At the very least I needed to look at the entirety of prenatal care, and beyond that the differences in black-white lifetime medical care. Fighting the maternal mortality crisis ... the benefits of working with a doula but said there was no evidence showing they reduce mortality rates. Researchers have looked at poverty, education, drinking, smoking, and genetic causes. 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. Alarmingly, maternal mortality rates for women living in the U.S. are the highest in the developed world with stark racial disparities. The data becomes even more pronounced when examining maternal mortality rates for black women. But there’s finally some good news on this front. 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.”. Both Zephyrin and McLemore emphasized the importance of increasing perinatal access to telehealth services, including doula care. Currently, with the U.S. ranking 47th out of 183 countries in maternal mortality, the stakes are high, and the pressure is intense. After decades of decline, the maternal mortality rate in the United States has increased over the last 10 years. In 2015, the maternal mortality rate increased from 17 deaths to 26 deaths per 100,000 live births. The Preventing Maternal Deaths Act, signed in 2018, funds states to create committees to examine maternal mortality and morbidity rates. “I’m not worried about the virus,” Young told Guo. Using a back-of-the-envelope look at patterns of racial bias vs. racial differences in maternal mortality, I found little reason to think that racism among delivery doctors was the likely cause of this. The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 … Maternal mortality is higher in the U.S. than any other developed country. That said, there are shockingly few rigorous studies trying to tease out the causes of this disparity. Proposed funding will dramatically expand Medicaid coverage for new moms, increase home visiting, and explore Medicaid reimbursement for Doula support services. However, there are multiple studies confirming that racial differences in allostatic load are small. Doctors hold training sessions and do drills of what might happen in an actual emergency. 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. Last year, for example, the New York Times Magazine published a long article about black maternal mortality written by Linda Villarosa, a journalist who’s been following the subject for many years: The reasons for the black-white divide in both infant and maternal mortality have been debated by researchers and doctors for more than two decades. The numbers clearly demonstrate that the U.S. is one of the most dangerous high-income countries for Black women to give birth. According to the Centers for Disease Control and Prevention (CDC), between 800 and 900 women in the United States die each year from pregnancy-related complications, illnesses or events. Unfortunately, COVID-19 has necessitated physical distancing, and hospitals from San Francisco to New York have banned visitors from labor and delivery to protect patients and staff. To reduce maternal mortality disparities and birth-related complications experienced by Black women, hospitals and other medical facilities can address implicit biases and improve their quality of care: Educate … 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. The white hospitals, in general, provided better care, but it’s not obvious why they’d diagnose post-delivery cerebrovascular disorders in black mothers so much more often than black hospitals. 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. 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 . 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. The new aim is to reduce the global MMR to less than 70 by 2030. More than half of maternal deaths occur in fragile and humanitarian settings. Can you pitch in a few bucks to help fund Mother Jones' investigative journalism? We noticed you have an ad blocker on. The reason we know so little is that there’s hardly any funding for research into the causes and prevention of maternal mortality. 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. But if toxic stress turns out not to be the answer, what is? join us with a tax-deductible donation today. 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. 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. Dean drove them to the hospital only to discover that new restrictions on visitors in labor and delivery rooms meant that Young would have to labor alone, Eileen Guo reported in the New York Times. She is the author of the weekly “Essential Coverage” column in The CHCF Blog. Between 2000 and 2017, the global MMR decreased by 38%. Instead, she was worried that without her doula by her side, the delivery room staff would not listen to her. 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. Latoyha Young had a birth plan. “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. To reduce the mortality and morbidity associated with preterm births, policymakers should make screening available to the full extent of current evidence-based … The maternal mortality crisis in the U.S. has long been a raw issue and the data makes it clear that it impacts Black women at twice the rate of many other racial groups. Medical facilities can also take action. 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. Put all this together and the toxic stress/weathering hypotheses look shaky. Telomeres are the stabilizing caps on chromosomes, which shorten with age. 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 hospitals follow the lead of the California Maternal Quality Care Collaborative, an organization that has helped California dramatically reduce maternal death in a short amount of time and serves as an example of success. 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. Medically, the cause of the difference appears to be related to the circulatory system, which is sensitive to stress. Highly-educated black women, for example, experience maternal mortality at much higher levels than highly-educated white women. 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. She was going to have the baby in Sacramento with community doula Joy Dean by her side. So lack of education isn’t the cause. 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. It will also investigate whether a mother can transmit the virus to her baby during pregnancy and birth or through breast milk. - 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? Even California, which has cut its maternal mortality rate in half over the past ten years—mostly by reducing the use of cesarian sections—has cut it equally for both black and white mothers. The problem is that every other hypothesis seems wrong too. By signing up, you agree to our privacy policy and terms of use, and to receive messages from Mother Jones and our partners. Abstract. Most pregnancy-related deaths are preventable. © 2021 California Health Care Foundation. Listen on Apple Podcasts. Solutions to Reduce Maternal Mortality and Morbidity. And so far there is no published literature demonstrating that doulas actually 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. 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. Is it because of a genuine difference, or simply due to better diagnostics? More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia. 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.”. Anne Sunderland For instance, the NBEC provides racial equity training sessions to … Black women are 3 to 4 times more likely to die a pregnancy-related death as compared with white women. 14 In the United States, pregnancy-related mortality is three to four times higher among Black women than among White women. To further complicate matters, the visitor restrictions “could change within hours of you getting to the hospital,” Erica Chidi Cohen, CEO of Loom, the Los Angeles sexual and reproductive health education center, told Sonja Sharp in the Los Angeles Times. And that societal racism is further expressed in a pervasive, longstanding racial bias in health care — including the dismissal of legitimate concerns and symptoms — that can help explain poor birth outcomes even in the case of black women with the most advantages. One study—also with large sample sizes—reviewed three different measures of allostatic load. 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 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. 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. 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. 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. Historically, the United States has consistently held an awful record of racial disparities in maternal health. What about other measures of stress? The November 2017 session, Meeting the Challenges of Measuring and Preventing Maternal Mortality in the United States, discusses efforts to analyze and prevent future deaths. The reasons for both of these are unclear. And last year, UNICEF reported that compared to other high-income countries, American women experience the highest rate of maternal mortality …

how to reduce black maternal mortality 2021