Originally published on LinkedIn on May 13, 2020
National Women’s Health Week is May 10-16. While the focus is often on what individual women can do to improve their health, another important focus is what we can do as a community to support healthier environments and better health outcomes for women. One critical area for community support is pregnancy health and reducing pregnancy-related mortality rates (PRMR)*.
The Data
The U.S. has not reported a PRMR since 2007. Updated Centers for Disease Control data for 2018 reflect standardized tracking methods; however, this standardization doesn’t fix all data issues. It reflects that all states are collecting this information, lowering the age range for collecting this information from 10-54 to 10-44, and narrowing the period associated with pregnancy-related mortality to 42 days after giving birth. These changes are designed to help reduce data quality errors that may have over-reported PRMRs for women over 40 and provide some consistency in the rates. However, the age range reduction and limited number of days after giving birth may lead to under counting.
The rates indicate that the U.S. is far behind other similar countries. Overall, the PRMR for 2018 is 17.4 per 100,000 live births. This puts the U.S. about 56th in comparison to World Health Organization data for 2017. When comparing only to similar countries of similar wealth – such as Canada (10), France (8), Germany (7), the UK (7), Australia (6), Japan (6), Sweden (4), Israel (3), Italy (2) and Poland (2) – the U.S. is last.
The rate for non-Hispanic Black women is 37.1. For non-Hispanic white women it is 14.7, and for Hispanic women it is 11.8. This demonstrates a significant disparity for Black women. Prior CDC studies that include multiple years reflect that Native American and Alaska Native women also have high PRMRs. For 2007-2016, the PRMR for this group was 29.7, when narrowing the years to 2011-2015 to PRMR increases to 32.5. Similarly, the rate for these years increases for Black women as well as shown in the graph. While there are some data quality errors in these numbers, even assuming a significant data quality issue of 10 points, these rates reveal major disparities.
Source: CDC, National Vital Statistics, Morality: 2007-2016, 2011-2015, 2018. Note: The 2018 study included three races: Black non-Hispanic, Hispanic, and white.
Critically, this disparity continues for Black women when controlling for education and in past studies when controlling for income. Thus, traditional methods to provide greater educational opportunities and increase personal or household income that might help lower the rate for white women have not helped lower the rate for Black women.
Why Is This A Community Issue?
If you were born, you have skin in the game.
You don’t have to be pregnant, a woman, a parent or know a pregnant person to be affected by these rates. Everyone is born. Our communities thrive or don’t in relation to how we view women’s health. When we treat this only as an individual issue, we ignore the social determinants of health. The social determinants of health are broad and include access to healthcare, education, and economic and job opportunities as well as our culture, the quality and availability of resources to meet our everyday needs, safety and social support, transportation and communications options, and much more.
Why the Disparity?
A key reason for these disparities is racial bias in healthcare as substantiated by the CDC. This occurs in individual interactions among healthcare providers and their patients as well as in structural ways including the allocation of funding, equipment and other resources for hospitals and healthcare providers.
Racial bias does not mean that doctors and nurses are always trying to discriminate. It does mean that even without intending to the impact of their actions is causing harm. The U.S. has a history of systemic racism. We all participate in that even if we don’t want to. We can unlearn these behaviors and create new structures that support inclusivity and equity.
How Do We Create Change?
Within Healthcare
Patients and their families can work with their healthcare providers to come up with plans to promote healthy pregnancy outcomes.
Questions for Pregnant Patients
I’ve heard the U.S. has pretty high pregnancy-related mortality rates. What can we do to ensure my pregnancy is safe?
What is your PRMR as a provider? What is the hospital’s or delivery location’s PRMR?
For Black women: "I understand that the PRMR is significantly higher for Black women...."
What can we do to ensure I am listened to during my pregnancy?
What can we do to ensure that I receive appropriate pain control during and after my pregnancy?
What can we do to ensure that health conditions that have a higher incidence or are specific to Black women are considered and quickly and appropriately addressed in my care?
Other women of color, especially Native American and Alaska Native women, may also find these questions applicable to their pregnancy care.
Actions for Everyone
Support doctors and healthcare providers from marginalized groups, especially Black women. Black women and other marginalized people, including disabled people, religious minorities, and LGBTQ people, need to be represented in healthcare policy within hospitals and other healthcare institutions as well as in local, state and national government.
If your own doctors, nurses or healthcare providers are from a marginalized group(s), ask if they want to serve on boards or in organizations that have a voice in policy.
Sign up for a patient advocacy panel at a hospital or with a healthcare provider. Encourage people from marginalized groups to join patient advocacy efforts. Offer to support their participation with transportation, childcare and other community care efforts.
These methods provide the opportunity to support providers with individual and group letters of recommendation, which can help give them the standing needed to help others beyond their practice and create institutional change.
Outside Healthcare
Find/link an issue you’re passion about to the social determinants of health.
Love to ride your bike in the city? Learn about the built environment for bike lanes or public transportation options in areas of the city that don’t typically get these resources
Love to garden? Support green space or community gardening to help address environmental health and food insecurity
Be intentional about working with marginalized people to have their voices heard and avoid swooping in as a rescuer or savior. Even people from other marginalized groups or with the same marginalized identity can talk over other people in their communities. Check in with each other and keep asking the questions: Who and what are we missing?
Ask local community leaders about their support for women’s health and comprehensive reproductive health. Ask even if you aren’t a woman. Support from allies helps normalize women’s health as crucial to the community and not a special issue or inessential extra.
Work on your own biases. We all have them. One way to address them is to confront the stereotypes you may hold. Explore books, movies and other art forms you enjoy from a variety of perspectives. Accept that we all cause harm, and work to repair relationships. Notice differences and learn how to celebrate them respectfully. Consider that what makes you uncomfortable about these differences may be a place for learning and growth.
Marginalized people don’t need fixing; systems that marginalize people need fixing. Additional Resources
Martin, Nina. (2020, Feb 13). The new U.S. maternal mortality rate fails to capture many deaths. ProPublica.
National Partnership for Women & Families. (2018, Apr). Issue Brief – Black women’s maternal health: A multifaceted approach to addressing persistent and dire health disparities.
Roeder, Amy. (Winter 2019). America is failing its Black mothers. Harvard Public Health: Magazine of the Harvard T.H. Chan School of Public Health.
Cover Image & Description
Photo by Chona Kasinger for AffectTheVerb.com. Three Black and disabled folx (a non-binary person holding a cane, a woman sitting in a power wheelchair, and a woman sitting in a chair) partially smiling at the camera while a rainbow pride flag drapes on the wall behind them. *Non-binary people, trans men and people of other genders can become pregnant, therefore, the term pregnancy-related mortality rate (PRMR) is preferred. As this article focuses on women’s pregnancy health, the article refers to women as the pregnant population throughout.
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