Why do stark racial/ethnic inequities in maternal mortality persist in the United States?
It is impossible to celebrate Mother’s Day without reflecting on the stark racial/ethnic inequities in maternal mortality that persist in 2018 in the United States. Why do stark racial/ethnic inequities in maternal mortality persist in the United States? A growing body of evidence suggests racism drives the inequities in at least two ways.
High levels of stress can be harmful to any pregnancy. However, there appears to be an added burden for women of color, especially African American women: chronic exposure to racism-related stress. Chronic exposure to various forms of racism over the lifecourse serves as a stressor; it is associated with complications during pregnancy or birth, and it is associated with maternal mortality.(1,2) That this is tied to racism-related stress rather than stress in general (e.g., stress due to poverty) is evident from studies such as one(3) that compared the experiences of discrimination and pregnancy/birth among women with Arabic surnames in the period following vs. preceding the terrorist attacks of September 11, 2001, when such persons were often targeted for discrimination in the U.S. The study’s authors reported that the “risk of poor birth outcomes was significantly elevated for Arabic-named women and not for any of the other groups.”
Second, as stories recently published in the popular media reveal, healthcare providers may fail to provide African American patients the high caliber, respectful medical care they deserve before and after pregnancy. This helps to explain why maternal mortality is a risk even among women of color with high incomes and access to healthcare services.
The patterns on racism’s relationship to maternal mortality are consistent with much of the broader evidence base on racism and health, which indicates that racism affects health both because it is a chronic stressor and because it influences the care diverse patients receive in the healthcare settings.
Health equity researchers and advocates are not exempted from these inequities; we know women who have fought these battles. Some won unscathed. Some fought valiantly and survived with lasting scars. Others who fought valiantly are no longer here to share their stories. So, this Mother’s Day let us celebrate all mothers, while acknowledging how risky pregnancy still is in 2018 for women of color living in a society where racism persists.
Resources on how racism affects pregnancy:
TED talk by Miriam Zoila Perez
Segments from the documentary Unnatural Causes
1. Mendez DD, Hogan VK, Culhane JF. Stress during pregnancy: the role of institutional racism. Stress Health. Oct 2013;29(4):266-274.
2. Stancil TR, Hertz-Picciotto I, Schramm M, Watt-Morse M. Stress and pregnancy among African-American women. Paediatric and Perinatal Epidemiology. Apr 2000;14(2):127-135.
3. Lauderdale DS. Birth outcomes for Arabic-named women in California before and after September 11. Demography. Feb 2006;43(1):185-201.