The More You Know: On Maternal Mortality And Why “We Want Black Women To Thrive,” Not Just Survive Pregnancy
From May 12-18 it’s National Women’s Health Week, an annual effort put on by the U.S. Department of Health and Human Services’ Office to encourage women to be as healthy as possible. To help observe the week, we’re speaking with experts about everything from mental health, diet, pregnancy, fertility issues and more.
Between the years 2000 and 2014, there was a staggering 26 percent increase in the maternal mortality rate in the United States. To make things all the more alarming, it was found between 2011 and 2015 that the Black women’s pregnancy-related mortality ratio was three times that of white women, and that many of us are dying not just while giving birth or soon after, but between 43 and 365 days postpartum.
You’ve heard a lot about maternal mortality rates already, but what is really going on that is causing it?
“In the United States, women in general are not treated very well when it comes to the healthcare system,” said Joia Adele Crear-Perry, obstetrician-gynecologist and both founder and president of the National Birth Equity Collaborative. “While other countries may have more access to midwifery and more community-based work, we really haven’t listened to women historically in this country. And when you add on racism with being a Black woman, that’s even worse than being not listened to and not heard. So different treatment and structural racism is why we have worse outcomes for Black women in childbirth.”
It’s true that often, the concerns of mothers-to-be are not taken as seriously as they should be leading up to delivery and after giving birth. With that in mind, we asked Crear-Perry, a doctor and mother of three, in what ways expectant moms could protect themselves and their babies while navigating pregnancy and a complicated healthcare system. One of the things she recommended was finding a provider or midwife you can trust, and if possible, a doula or someone who could help to advocate for you when you are feeling vulnerable and disregarded.
“We have to be able to have options,” she said. “When we know we’re not being treated well, we need to be able to move to a different doctor, midwife, or bring a doula with us. You need to have an advocate with you. You shouldn’t go to appointments by yourself, so if a doula is expensive and you can’t afford one, you need to make sure you have a friend with you, a cousin with you, a spouse; a support person or partner. Having someone there with you to advocate for you is important.”
However, it’s also important for moms-to-be to advocate for themselves; to push their doctors to address their concerns and to not be intimidated out of calling out inattentive behavior. When asked what to expect from a quality obstetric appointment, Crear-Perry said, it’s to “feel like we’re listened to and valued.”
“We talk to the women who’ve had a near-miss, which is, that you didn’t die. Although there’s about 700 to 900 women who do die each year in childbirth, it’s about 100 times that who almost die. Those are women who go to the ICU, end up having a blood transfusion. When we talk to them, they say they had to advocate for themselves. They’ve had a family member or a person with them or they themselves had to really fight to be heard and to be seen,” she said. “We have to realize that until we get providers in hospitals to be held accountable for not listening, and to change how we view patients and our relationship with shared decision making and all of that, in the interim, advocating for yourself and making sure they’re listening to you, they hear you, they value your input and they are answering all of your concerns, is important. We don’t want people to just survive pregnancy. We want Black women to thrive, right? So to be able to thrive, you need to be able to ask whatever questions you like and there’s no silly questions.”
She also says it’s important to take advantage of opportunities to be heard outside of the doctor’s office. That includes being aware of options to send emails and being able to contact your physician’s assistant so that you can share your thoughts and concerns and have your needs met, even if it doesn’t happen in the 15 minutes that a visit tends to last.
There are structural issues that we can’t control, that people like Crear-Perry, the National Birth Equity Collective and other organizations are fighting to change and hoping will evolve. Those changes include not only increasing but also diversifying the number of obstetricians out there who won’t blame mothers for their birth outcomes. It involves pushing insurance companies to adequately pay for patient care and not only pay for you to give birth, but provide birthing care and and services for mental health issues like postpartum depression and postpartum anxiety. There’s a lot of work to be done to transform the entire broken structure, which creates the outcomes we’ve read and been alarmed about.
Still, Crear-Perry is optimistic about the efforts being made to address these issues, including an investigation being launched by the House Ways & Means Committee, the plans being proposed by presidential hopefuls, the counts finally being taken to show people how many women truly succumb to maternal deaths year after year (the CDC says it’s about 700 women), and the spotlight being put on social structure failures.
“This is huge, this attention and finally getting people to look, because you don’t count what you don’t value,” she said. “We don’t have the systems and structures in place to adequately see what’s happening to moms, and we’re finally starting to build that, so that means that hopefully, once we get that information, we can then start building structures around it. So, for example, if you see that moms are dying because there’s increased mental health care needs, we can build a mental health care system to ensure that we address postpartum depression and postpartum anxiety, which is actually higher than depression. What are we doing to relieve those anxieties? How are we ensuring that moms have paid leave, that they have child care, that they have equal pay? All of those things contribute to maternal mortality. It’s not the interaction of just going to the doctor and getting your blood pressure checked. It’s all of the social structures. A person who has better outcomes has a better social safety net. Period.”