The health disparities that exist for Black mothers in America are well documented. Black women are three to four times more likely to die from childbirth than their White counterparts. Yet, aside from listing “being Black” as a risk factor for maternal death, little has been done to address this alarming statistic. The inaugural Black Maternal Health Week, held from April 11–17, 2018, sought to change this through offering a forum for continued conversation. Importantly, they shed light on an oft-overlooked but significant distinction: The huge disparities between Black and White maternal mortality are not due to race, but racism.
Dr. Joia Crear-Perry, founder of the National Birth Equity Collaborative, asserts, “Based on well-established data, risk factors are categorized as modifiable or non-modifiable, and health-care providers use them to counsel patients on how they can avoid or decrease their likelihood of death or disease. Knowing the risk factors allows patients to do things like get tested earlier for an illness or, for example, participate in a smoking cessation program. Risk factors can include attributes like fair skin for melanoma, which you can’t modify but you can cover or add sunscreen. But no one’s saying that whiteness is a risk factor for melanoma.”
Dr. Crear-Perry’s definition of a risk factor brings a new perspective to the issue of racism and maternal death. Seeing race as a risk factor for maternal death would suggest that there is some genetic predisposition that has been passed to Black mothers, much like Tay-Sachs disease is common among individuals of Eastern European descent. This is not the case, however. A growing body of research indicates that, in fact, the stress caused by discrimination plays a noteworthy role in both maternal and infant mortality.
NPQ’s own coverage reflects this. In Megan Aebi’s “Race and Health, and Doulas for Social Justice,” she says, “Research has demonstrated that such disparities—like the egregious race-based difference in maternal mortality and increased rates of preterm birth—reflect differences in quality of care, decreased access to care, discriminatory treatment, and other social determinants of health.” In NPQ’s “Racial Health Disparities are Well Documented,” we saw how even when Black mothers are well educated, wealthy, and have access to healthcare, they still face a higher maternal mortality rate.
Taken together, all the research suggests that the reason Black women are dying at disproportionately high rates is actually due to racism. Whether it is from invisible bias leading to sub-par care, or a lifetime of discrimination leading to chronic stress, racism seems to be the culprit.
Amani Nuru-Jeter, an epidemiologist at the University of California, Berkeley, is researching how chronic stress from discrimination causes biological changes that lead to health disparities. She says, “Prolonged elevation and circulation of the stress hormones in our bodies can be very toxic and compromise our body’s ability to regulate key biological systems like our cardiovascular system, our inflammatory system, our neuroendocrine system. It just gets us really out of whack and leaves us susceptible to a bunch of poor health outcomes.”
In other words, there is no inherent biological risk factor for maternal death associated with being Black. We need to stop thinking of race as a risk factor because it gives the impression that there is nothing we can do to change these health outcomes. Rather, we need to call it what it is. Racism is a risk factor for maternal death, and we can do something about that.—Sheela Nimishakavi