Black Maternal Health: Help in a Crisis

The statistic is eye-opening: Black women are three times more likely to die from pregnancy-related complications than women of other racial and ethnic groups, according to the Centers for Disease Control and Prevention (CDC).

While giving birth is often framed as one of the happiest moments in a woman’s life, for too many Black mothers, it is a traumatic and even fatal experience.

As we honor Black History Month, we recognize the need to prevent pregnancy-related deaths and improve maternal health outcomes among Black women. 

Joyce Arand, PhD, Lee Health System Director Women’s Services, says reducing the crisis of newborn mortality begins with raising awareness about the prevalence of racial and ethnic disparities.

“The crisis of black maternal health reveals the deep roots of racial inequity in the U.S. healthcare system. This racial disparity in maternal health outcomes persists even when controlling for (taking into consideration) income and education levels. It spans across socioeconomic status,” Joyce says. “Every pregnancy-related death is tragic, especially because more than 80 percent of pregnancy-related deaths in the U.S. are preventable.” 

What is birth equity?

A positive childbirth experience “should meet a woman’s personal and sociocultural beliefs and expectations in every setting,” according to the World Health Organization (WHO).

But for Black women in the United States, maternal healthcare services are failing to make them feel safe, comfortable, and positive about their experience. The results, as the research shows, are dire.

The National Birth Equity Collaborative (NBEC) defines birth equity as “the assurance of the conditions of optimal births for all people with a willingness to address racial and social inequities in a sustained effort.”

The NBEC maintains that by addressing birth equity through the lens of understanding how structural racism and health inequities affect maternal and infant health, healthcare providers can improve maternal care, not only for Black mothers where it is most needed but also for all birthing women of color.

The approach to reducing disparities in maternal morbidity and mortality outcomes begins with delivering “respectful maternity care,” or RMC, Joyce says.

“Respectful maternity care is care that makes a birthing mother feel seen and heard, that makes them feel safe and feel like they’re the priority,” Joyce says. “It’s care that says that patients have a voice in the decisions being made about their body, their pregnancy, their labor and their birth.”

More formally stated, RMC is “care that emphasizes the fundamental rights of women, newborns, and families, promoting equitable access to evidence-based care while recognizing unique needs and preferences,” Joyce says, citing the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN). 

But to make RMC an effective practice, Joyce says, healthcare providers must become aware of their own implicit bias, which can cause unintended harm during patient interactions and lead to poorer quality of care.

What is ‘implicit bias’? 

Implicit bias involves attitudes and behaviors that we aren’t aware of that affect our understanding, actions, and decisions. They influence our attitudes in negative ways about other people based on personal characteristics, such as age, race, and ethnicity. 

It’s human nature to be biased about something or a person. We’d hardly be human if we didn’t, experts say.

But implicit bias, or unconscious bias as it’s often called, is especially harmful in the healthcare setting.

Implicit bias may place patients at greater risk for not receiving appropriate attention to address individual concerns or quality of care, specifically in the intrapartum and postpartum periods, Joyce says, quoting AWHONN and its sources (Levine & Lowe, 2015; Miller et al., 2016; Saluja & Bryant, 2021).

“There’s significant research that Black mothers often have their symptoms downplayed and dismissed by healthcare providers,” Joyce notes. “Healthcare providers are less likely to believe their reports of pain. This reflects implicit bias – subconscious racial prejudice that affects medical judgments and treatment decisions for Black patients."

Reducing implicit bias through education a key to improving Black maternal healthcare services

Despite advancements in healthcare in the past century, disparities based on race and ethnicity persist in access to healthcare, quality of care received, disease incidence and prevalence, life expectancy, and mortality.

To overcome these challenges, Joyce says Lee Health Women’s Health works with the Florida Perinatal Quality Collaborative (FPQC). Established in 2010, the FPQC aims to improve Florida’s maternal and infant health outcomes by delivering high-quality, evidence-based perinatal care. 

“We’re among a state-wide group of maternity hospitals who work together and with FPQC to reduce implicit bias among our healthcare staff,” Joyce says. “As humans, we all have biases, of course. But as healthcare providers, we’re uniquely positioned to promote birth equity and make sure that Black mothers in our care are listened to and respected.

"Our goal is to make sure that our increased awareness leads to action, and that action leads to better outcomes for all birthing mothers.”

To do that, Joyce says, her staff is required to take classes designed to increase their self-awareness about their role in patient interactions. 

“The program brings awareness around the impact their attitudes and beliefs can have on women during prepartum, labor, birth and post-partum patient interactions,” Joyce notes. “We’re trying to make all of us more aware of our personal biases. It’s a step toward standardizing care, which will go a long way toward advancing maternal health equality.”

Joyce says that standardization removes variability by relying on evidence-based care that avoids haphazard decisions when treating a patient while, hopefully, avoiding biases. In other words, all patients, regardless of color, receive the same quality of high-level maternal care services.

“We want patients to know that we see you. We hear you, we will advocate for you,” Joyce says. “We’re committed to hearing what’s important to you. This is your labor, your birth, your postpartum period, and what’s important to you is important to us as well.”