Racial Disparity in the HealthCare System
Mid-April I participated in a national webinar hosted by the Doulas of North America during Black Maternal Health Week. Their focus is health equity. Jennie Joseph, a respected health advocate for women and newborn babies led the webinar and she was fired up. She told the doulas on the call to move from awareness to action; to join her in the perinatal revolution. The time is now. I felt a little uncomfortable sitting in my beautiful OMazing studio listening.
A couple of years ago I read a chilling New York Times Magazine article, Why America’s Black Mothers and Babies are in a Life and Death Crisis by Linda Villarosa. That day, I learned that, according to the CDC, black women are three to four times as likely to die from pregnancy-related causes as white women - a rate higher than Mexico, where nearly half the population lives in poverty. I remember being stunned to learn that American Black infants are more than twice as likely to die as white infants: 11.3 per 1,000 black babies, vs 4.9 per 1,000 white babies. Ms. Villarosa points out that this racial disparity is worse than in it was in 1850, 15 years before the end of slavery. Shamefully, the US is one of thirteen countries in the world where the mortality rate is worse today than it was twenty-five years ago.
These statistics are abhorrent.
Racial disparities are not isolated to the health care system. They are deeply rooted inequalities across society, politics and the economy. There are many reasons why black women have worse birth outcomes than white women. The stress of living with racial bias can contribute to complications in pregnancy like hypertension and pre-eclampsia. Those conditions can lead higher rates of infant and maternal loss. Vallarosa writes “societal racism is further expressed in a pervasive, longstanding racial bias in health care — including the dismissal of legitimate concerns and symptoms — that can help explain poor birth outcomes even in the case of black women with the most advantages.”
This is not a class issue. This crisis exists for black women across all socio-economic populations.
My good friend, Nyitur is South Sudanese. She and her husband have suffered terrible racism in this country. To such an extreme they are in the middle of a malpractice lawsuit. Andrew suffered a stroke in 2014 and was misdiagnosed. First the doctors treated him like a drug addict. Next, they thought he had malaria. He had no use of his left side. Hours passed before he was diagnosed and treated for a stroke. Six years later, Andrew is still unable to talk in complete sentences and will never work again.
Eight months after Andrew’s stroke, Nyitur gave birth to her daughter Athiei. She arrived at the hospital in active labor. She knew birth was imminent based on her three previous births. Her contractions were strong and painful. Her three older children were born rapidly so she was anxious to settle into her hospital room. When she arrived at the hospital, the Labor and Delivery nurse performed her routine cervical check. She proclaimed Nyitur was not dilated enough to be admitted. They sent her home. Both adamantly and politely Nyitur begged to stay. She knew the baby was coming soon. The nurse firmly refused. “You don’t know. Every birth is different”. Defeated, Nyitur and her friend Susan left the hospital and drove twenty minutes home to Nyitur’s apartment. Less than ten minutes later they were on their way back to the hospital. Fortunately, the nurses admitted her because in less than an hour later, Athiei was born.
I wonder, if based on my whiteness if I would have been able to convince the nurse to let me stay? I don’t know. I am sure that I would have been more irritated than Nyitur was. Everything rolls off her back. She laughed when she told me the story again this week. “They didn’t believe me that I needed to stay! I knew my baby was coming. I am happy she wasn’t born in Susan’s car!”
Once I asked where Nyitur was born. With a big smile and told me that she was born in a field in Sudan by her grandmother. So much has changed for Nyitur in just one generation. I wonder how her daughter will be treated in the birth room. Research has demonstrated a disparity among immigrant and native-born mothers. “Black immigrant women—mostly from African and Caribbean countries—who arrived in the United States as adults enjoy better birth outcomes than native-born African American women.” (Tiffany L. Green, “Black and Immigrant: Exploring the Effects of Ethnicity and Foreign-Born Status on Infant Health” )
It doesn’t stop with the birth. It’s harder for African-American women to receive postpartum care than it is for white women. Regardless of race, it’s difficult for some women to seek support after having a baby. Mental health can be stigmatized. New mothers don’t know what is normal. In this frightening article written in the New York Magazine “Do I Really Want to Hurt My Baby?Inside the disturbing thoughts that haunt new parents.” a woman, Emilia struggles with intrusive thoughts. She thinks about harming her baby. She lives in fear of admitting her truth. She has no idea her thoughts were common and could be treated. She finds help and feels better. Her story shines a light on a huge problem in our country with postpartum regardless of race.
Postpartum mood disorders are real. One in five women suffer some degree of depression, anxiety, OCD, bipolar or even psychosis. And then, for people of color… imagine the additional stigma preventing them from seeking help. NPR reported on Morning Edition November 29, 2019, that "the black community don't know postpartum," as one woman put it. "There's this expectation on us as women of color that we have to be these superhero strong, that we're not allowed to be vulnerable."
We have a lot of work to do to bring health equity to this country. It’s not just in the maternal world. You are probably seeing these sickening COVID statistics:
· 36% of coronavirus deaths recorded in Wisconsin have been among blacks, though they comprise just 6.7 % of the state’s population.
· 71% of fatalities around Memphis, Tennessee are Africans Americans, who make up half the population.
· 56% of Chicago’s deaths have been African American, though they make up just 30 % of the city’s population. (African Americans struggle with the Disproportionate COVID Death Toll, Rodney Brooks)
Chicago’s Mayor Lori E. Lightfoot said the numbers are “troubling” and “a stark reminder of the deep-seated issues which have long created disparate health impacts in communities across Chicago.” There are so many issues: health, socio-economic, poverty, education and systematic racism. But as highlighted in the Brooks article, “it’s the healthcare disparity that’s driving the epidemic.”
I ask myself: what do I do with this awareness?
What is my action?
In 2018 when I read the New York Times article, I was in the midst of earning my doula certification. I felt hopeful when I read that being a doula can be part of the solution. Doulas are advocates for mothers. Doulas witness the birth and can potentially minimize tragedy. Dána-Ain Davis, the director of the Center for the Study of Women and Society at the City University of New York, said in the Times article that “at the point a woman is most vulnerable, she has another set of ears and another voice to help get through some of the potentially traumatic decisions that have to be made.”
My volunteer work at the University of Utah has provided me opportunities to support women of color. I think about my friend Rose Marie who was African and alone in her birth room. I am so happy I was there for her birth. I am inspired to do more. The world needs more doulas. And doulas of color. I am going to work on that.
As for the rest of the health care system, I, like you, wait anxiously to see what change the “great pause” brings. Race is hard to ignore when the data is right in front of us. Let’s talk about these issues even if – especially if – they make us uncomfortable.
COVID-19 present us with new opportunities. The question is not whether the post-pandemic world will be different. It is how. I hope that we move towards more health equity. We will see.