurse leaders should champion policies that expand and maintain black women’s access to coverage and care. With healthcare coverage, black women can access good maternity and prenatal care to enhance their children’s health and pregnancies. Uninsured pregnant women forego or delay prenatal care leading to higher maternal mortality rates. Therefore, expanding coverage will boost Black women’s access to quality maternal care. 

Providing Patient-Centered Care that reacts to Black Women’s Needs

Nurses and allied healthcare workers should ensure that American women access care of the highest quality, safe, culturally competent, and respectful.  Research indicates that women of black descent access poor acre quality than their white counterparts. Their discrimination in the healthcare sector worsens the situation. Therefore, nurses should ensure that medical practice and public policies focus on patient-centered care. Patient-centered care concentrates on meeting black women’s individual needs. Additionally, advanced practice nurses should champion health policies that remove discrimination and cultural biases in health education and health practices.  Healthcare systems should increase healthcare workers’ diversity in prenatal care and ensurr that healthcare workers are responsible for their facilities failing to offer evidence-based, high-quality, and unbiased care to African American women.

Expanding and Protecting Black Women Access to Competent Community Providers

 Black women access maternal, reproductive, and basic healthcare services from community health care providers.  Minus these services, African American women’s information about preventive care, prenatal care, annual exams, or birth control will be limited (National Partnership for Women & Families, 2018). Therefore, policymakers should increase funding for competent community-based providers to help African American pregnant women remain healthy throughout their pregnancy.

Improving Interactions between Healthcare Workers and Pregnant Black Women

  Training healthcare workers is necessary to reduce bias and discrimination of African American women when accessing prenatal care.  The training should enhance healthcare workers’ cultural competence to facilitate their delivery of care to an ethnically diverse patient population. The training should also incorporate midwives from diverse racial backgrounds to address black women’s reproductive health care needs and reduce maternal deaths related to pregnancy-related complications.

Conclusion

 Racial discrimination results in pregnant black women accessing poor care quality. Like their white counterparts, African American women deserve quality health care services and safe childbirth and pregnancies. Therefore, policymakers, nurse leaders, and communities should partner to address African American women’s barriers to accessing quality and safe care. Some of these barriers include racial bias and underinsurance. Systematic changes in the healthcare delivery system are necessary to enhance black women’s access to respectful, patient-centered, quality, and safe care that reflects their needs. These changes will ensure the optimal well-being and health of pregnant African-American women.

References

American Heart Association News. (2019, February 20). Why are black women at such high risk of dying from pregnancy complications? https://www.heart.org/en/news/2019/02/20/why-are-black-women-at-such-high-risk-of-dying-from-pregnancy-complications

CDC (2019, February 26). Pregnancy-related deaths. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm.

Howell, E. A., Egorova, N., Balbierz, A., Zeitlin, J., & Hebert, P. L. (2016). Black-white differences in severe maternal morbidity and site of care. American journal of obstetrics and gynecology, 214(1), 122-e1. https:/doi.org/ 10.1016/j.ajog.2015.08.019.

Madeline, C. (2020). Disbelieving black women to death; the double jeopardy: Racism and sexism affects black women’s access to and quality of care during pregnancy, birth, and postpartum. Theses/Capstones/Creative Projects, https://digitalcommons.unomaha.edu/cgi/viewcontent.cgi?article=1085&context=university_honors_program

National Partnership for Women & Families.(2018, April). Black women’s maternal health: A multifaceted approach to addressing persistent and dire health disparities. https://www.nationalpartnership.org/our-work/resources/health-care/maternity/black-womens-maternal-health-issue-brief.pdf

 Novoa, C., & Taylor, J.(2018, February 01). Exploring African Americans’ high maternal and infant death rates. Center for American Progress, https://www.americanprogress.org/issues/early-childhood/reports/2018/02/01/445576/exploring-african-americans-high-maternal-infant-death-rates/

 Taylor, J., Novoa, C., Hamm, K., & Phadke, S.(2019, May 2). Eliminating racial disparities in maternal and infant mortality. Center for American Progress, https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparities-maternal-infant-mortality/