|Hospitals: Stop failing mothers of color|
|Published Thursday, August 1, 2019|
We are facing a maternal health crisis in the United States, particularly among women of color. Mothers are dying at staggering rates – nearly triple the rate of all other developed countries and higher than even some developing ones. Black women are three to four times as likely to die as a result of childbirth complications than white women. Meanwhile, the tools to prevent their deaths are basic, inexpensive safety steps that can and should be easily implemented at all hospitals. North Carolina is making great strides in addressing this crisis, but more needs to be done to protect pregnant women – especially women of color - across the country.
When it comes to maternal deaths, the overall national average is 24.6 deaths per 100,000 live births. But for black women, that rate is much higher at 43.5 compared to 12.7 per 100,000 for white women.
Structural challenges increase the racial disparity in maternal care. There tend to be fewer health care facilities in predominantly black communities. This is particularly true in rural areas, where hospitals are closing at alarming rates. Eighty-five rural hospitals have shuttered since 2010, including at least five right here in North Carolina, with more at risk of closure. As obstetric services are costly and require constant readiness as well as high specialization, they are often the first ones to be cut in hospitals trying to limit expenses, forcing many women to drive more than an hour to receive care in the event of birth or complications.
A USA Today investigation found that this dramatically high maternal mortality rate and incidents of injury can be a result of American hospitals not following safety procedures that have been proven to be effective in preventing such tragedies. Simple and inexpensive steps, such as weighing bloody pads to measure blood loss and giving medication within an hour of detecting high blood pressure, can be taken to prevent women’s deaths. An important part of the answer, though, particularly for women of color, is also ensuring that they receive appropriate health care before and during their childbearing years.
Implicit biases and racism within the medical system contribute to the disproportionately high maternal mortality rate among black women. Studies have shown that physicians spend less time with black patients, and when they are seen, their concerns tend to be dismissed or ignored. One recent report found roughly 17 percent of women experience mistreatment in childbirth, but this number is even higher for black women (23 percent).
Even before black women go into labor, their health has been compromised by institutional racism. Studies show that racism can act as a stressor that over their lifetime can lead to physiological changes that make black women more susceptible to disease and worse overall health. These problems are only exacerbated when they have limited access to care and are systematically dismissed when they present symptoms or express concerns.
In North Carolina, great strides have been made to reduce the disparity in maternal health care, effectively closing the gap in 2013. Thanks to the Pregnancy Medical Home program, doctors here are incentivized through Medicaid reimbursements to thoroughly screen for health conditions that might impact her pregnancy. Women with pregnancies that are high risk are receiving individualized treatment from a pregnancy care manager. Groups like the Perinatal Quality Collaborative of North Carolina have worked closely with hospitals to improve the obstetrics departments.
Still, hospitals and the health care system are failing women of color around the country. We need our leaders in Washington to address this crisis, and to do so effectively, changes need to take place in the care of women of color across their entire life span.
Donna Christensen is a physician, board member of Consumers for Quality Care, and former member of the U.S. House of Representatives.
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