Africa-American Pregnancy in the U.S. by Tamia Bonville

Abstract

Pregnancy and birth can be a very special time in the life of a woman. The nine months of pregnancy, as well as labor and delivery, are filled with many physical and psychological changes, as well as changes in lifestyle. However, the minority community – specifically the African American community, is just one of the latest of subsets that is getting exposed for not having equal treatment throughout their pregnancies. Once you dive beneath the surface, you end up finding out that there is a long-standing history of physician abuse, miseducation, and lack of competent resources that stacks the deck against individuals seeking to give birth to healthy babies. The institution of racism runs rampant as well. Combining these elements together makes the perfect storm of health disparities that create fatal outcomes.

Along with that comes several medical and healthcare issues that are commonplace to this at-risk community. To make matters worse, “the likelihood of experiencing one or any number of these events does not discriminate based on age, geographic location, or educational pedigree.” (Williams, 2011) Black women are approximately three times more likely to die from complications from pregnancy than white women. There is no need to quote a source for that, because it’s become a widespread fact. Just reading that makes one ask, why? There are so many questions that I have upon seeing it, and after starting to investigate, the reasons behind that statistic are infuriating. In this paper, the physical and emotional difficulties of being a pregnant black woman in America will be discussed, while also comparing the differences between the African American and non-minority communities when it comes to healthcare, pregnancies and the overall treatment of both mother and child.

The Exploration of Black Pregnancies in America

For years, African American women of all backgrounds have shared experiences of racial and gender discrimination throughout their lifetime. The impacts of such racism and sexism compromise women’s health across time, leading to poorer outcomes for the African American community, especially for pregnant women and infants. On top of that, many African American women face a tumultuous amount of physical and emotional barriers that prevents them from having a safe and successful delivery. Researchers have even suggested that stress induced by this discrimination and other difficult experiences can play a significant role in maternal and infant complications. Black women are facing higher infertility rates, greater stigma around reproductive challenges, and less access to fertility care. To improve black women’s maternal health, we need an approach that addresses black women’s health across the lifespan, improves access to quality care, addresses social determinants of health and provides greater economic security.

The Community of African American Pregnancies

African Americans make up nearly 13 percent of the United States with over 3 million identifying as African American in combination with one or more other race. Though African Americans are mainly descendants of African slaves brought between the 17th and 19th centuries, they are the second largest minority in the country as of today. Besides the traditional African American community, an increasing number of other black immigrants for countries like Jamaica, Haiti, Guyana and other Caribbean nations have made America their home for the freedom and better economic opportunities. Many African Americans populate within the urban areas of the United States and make up majority of the population in popular cities such as Detroit, New Orleans and Washington DC.

Despite the rocky beginnings of African Americans, their influence and innovative minds have contributed to much of the country’s vitality. However, racism against the black community continues to be a living nightmare and harsh reality for some. Racial disparities have been exposed over the last few years between the health care system and black patients. Specifically, light is being shed on the critically important health crisis regarding pregnancies within the African American community and the alarming rate of maternal mortality. For the last decade, black infants have shown to be more than twice as likely to die within the first year of life compared to infants of other races and have significantly worse birth outcomes. This can attribute to factors like preterm birth, extremely low birth weights, poor health issues from the mother and/or the lack of resources provided by health care professionals. Although there are investigations on the death of many African American mothers and infants, it will take real change and greater knowledge of why African American women and infants are most likely to die from pregnancy-related complications than all other races. "It feels like an (obstetrician) problem, but really, maternal mortality is a broader societal problem," she said. "If everyone pays a little more attention to their piece of the pie, hopefully we can start to move the needle." (American Heart Association News, 2019)

Health Issues Among the Community

In the United States, black women experience unacceptably poor maternal health outcomes, including dangerously high rates of death related to pregnancy or childbirth. At the same time, black women experience higher rates of many preventable diseases and chronic health conditions including diabetes, hypertension and cardiovascular disease compared to other non-Hispanic races. When, or if, black women choose to become pregnant, these health conditions can significantly influence both maternal and infant health outcomes.

Infant/Maternal Mortality: Currently, the United States holds the worst records for maternal and infant mortality among other countries. More specifically, research shows that “higher rates of maternal and infant death among African American women drive the United States’ mortality crisis.” (Novoa & Taylor, 2018) “Black women are 3–4 times more likely to die from pregnancy-related complications than White women.” (Beim, 2020) This could be caused by lack of resources, inadequate prenatal care, underlying health issues or improper care during and after childbirth. At the same time, “infants in the United States have a 76 percent higher risk of death compared with infants in other wealthy nations.” Higher rates of preterm births and low birth weights among African American pregnancies are just a few factors that drive the racial gap in infant mortality. Since most studies focus on African American women’s greater exposure to risk factors during pregnancy such as poverty and poor physical/mental health, these can account for harsher complications on the infants. “African American infants are 3.2 times more likely than non-Hispanic white infants to die from complications related to low birth weight.” (Novoa & Taylor, 2018)

PCOS (Polycystic Ovarian Syndrome): Polycystic Ovarian Syndrome, or PCOS, affects women of all backgrounds, but there are some ways in which it may affect black women specifically. PCOS develops when your ovaries or adrenal glands produce more male hormones than they’re supposed to, resulting in painful and irregular periods. PCOS can also affect the body through an increased risk of developing Type 2 diabetes, heart disease and/or high blood pressure, extra body or facial hair, acne, weight gain, skin changes and more. However, one of the biggest issues with PCOS is the lack of ovulation. “Lack of ovulation—a.k.a. the ovaries don’t release eggs to be fertilized—is the main cause of infertility in women with PCOS. But, it’s not necessarily the only reason. The extra weight can cause the body to produce too much of the hormone insulin. Together, the excess weight and insulin can lead to problems getting pregnant.” (BWHI Staff, 2017) More specifically for black women, the likelihood of getting pregnant with PCOS is extremely lower than white women. “Black women do not have as much success with in vitro fertilization as white women, and they’re also more likely to be obese—a risk factor for infertility.” (BWHI Staff, 2017)

High blood pressure/Hypertension: Due to racial/ethnic differences, African Americans face significantly higher rates of hypertension compared to whites. High blood pressure is a major risk factor for heart disease, heart attacks and strokes. “Black adults are up to two times more likely to develop high blood pressure by age 55 compared to whites, with many of these racial differences developing before age 30.” (American College of Cardiology, 2018) The American College of Cardiology led a research group, the Coronary Artery Risk Development in Young Adults Study, that tracked the blood pressure of nearly 4,000 racially different American adults between the age of 18 and 30 from young adulthood through middle age. “By the end of the CARDIA study, 75% of blacks had developed high blood pressure, compared to just 55% of white men and 40% of white women. Depending on participant’s initial blood pressure, this difference translated to 1.5–2 times greater risk for hypertension among black adults than whites.” (American College of Cardiology, 2018)

Pre-eclampsia: Along with high blood pressure, pre-eclampsia is a potentially fatal pregnancy condition also referred to as toxemia. “In 2014, 70 out of 1,000 African American women giving birth had pre-eclampsia or eclampsia, according to the HCUP study released in April 2017. That was 60 percent higher than the 43 per 1,000 Caucasian women. And most Caucasian women had mild cases, while only 37 percent of African American women had mild symptoms.” (Norton Healthcare, 2018) Symptoms of pre-eclampsia include high blood pressure, an unusual increase of protein in the urine of pregnant women and an alarming risk of the placenta not receiving enough blood – reducing the amount of oxygen and food for the infant. Though it is considered one of the most preventable causes of maternal death, “the rate of pre-eclampsia in the U.S. has increased 25 percent in the past two decades, according to the American College of Obstetricians and Gynecologists.” (Norton Healthcare, 2018)

Eclampsia: Similar to pre-eclampsia, the condition involves severely high blood pressure but in a more serious and dangerous way. Eclampsia is a rare condition that involves seizures – disturbed brain activity, or comas during pregnancy. “The rate of preeclampsia and eclampsia for black women is 61% higher than it is for white women and 50% higher than for women overall, according to the Agency for Healthcare Research and Quality.” (Franki, 2017) When black women develop pre-eclampsia or eclampsia, it surprisingly presents earlier than in women of other races. However, if left untreated, the seizures can result in coma, temporary/permanent brain damage and potential maternal or infant death.

Low birth weight/Preterm birth: Even when compared to birthweights across cultures, African American babies were lower. This was also true even when the mothers enrolled in early prenatal care. Circumstances often beyond the mother’s control shape the path of the pregnancy. For example, if the mother lives in a poor neighborhood, she likely will not have access to grocery stores that carry the best produce for reasonable prices.

Mental/Physical Health: If black women are not receiving care from persons that do not seem even the slightest bit concerned for their care, it can make all the difference between a woman embracing her pregnancy and looking upon it with trepidation. “Black women experience physical “weathering,” meaning their bodies age faster than white women’s due to exposure to chronic stress linked to socioeconomic disadvantage and discrimination over the life course, thus making pregnancy riskier at an earlier age.” (National Partnership for Women & Families, 2018) Again, this stress connects directly from mother to baby. Studies have shown that “even though Black women have the same conditions with the same prevalence as their White counterparts, the death rate is much higher.” (Tucker, 2007). Going through pregnancy and delivering a baby is as much a mental process as a physical one.

Determinants of Health for the Pregnant African American Community

Both societal and health system factors contribute to the poor health outcomes and maternal mortality among the African American community. Compared to white women, black women are more likely to face greater financial barriers to care when they need it and are less likely to access prenatal care. “Due to racism, sexism and other systemic barriers that have contributed to income inequality, black women are typically paid just 63 cents for every dollar paid to white, non-Hispanic men. Median wages for Black women in the United States are $36,227 per year, which is $21,698 less than the median wages for white, non-Hispanic men.” (National Partnership for Women & Families, 2018) These lost wages mean black women and their families have less money to support themselves and their families and may have to choose between essential resources like housing, childcare, food and health care. These trade-offs are very much evident in the health outcomes of black women and use of medical care.

Since black women face greater financial barriers, it leaves many to be uninsured, and less likely to receive the necessary medical care needed during pregnancy. “Many Black women lack access to quality contraceptive care and counseling. For example, in a recent analysis of California women enrolled in Medicaid, Black women were less likely than white or Latina women to receive postpartum contraception, and when they did receive it, they were less likely to receive a highly effective method.” (National Partnership for Women & Families, 2018) Even so, before a woman can either make the best decision as far as continuing with the pregnancy, their access to abortion is very limited. “Black women’s access to abortion is limited, and they may be more likely to experience the ill effects of abortion restrictions — such as delayed care, increased costs or lack of access to care.” (National Partnership for Women & Families, 2018) This is due to the lack of health workforce training within the medical field regarding how to care for culturally/ethnically different patients, especially pregnant ones.

Major Health Issue: Increasingly High Mortality Rates Between

Black Mothers and their Infants

Black women in the United States experience unacceptably poor maternal health outcomes, including disproportionately high rates of death related to pregnancy and childbirth. As stated before, black women are approximately three times more likely to die from complications during pregnancy than white women. Similarly, the rate of infant mortality has not changed, and it seems as though little to no effort is being done to emphasize and correct the issue. “However, the racial gap in infant mortality rates has been present since these data started being collected by the government and hospitals more than 100 years ago, and it has not significantly changed in more than 50 years.” (Novoa & Taylor, 2018) On top of that, “black women are also 3-4 times more likely to suffer from a severe disability resulting from childbirth than white women.” (Beim, 2020) These disabilities can come from underlying health issues, but mostly come from a strenuous and physically tough pregnancy. “Black women are more likely to experience complications throughout the course of their pregnancies than white women.” (National Partnership for Women & Families, 2018) For example, a specific complication that plagues not just pregnant individuals, but black community members in general is high blood pressure and hypertension. High blood pressure and hypertension can lead to toxemia within the mother, which can result in severe eclampsia and/or potential death if left untreated during or after delivery.

At the same time, this heightened risk of pregnancy-related complications tests both the income of African American mothers and the education levels of American doctors and nurses. Nearly seventy-five percent of black women give birth at hospitals that serve predominantly black populations. “Black-serving hospitals have higher rates of maternal complications than other hospitals. They also perform worse on 12 of 15 birth outcomes, including elective deliveries, non-elective cesarean births and maternal mortality.” (National Partnership for Women & Families, 2018) If African American mothers cannot receive the appropriate quality care from hospitals provided by members of their community, then how can they trust to be cared by a doctor, nurse or hospital of any other community?

Future Trends for the Community’s Health

As of today, the mortality crisis among American mothers continues to rise. However, there is a significant difference when you compare the mortality rates for mothers of different races. “Black women are three to four times more likely to die from pregnancy-related causes than white women, according to the Centers for Disease Control and Prevention. It's partly why the overall rate of pregnancy-related deaths has climbed over the past two decades, making the maternal mortality rate in the United States the worst in any industrialized country.” (American Heart Association News, 2019)

Though lack of access, low socioeconomic status and poor quality of care are only a few leading factors, the bigger issue is that black women are continuing to be undervalued. They are not monitored as carefully as women of other races, and they are often dismissed when symptoms begin to present themselves. This situation became true for African American tennis player Serena Williams when she experienced life-threatening pregnancy complications after giving birth to her daughter via cesarean section in 2017. Williams experienced a pulmonary embolism and recognized that blood clots began to block arteries within her lungs. Nurses initially dismissed her concerns, which wasted crucial time before her diagnosis and specific treatment she requested for. "Racism affects so many things before the patient even gets to the clinical encounter," she said. "Both implicit bias and structural racism affect how women are cared for in the health care system." (American Heart Association News, 2019)

Currently, many hospitals are working to correct the issue by implementing education and training on stereotypes and bias. "Some hospitals and health care systems have implemented training on implicit or unconscious bias," Petersen said, "to think about how people's backgrounds and unconsciousness may be affecting their care." (American Heart Association News, 2019) At the same time, stories and cases similar to Williams also help tackle the problem by encouraging the public and all health establishments to take this crisis seriously.

Strategy for Improving the Health of Pregnant African American Women

There are many ways policymakers, health care professionals and even communities can collaborate to improve the maternal health of all African American women. “Greater political will is also essential to undoing the legacy of racism in the United States, which is a contributing factor in maternal and infant mortality among African Americans.” (Novoa & Taylor, 2018) To start off, the social determinants of health should be addressed in order to eliminate the negative effects on a black woman’s pregnancy. Policymakers can initiate policies that raise incomes and build wealth for more affordable healthcare. “Only 87 percent of Black women of reproductive age have health insurance, and many more experience gaps in coverage during their lives. To improve Black women’s health outcomes, policies should focus on expanding and maintaining access to care and coverage.” (National Partnership for Women & Families, 2018) Women need health coverage in order to not only take care of their children, but to maintain their physical and mental well-being. Quality prenatal and maternity care are critically important for healthy pregnancies and babies. This lack of health coverage can delay prenatal care among black mothers and is often associated with higher rates of maternal mortality.

Additionally, lawmakers can discuss the possibilities of providing access to public transportation for medical appointments and pursuing paid leave policies that are affordable for all working people. “More than one in four Black workers report that there was a time in the last two years that they needed or wanted to take time away from work for parental, family or medical reasons but could not. Only 30 percent of Black mothers are both eligible for and able to afford to take unpaid leave under the federal Family and Medical Leave Act.” (National Partnership for Women & Families, 2018) Specifically for health care workers, employees can work towards increasing the availability of educated health practices and professionals. Public policies should be set to ensure that medical facilities are providing the necessary training towards responding to the needs of black patients. “Unfortunately, research shows that Black women receive a lower quality of care than white women. Much too often, Black women are subject to discrimination in the health care field — 22 percent report discrimination when going to the doctor or clinic.” (National Partnership for Women & Families, 2018) Black women should receive safe and culturally competent health care that will make a healthy impact for both mother and baby.

Conclusion

While inequality comes in many forms for African Americans, race-related health disparities are among the most resistant to progress. It is statistically clear that African Americans are underrepresented when it comes to research, innovation, delivery and overall health care funding. However, being a black female only further amplifies these inequities, which is particularly troubling and ironic given the fact that women of color make up the majority of healthcare workers. A fractured and unequal health care system and gaps in health workforce training continue to just simply aggravate these racial disparities. African Americans have continuously experienced racial discrimination for decades and it is time to put that to an end. “It is racism, not race itself, that threatens the lives of African American women and infants.” (Novoa & Taylor, 2018) In order to meaningfully improve black maternal health outcomes, we need systemic change that starts with the health care system, improves access to care and makes the places black women live and work healthier and more responsive to their needs. The lives and optimal health and well-being of all African American mothers and infants depends on it.

References

American College of Cardiology. (2018, August 9). African Americans are More Likely to Develop High Blood Pressure by Middle Age. Retrieved from https://www.cardiosmart.org/news/2018/8/african-americans-are-more-likely-to-develop-high-blood-pressure-by-middle-age

American Heart Association News. (2019, February 20). Why are black women at such high risk of dying from pregnancy complications? Retrieved from https://www.heart.org/en/news/2019/02/20/why-are-black-women-at-such-high-risk-of-dying-from-pregnancy-complications

Beim, P. (2020, June 6). The Disparities in Healthcare for Black Women. Retrieved from https://www.endofound.org/the-disparities-in-healthcare-for-black-women

Black Women’s Health Imperative. (2017, August 1). What Is PCOS? Understanding Polycystic Ovary Syndrome. Retrieved from https://bwhi.org/2017/08/01/pcos-understanding-polycystic-ovary-syndrome/

Franki, R. (2017, April 29). Preeclampsia/eclampsia rate highest in black women. Retrieved from https://www.mdedge.com/obgyn/article/136887/obstetrics/preeclampsia/eclampsia-rate-highest-black-women

National Partnership for Women & Families. (2018, April). Black Women's Maternal Health. Retrieved August, 2020, from https://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html

Norton Healthcare. (2018, May 16). Pregnant African American women far more likely to have pre-eclampsia than white women | Norton Healthcare Louisville, Ky. Retrieved from https://nortonhealthcare.com/news/pregnant-african-american-women-pre-eclampsia/

Novoa, C., & Taylor, J. (2018, February 1). Exploring African Americans’ High Maternal and Infant Death Rates. Retrieved from https://www.americanprogress.org/issues/early-childhood/reports/2018/02/01/445576/exploring-african-americans-high-maternal-infant-death-rates/

Tucker, Myra J., et al. “The Black-White Disparity in Pregnancy-Related Mortality From 5 Conditions: Differences in Prevalence and Case-Fatality Rates.” American Journal of Public Health, vol. 97, no. 2, Feb. 2007, pp. 247–251. EBSCOhost, doi:10.2105/AJPH.2005.072975.

Williams, T. (2011, Oct 15). Tackling high infant mortality rates among blacks: [national desk]. New York Times Retrieved from http://mylibrary.wilmu.edu/login?url=https://search-proquest-com.mylibrary.wilmu.edu/docview/898383735?accountid=40461