“The past months have been profoundly difficult for our nation, and for Black communities in particular,” said Representative Lauren Underwood (D-IL-14) at a recent March of Dimes event on the impact of structural racism on maternal health. COVID-19 has highlighted health outcome inequity caused by race and racism. Though Black people constitute 13 percent of the U.S. population, the CDC estimates they represent over 30 percent of COVID-19 cases.
This racial disparity is present across many health outcomes and uniquely impact mothers and babies. During the H1N1 pandemic in 2009, data from Illinois showed that Black and Hispanic patients were two to three times more likely to be hospitalized with H1N1, said Jaqueline Howard, a reporter for CNN Health. Black women are 2.5 times more likely than white women to die during childbirth. “Influence and education, and even celebrity status, don’t shield women of color from some of these outcomes,” said Stacey D. Stewart, President and CEO of March of Dimes.
The social determinants of health, or underlying environmental conditions, disproportionately impact Black people’s health. Dr. Robyn Jones, Senior Medical Director of Women’s Health at Johnson & Johnson cited dense housing environments, poor air and water quality, reliance on crowded public transit, and lack of healthcare access as prominent factors in the Black community that influence health outcomes. For many Black people, lack of access to health care goes beyond limitations in access to a physical health facility. Centuries of racism, mistreatment, and neglect by medical professionals has led to a distrust of the medical system and the construction of invisible barriers to quality care, Jones said.
Simply experiencing racism can be a determinant for racial inequities in maternal health, said Jones. Weathering, or the physiological consequences of constant stress conditions, contributes to these health disparities. Constant exposure to discrimination creates a persistent “fight or flight” response, said Jones. The hormones and neurotransmitters released during this kind of stress are also related to non-communicable diseases like hypertension, heart disease, diabetes, and other chronic conditions persistent in Black communities. Additionally, the weathering effect is associated with an eight years shorter lifespan for Black women than white women. “Being presented with chronic stress of being Black in the U.S. is weathering us. It is physically aging us, physically making us more susceptible to chronic illness,” said Jones.
Emergencies like the COVID-19 pandemic exacerbate racial biases, but data on healthcare systems and medical schools demonstrate a long history of anti-Black teachings, said Dr. Dierdre Cooper Owens, Charles and Linda Wilson Professor in the History of Medicine and Director of Humanities in Medicine at the University of Nebraska-Lincoln. The belief that Black people have a higher pain tolerance and other outdated ideas can be traced to the Jim Crow era, when much of America was racially segregated, she said. Another common misconception is that increased representation of Black medical professionals in hospitals can address these structural biases. However, even hospitals with predominantly non-white staff experience high rates of poor health outcomes among Black patients, largely because these hospitals often lack proper resources. Solutions to these issues involve changing systems, not individual behaviors, said Owens, and to be sustainable, these changes must occur outside of crisis situations.
Policy change plays a large role in the systematic reform needed to improve Black maternal health outcomes. The bipartisan Preventing Maternal Deaths Act of 2018 was a crucial first step to reduce disparities, said Charles Johnson, founder of 4Kira4Moms. Johnson shared the story of losing his wife Kira to internal bleeding after a scheduled C-section and his subsequent journey advocating for policy change to address the systemic issues that caused her death. The Momnibus Act, recently introduced by Representative Underwood, Representative Alma Adams (D-NC-12), and other members of the Black Maternal Health Caucus calls for mental health care reform, resources for women in the military, advancing telemedicine, and funding Black-led community organizations.
“This is not a women’s issue, this is not a Black issue, this is a human rights issue,” said Johnson.
Sources: Centers for Disease Control and Prevention, PLoS One.
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