Racial Disparity: Maternal and Infant Mortality What the Data and Our Experience Supports

It is often difficult for our society to accept a premise that maternal death and infant mortality is directly attributable to racial disparity, (white vs. black) as many contrarians will point to other factors and variables such as socio-economic status, income distribution, (the wealth of the parents), age, marital status, education, country of birth, and access to care as the “explanations” for the deaths of Mom and Baby. The data, however, is now undeniable and incontrovertible based upon a study of maternal and infant death surveying two (2) million births in California finding “the richest black mothers and their babies are twice as likely to die as the richest white mothers and their babies.”[1] Specifically, income distribution was determined NOT to be the driving force for this disparity, but race was. [2] There must be an awareness and acknowledgment of this reality and it must be addressed to ensure that our healthcare system moves toward transformational change.

By way of background in 2018 the data from the National Center for Health Statistics demonstrated racial disparity with the total Maternal Morbidity Rate (MMR) in the United States of America of 17.4 deaths per 100,000 live births. [3] Tragically, the maternal death rate among black women was more than double than that of white women with 37.1 deaths per 100,000 live births. [4] These maternal death rates have become progressively worse over time for Black woman increasing to 44 per 100,000 live births in 2019, then to 55.3 in 2020 and 68.9 in 2021. By way of contrast, White women had extraordinarily lower death rates of 17.9, 29.1 and 26.1 respectively. [5] In New York City, the Maternal Mortality Rate of black mothers revealed an even more disparate statistic with the black maternal death rate at nearly 4 times higher than white mothers in 2017 with black women accounting for only 23% of births in New York City, but 55% of pregnancy related deaths. [6] Most recently, statistics with respect to Covid -19 related deaths showed that Black maternal deaths from 2020-2021 occurred at approximately 3 times the rate of white women with 13.2 per 100,000 and 4.5 per 100,000 respectively. [7] Finally, on December 7, 2021 Vice President Kamala Harris announced a call to action to reduce maternal mortality and morbidity confirming maternal deaths are a clear public health crisis. [8]

According to the New York Times Article Childbirth is Deadlier for Black Families Even When they’re Rich, Expansive Study Finds, it gives voice to the injustices of the racial disparity by accentuating infant death (those most vulnerable in society) in that for every 100,000 births of the number of infants who die before their first birthday 173 of the babies are born to the richest white mothers, 350 babies are born to the poorest white mothers, 437 babies are born to the richest Black mothers and 643 babies are born to the poorest black mothers. [9] This statistic underscores that black mothers who were rich (the top tenth of earners) and in a high socioeconomic status received substandard or poor care with “the richest Black mothers and their babies twice as likely to die as the richest white mothers and their babies”. [10] Additionally, those Black women who completed a college education had a 5.2 times higher rate of mortality than white women with the same level of education. [11]

Significantly, it should be noted that the CDC found that an unfathomable 84% of all pregnancy related deaths were preventable. [12] Notwithstanding that, racism and discrimination was the driving cause in the outcome whether the underlying medical condition was an obstetric hemorrhage, anesthesia complications, cardiovascular conditions, infection, pulmonary embolism, amniotic embolism and hypertensive disorders. Similarly, racial and ethnic disparities was a leading factor as to infant mortality whether the infant died from prematurity, low birth weight, gestational diabetes, intrauterine growth restriction, placental abruption or uterine rupture.

The Urban Institute Study of Perceptions of Discrimination and Unfair judgment while seeking Health Care lends additional support that black women indeed perceive that they experience unfair judgment or discrimination by their health care provider at a significantly higher rate than any other population of patients at 13.1% or 1 in 8 black women. [13] Even Serena Williams, the very famous black woman tennis player, who suffered a pulmonary embolism after giving birth pleaded with her nurse and doctor for a heparin drip and CT scan due to her prior clotting disorder and her shortness of breath ultimately self-diagnosing her pulmonary embolisms and clots in her lungs after the delivery of her baby. Serena was ignored and the treatment was delayed but eventually due to her persistence the clots in her lungs were visualized on CT and treated but she did suffer additional complications due to the delay. [14]

Practicing as a plaintiff attorney in the field of obstetrical medical malpractice for (30) years and representing families in maternal and infant death cases, the supportive studies cited have only confirmed the reality of my own experience in the litigation of these maters. Many of my clients who are black have registered the widespread undertone of racism in medical care, and rightfully so. A pattern of systematic racism is now indeed supported by the data. Black Mom’s being summarily dismissed by their physicians contributes to a lack of communication and unwillingness on the part of the medical team to provide the necessary time and attention required. Their suspicions have now been realized by statistical data. Many Black Mom’s have not been “heard” “helped” or “treated fairly” and ultimately marginalized in our society, and consequently have suffered the tragic loss of their newborn infant and have even succumbed to their own death.

Citations

[1] Miller, C. C., Kliff, S., & Buchanan, L. (2023). Childbirth is Deadlier for Black Families Even When They’re Rich, Expansive Study Finds. New York Times. https://www.nytimes.com/interactive/2023/02/12/upshot/child-maternal-mortality-rich-poor.html

[2] Hill, L., Artiga, S., & Ranji, U. (2022).  Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them. Kaiser Family Foundation. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/

[3] Centers for Disease Control and Prevention. (2021). Maternal Mortality. National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/maternal-mortality/

[4] Centers for Disease Control and Prevention. (2021). Maternal Mortality Highlight Wide Racial and Ethnic Gaps. National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/maternal-mortality/

[5] ​​Government Accountability Office. (2023). 2023 Annual Report: Additional Opportunities to Reduce Fragmentation, Overlap, and Duplication and Achieve Other Financial Benefits. GAO-23-105871. Retrieved from https://www.gao.gov/products/gao-23-105871

[6] New York City Department of Health and Mental Hygiene. (n.d.). Vital Statistics Data and Publications. Retrieved from https://www.nyc.gov/site/doh/data/data-sets/vital-statistics-data.page

[7] Artiga, S., Hill, L., & Usha, S. (2021). Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them. Kaiser Family Foundation. Retrieved from https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/

[8] The White House. (2021, December 7). Fact Sheet: Vice President Kamala Harris Announces Call to Action to Reduce Maternal Mortality and Morbidity. Retrieved from https://www.whitehouse.gov/briefing-room/statements-releases/2021/12/07/fact-sheet-vice-president-kamala-harris-announces-call-to-action-to-reduce-maternal-mortality-and-morbidity/

[9] Leonhardt, D., & Patel, J. K. (2023, February 12). The Child and Maternal Mortality Divide Between the Rich and Poor. The New York Times. Retrieved from https://www.nytimes.com/interactive/2023/02/12/upshot/child-maternal-mortality-rich-poor.html

[10] Id.

[11] Artiga, S., Hill, L., & Usha, S. (2021). Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them. Kaiser Family Foundation. Retrieved from https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/

[12] Id.

[13] Gonzalez, D., Skopec, L., McDaniel, M., and Kenny, G. Perceptions of Discrimination and Unfair Judgment While Seeking Health Care: Findings from the September 11-28 Coronavirus Tracking Survey. Retrieved from: https://www.urban.org/sites/default/files/publication/103953/perceptions-of-discrimination-and-unfair-judgment-while-seeking-health-care.pdf

[14] Haskell, R. (2018, January 10). Serena Williams on Motherhood, Marriage, and Making Her Comeback. Vogue. Retrieved April 11, 2023, from https://www.vogue.com/article/serena-williams-vogue-cover-interview-february-2018