To prevent maternal mental health from falling to the wayside during the pandemic, the Shades of Blue Project started an eight-week online support group for pregnant and postpartum individuals and a separate online support series for providers and community leaders. This site is protected by reCAPTCHA and the Google Privacy Policy and Then there’s the startlingly high in-hospital mortality rate in white hospitals vs. black hospitals. Black women specifically have the highest maternal mortality rate in the U.S. and are nearly four times more likely to die from pregnancy-related causes compared to White women. If you value what you get from Mother Jones, please join us with a tax-deductible donation today so we can keep on doing the type of journalism 2021 demands. The first thing to look at is the causes of maternal mortality: The three causes with the biggest black-white differences are cardiomyopathy (heart disease), embolism (blood clots), and eclampsia (a pregnancy-related illness that produces swelling and high blood pressure). 15 However, there are multiple studies confirming that racial differences in allostatic load are small. Inexpensive, too! But recently there has been growing acceptance of what has largely been, for the medical establishment, a shocking idea: For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions — including hypertension and pre-eclampsia — that lead directly to higher rates of infant and maternal death. Tweet at me with #EssentialCoverage or email me. How to Reduce Maternal Mortality and Save Mothers’ Lives. The reasons for both of these are unclear. Midwives Can Significantly Reduce Maternal Mortality, But They Need Support Posted on May 5, 2016 May 4, 2018 By: Kayla McGowan , Project Coordinator, Women and Health Initiative , Harvard T.H. “Growing acceptance” is correct, and the toxic stress hypothesis is intuitively appealing. Instead, she was worried that without her doula by her side, the delivery room staff would not listen to her. While some benefits of doula care are documented, the quality and breadth of studies on how they could theoretically impact maternal mortality, particularly among Black American women, remain limited . Many NGOs work throughout the region to combat maternal mortality in Africa. Help Mother Jones' reporters dig deep with a tax-deductible donation. Telomeres are the stabilizing caps on chromosomes, which shorten with age. Yet, between 2000 and 2013, high Black maternal death rates placed the United States second worst in maternal mortality among 31 Organisation for Economic Co-operation and Development nations. This is shocking: we still have almost no idea of what’s going on even though this has been a well-known problem for more than two decades. During Black Maternal Health Week, which is led by the Black Mamas Matter Alliance and held every April, California senator Kamala Harris wrote in Essence, “We must speak the truth about America’s history of health disparities that existed long before the coronavirus pandemic, including the grave ongoing crisis of Black maternal mortality.” A third study, unfortunately, doesn’t report standard deviations, but the results that were reported are consistent with a black-white difference of perhaps one-quarter of a standard deviation. That was fair enough, so I decided to look into this. In the words of Senator Harris, “When we address both the systematic disparities and implicit bias in both our society and our health care system, we can get to the point where being Black and pregnant is full of joy and free from fear of preventable death.”. Hopefully a portion of this funding will be used specifically to study the black-white gap. For instance, the NBEC provides racial equity training sessions to … But there’s finally some good news on this front. Given the already unacceptable Black maternal mortality rate in the US, how can we double down on our support of Black mothers and birthing people* during a pandemic that is amplifying health disparities? They’re hard to come by, but Arline Geronimus, who originated the “weathering” theory to explain black-white differences, has studied the length of telomeres in black and white women. Young’s concern is not unique to the COVID-19 crisis. Growing research indicates that quality of health care, from preconception through postpar … Again, this suggests a fairly small difference between black and white women. Although the numbers are alarming, the disparity in mortality rates for minority women are even more devastating, with Black women being three to four times more likely to die from a pregnancy-related complication than their white counterparts. Nor is this something that’s been recognized only recently: there are papers going back more than 20 years on the subject. Dean was funded by the county’s Black Child Legacy Campaign, which works to reduce the disproportional number of Black infant and child deaths in Sacramento. join us with a tax-deductible donation today. Alarmingly, maternal mortality rates for women living in the U.S. are the highest in the developed world with stark racial disparities. More than 22,000 babies die before their first birthday each year in the U.S. and the infant mortality rate is twice as high among Black babies compared to white babies. Subscribe today and get a full year of Mother Jones for just $12. The registry “will track participants for a year to learn how the virus impacts maternal health, fetal development, preterm delivery, newborn health and outcomes for underserved women at higher risk of mortality during pregnancy,” Feldberg wrote. The Shades of Blue Project was founded by Licensed Community Health Worker Kat Matthews to help minority women suffering from postpartum depression and/or anxiety. Because little is known about how the coronavirus affects pregnant women and their babies, research is needed to inform health care, policy, and personal decisions around labor and delivery. What it seems to tell us is that there’s a difference in when black mothers die. Ancient Song, founded by Chanel Porchia-Albert in 2008, primarily serves pregnant people of color and has been working to provide its clients with reassurance and information about changes to birthing protocols. Highly-educated black women, for example, experience maternal mortality at much higher levels than highly-educated white women. Other high-income countries with success in preventing maternal deaths offer potential lessons for the U.S. Solutions to Reduce Maternal Mortality and Morbidity. While many countries have made progress in reducing maternal mortality, progress has stagnated or been reversed in many of the countries with the highest burden of maternal mortality:12 Most parts of the world are off-track to meet the MDG target of reducing maternal mortality.13 In 2015, the maternal mortality rate increased from 17 deaths to 26 deaths per 100,000 live births. It comes from a study that measured the average “allostatic load” for blacks, whites, and Hispanics. The numbers clearly demonstrate that the U.S. is one of the most dangerous high-income countries for Black women to give birth. In January 2020, California Senate Bill 464 took effect, requiring hospitals to train their maternity care staff about implicit bias. The Preventing Maternal Deaths Act, signed in 2018, funds states to create committees to examine maternal mortality and morbidity rates. With any luck, that’s the kind of study we’ll now be able to conduct. Sign up for a webinar on April 30 to learn more. Here are results from a large-scale study using NHANES data: The differences in allostatic load are tiny—about the equivalent of one IQ point on an intelligence test—and Hispanics have a higher allostatic load than either blacks or whites but the lowest maternal mortality rate. A national conversation about the United States’ indefensible Black maternal mortality problem is underway. Using standard deviations to normalize them, the three measures showed that blacks had a mean allostatic load that was 0.1, 0.2, and 0.29 SDs higher than whites. Latoyha Young had a birth plan. Taken together, then, the black-white difference in allostatic load appears to be the equivalent of 1-3 points on an IQ test. “I’m not worried about the virus,” Young told Guo. Birthing people who do not have access to technology or the internet should be given an iPad and a data plan to facilitate telehealth, McLemore wrote. - The racial differences are modest and don’t seem to correlate well with maternal mortality anyway. That’s barely enough to be noticeable. Almost all maternal deaths (99%) occur in developing countries. However, experts say many of these deaths are preventable, and prevention starts with taking care of expectant mothers and empowering them to deliver full-term, healthy babies. In late March, the UCSF Pregnancy Coronavirus Outcomes Registry began enrolling pregnant women across the country with confirmed or suspected COVID-19, Sarah Feldberg reported in the San Francisco Chronicle. Medicaid coverage for pregnant women now lasts 60 days postpartum, but research suggests that extending postpartum coverage can benefit all women of color, who are burdened with maternal health disparities. It’s unclear, however, whether these changes will continue after the pandemic. The reason we know so little is that there’s hardly any funding for research into the causes and prevention of maternal mortality. There’s no firmly accepted definition of allostatic load, but generally speaking it’s a combination of factors like high blood pressure, high cholesterol, and inflammation that are thought to be strongly influenced by long-term stress. Last year, California Senate Bill 104 authorized the state Department of Health Care Services (DHCS) to extend Medi-Cal coverage for 12 months from the last day of pregnancy for postpartum individuals diagnosed with a maternal mental health condition. 14 In the United States, pregnancy-related mortality is three to four times higher among Black women than among White women. Abstract. This makes the toxic stress hypothesis intuitively appealing, but it has little rigorous evidence supporting it. Today, reader support makes up about two-thirds of our budget, allows us to dig deep on stories that matter, and lets us keep our reporting free for everyone. It will also investigate whether a mother can transmit the virus to her baby during pregnancy and birth or through breast milk. These abrupt changes to the birthing experience disproportionately harm some populations, including Black women and birthing people, “who are already vulnerable to disbelief and mistreatment by hospital staff — a situation that could potentially worsen without anyone there to advocate for them,” Monica McLemore, PhD, MPH, RN, associate professor at the UCSF School of Nursing, wrote on the Scientific American blog. After decades of decline, the maternal mortality rate in the United States has increased over the last 10 years. More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia. Anne Sunderland Listen on Apple Podcasts. Fortunately, some organizations, like Ancient Song Doula Services in Brooklyn, NY, have been able to quickly pivot to virtual services. Subscribe to the Mother Jones Daily to have our top stories delivered directly to your inbox. We already know that. First let me just say that, we know the best policies are data-informed, but I do believe that the best policies are advanced by leaning in and lifting up those who have been most personally impacted. Senior Communications Officer, Improving Access, Kareem Abdul-Jabbar The timing of prenatal care doesn’t explain it. But if toxic stress turns out not to be the answer, what is? When a woman dies from anything having to do with pregnancy, it is called maternal mortality or maternal death.1 Maternal death can happen while a woman is pregnant, during labor and delivery, or in the 42 days after childbirth or the termination of pregnancy. Proposed funding will dramatically expand Medicaid coverage for new moms, increase home visiting, and explore Medicaid reimbursement for Doula support services. Public Health Grand Rounds is a monthly webcast created to foster discussion on major public health issues. Perhaps even more puzzling for the toxic stress hypothesis, self-reported stress among the poor is lower for blacks than for whites: Poor blacks report less stress and higher levels of optimism than both poor whites and poor Hispanics. It’s impossible to say what this means about the telomeres in younger women, but certainly the aging difference would be less, perhaps 2-3 years at most. That said, there are shockingly few rigorous studies trying to tease out the causes of this disparity. Save big on a full year of investigations, ideas, and insights. What you’d really like to see is a study that measures allostatic load in individuals during pregnancy and then analyzes whether it’s predictive of later maternal mortality. The virtual course has a human rights framework and teaches nurses how to elevate and honor communities of color, especially Black pregnant individuals, whose concerns about maternal mortality have been compounded by COVID-19. Read on at your own risk. Can you pitch in a few bucks to help fund Mother Jones' investigative journalism? First, pregnant individuals should be prioritized for COVID-19 testing, Laurie Zephyrin, MD, vice president of health care delivery system reform at the Commonwealth Fund, wrote in Stat. Black women specifically have the highest maternal mortality rate in the U.S. and are nearly four times more likely to die from pregnancy-related causes compared to White women. Copyright © 2021 Mother Jones and the Foundation for National Progress. * We use the term “birthing people” to recognize that not all people who become pregnant and give birth identify as a woman or a mother. After receiving numerous requests from labor and delivery nurses who wanted to better support pregnant patients who could no longer have a doula with them, Porchia-Albert created a “crash” doula course for nurses. Thus, an important intervention to reduce black maternal mortality rates is to subsidize and increase access to quality mental health treatment focused on … Geronimus found that in middle-aged women, the telomeres in black women suggested an “age” about 7.5 years higher than in white women. Alarmingly, maternal mortality rates for women living in the U.S. are the highest in the developed world with stark racial disparities. By signing up, you agree to our privacy policy and terms of use, and to receive messages from Mother Jones and our partners. It's us but for your ears. To reduce the mortality and morbidity associated with preterm births, policymakers should make screening available to the full extent of current evidence-based … We can also look at black-white differences in diagnostic indicators during and after delivery. Combined, these factors help explain why states with large populations of black Americans register some of the highest rates of maternal mortality in the country. For the first time, the United States has standardized maternal mortality data from all 50 states — a first step toward identifying ways to reduce pregnancy-related deaths, experts say. Medical facilities can also take action. - More than half of maternal deaths occur in fragile and humanitarian settings. To eliminate racial disparities in maternal mortality in this country, we must make a commitment to learn from every single maternal … During Black Maternal Health Week, which is led by the Black Mamas Matter Alliance and held every April, California senator Kamala Harris wrote in Essence, “We must speak the truth about America’s history of health disparities that existed long before the coronavirus pandemic, including the grave ongoing crisis of Black maternal mortality.”. The following are research-based policy recommendations to better address the unique needs of Black women and their infants, and thereby reduce Black infant and maternal mortality. Governor Ralph Northam today announced his proposed budget will include approximately $22 million to combat maternal and infant mortality and reduce the racial disparity in Virginia’s maternal mortality rate. The issue is critical — but it's also not new. “We immediately switched over to be able to provide virtual doula services, offered to all of our clients,” Porchia-Albert told Nina Bahadur in Self. Research shows that women who receive continuous labor support — whether through a nurse, midwife, or doula — are more likely to give birth without intervention or pain medications, be satisfied with their birth experience, and have babies with higher Apgar scores, which indicate the baby tolerated the birthing process better. Fair warning: this post is longish and chart-tastic and doesn’t come to any firm conclusions. Pressley: What am I trying to do specific to maternal mortality rates? According to the Centers for Disease Control (CDC), the maternal mortality rate for Black women in 2018 was more than 2.5 times higher than the maternal mortality rate of white women, and the infant mortality rate of babies born to Black women is more than 2.3 times higher than the infant mortality rate of babies born to white women. Prior to joining CHCF, Xenia was a research assistant at the Prevention Institute, where she wrote about nutrition policy. And because Medicaid pays for nearly half of all births in the US (Medi-Cal pays for half of California births), telehealth should be covered by Medicaid, Zephyrin advised. She was going to have the baby in Sacramento with community doula Joy Dean by her side. Medically, the cause of the difference appears to be related to the circulatory system, which is sensitive to stress. Fighting the maternal mortality crisis ... the benefits of working with a doula but said there was no evidence showing they reduce mortality rates. That changed a few months ago when Congress passed a bill that authorizes $58 million per year for the next four years to study maternal mortality. ¹California has recently added a specific program to look into the black-white gap, but it’s fairly new and hasn’t yet produced any results. Finally, a fourth study in New Orleans found that black mothers had a lower allostatic load than white mothers. During Black Maternal Health Week, which is led by the Black Mamas Matter Alliance and held every April, California senator Kamala Harris wrote in Essence, “We must speak the truth about America’s history of health disparities that existed long before the coronavirus pandemic, including the grave ongoing crisis of Black maternal mortality.” a journalist who’s been following the subject for many years: has studied the length of telomeres in black and white women. As a mother who has experienced the consequences of poor maternal health systems in Uganda, I thought it was time to tackle this crucial yet often neglected area of maternal health. Despite high-tech medical advances of the last century, women around the world are still dying in pregnancy and childbirth from age-old scourges such as hemorrhage and pre-eclampsia and, increasingly, from complications related to chronic diseases, obesity, and advanced maternal age. In fact, the United Nations initiated the Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016-2030. Although legislative efforts to address infant and maternal mortality have expanded since 1921, there is considerable room for improvement. Any pregnancy-related death within a year of delivery is counted as maternal mortality, and the difference in IHM rates suggests that in white hospitals black mothers die at high rates in the hospital, while in black hospitals they die at high rates after going home. This extension will take effect on July 1, 2020, according to a DHCS update (PDF). There’s some modest evidence that wider use of doulas could reduce both infant and maternal mortality, but no evidence that it would reduce the black-white gap. How is COVID-19 affecting maternity care in your community? Both Zephyrin and McLemore emphasized the importance of increasing perinatal access to telehealth services, including doula care. Despite high-tech medical advances of the last century, women around the world are still dying in pregnancy and childbirth from age-old scourges such as hemorrhage and pre-eclampsia and, increasingly, from complications related to chronic diseases, obesity, and advanced maternal age. Because of the COVID-19 crisis, California has made emergency changes to increase Medi-Cal enrollees’ access to telehealth, including new coverage for phone visits and expanded coverage for video visits. A national conversation about the United States’ indefensible Black maternal mortality problem is underway. Instead, the NBEC is analyzing which large-scale issues are at the crux of black maternal mortality, then addressing them. The problem is that every other hypothesis seems wrong too. The following chart from a CDC study is complicated, so take a look at it and then read the explanation: In this study, the researchers grouped hospitals as those that primarily served whites and those that primarily served blacks. Solutions to Reduce Maternal Mortality. The Listening to Mothers in California survey, led by the National Partnership for Women and Families and funded by CHCF and the Yellow Chair Foundation, found that almost one-third of Black mothers (PDF) reported that they did not feel the delivery room staff encouraged them to make decisions about their birth progression. For example, instead of looking at group differences in stress as measured by allostatic load—which is cheap but tricky to do right—we really need a study that measures allostatic load in individuals during pregnancy and then analyzes whether it’s predictive of later maternal mortality. 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