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Pregnancy and Childbirth Mortality Rates on the Rise for African American Women

Posted: November 14, 2017

Every year, around 700 women in the United States die as a result of pregnancy or delivery complications. As many as 60,000 expectant mothers suffer problems that come close to costing them their lives.

America is one of the most developed nations in the world. Average life expectancy has been generally increasing over at least the last five decades, and deaths from illnesses that were once widely fatal, including polio, smallpox, tuberculosis and AIDS, are sharply falling. Yet when it comes to the natural process of childbearing, women in the U.S. die in much higher numbers than those in most developed nations, where maternal deaths are generally declining.

A woman in the U.S., where the maternal death rate more than doubled between 1987 and 2013, is more likely to die from pregnancy-related causes than in any country but Mexico among the 31 industrialized countries of the Organization for Economic Cooperation and Development that reported data.

There are various theories why — persistent poverty, large numbers of women without adequate health insurance, risk factors related to stress and discrimination. All come together here in Texas, with a twist that has become one of America’s most confounding public health problems: African American women are dying of pregnancy- and childbirth-related causes here at stunningly high rates.

The maternal death rate in Texas after 2010 reached “levels not seen in other U.S. states,” according to a report compiled for the American College of Obstetricians and Gynecologists, based on figures from the U.S. Centers for Disease Control and Prevention.  Black women in Texas are dying at the highest rates of all. A 2016 joint report by the Texas Department of State Health Services’ Maternal Mortality and Morbidity Task Force found that black mothers accounted for 11.4% of Texas births in 2011 and 2012, but 28.8% of pregnancy-related deaths.

“This is a crisis,” said Marsha Jones, executive director of the Afiya Center, a Dallas-based nonprofit that has taken on the issue. In May, the center published its first report: “We Can’t Watch Black Women Die.”

“There isn’t a single thing that explains it,” said Lisa Hollier, an obstetrician-gynecologist who heads the state-appointed Maternal Mortality and Morbidity Task Force. “There are so many different factors.”  The task force compared the health of a group of women who died during pregnancy, childbirth or in the immediate aftermath to those who survived in 2011 and 2012.

Cardiac events, drug overdoses and disorders associated with hypertension were the leading causes of those maternal deaths, the task force found.  Nationally, problems such as obesity, diabetes, caesarean births and delayed prenatal care are among the risk factors commonly seen, Hollier said. Such factors are particularly prevalent among black women.  “So we have a population of women that is less healthy when they are entering pregnancy,” Hollier said.

Texas has the largest number of uninsured people in the U.S., and there have been substantial cuts to women’s health programs that offer family planning and other routine services to low-income women, including screening for diabetes, hypertension and cervical cancer, which if left untreated could play a role in maternal deaths. Many of the dozens of clinics shuttered in recent years due to slashed state funding also offered prenatal care.

Manda Hall, associate commissioner for community health improvement at the agency, said several initiatives are underway to address the maternal mortality crisis. They include a program that encourages women planning to become pregnant to make wholesome lifestyle choices and another targeting historically black academic institutions that offers training focused on preconception health, the importance of fathers, health disparities and reproductive life planning.

Researchers say such programs might have an effect, but given that low-income white women fare better than black women, the causes may run deeper.

“Just being a black woman in America comes with its own level of stress,” said Jones, the Afiya Center executive director.  Some studies have shown that chronic stress triggered by racism and discrimination can lead to health problems such as diabetes and high blood pressure, and these in turn can lead to preterm births, low birth weights and life-threatening complications.

Read more on LATimes.org



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