Racism alone does not kill black mothers. Inaction is.

[ad_1]

the United States celebrate after the Women’s 100m Final on Day 8 of the Rio 2016 Olympic Games at the Olympic Stadium on August 13, 2016 in Rio de Janeiro, Brazil. (Photo by Quinn Rooney/Getty Images)Getty Images

The recent death of Olympian Tori Bowie due to pregnancy-related complications has once again thrust the plight of black mothers into the media spotlight. Despite haphazard coverage, these tragedies are not isolated incidents. They reflect the impact of ongoing medical and public health neglect. These deaths expose the cost of systemic inaction.

We raise our heads when visible people like Serena Williams or Allyson Felix share their maternal health issues, but research shows that maternal mortality is mostly associated with socioeconomic factors such as poverty and low education. When the lights go out, it’s the mothers we leave behind.

This problem is not a mystery. The most common causes of maternal death are known.

Causes of maternal and pregnancy-related deaths.

Centers for Disaster Control and Prevention

Also, according to a CDC report, black women were more than three times more likely than white women to die from complications of pregnancy, childbirth, and puerperium. Possible explanations include differences in pregnancy-related morbidity, access to and utilization of health services, and content and quality of care. The problem is that this CDC excerpt is from 1990.

We have been describing and discussing disparities in black maternal health for at least 30 years. The same trends have been described recently in academic systematic reviews, by policy institutions like the Kaiser Family Foundation, the Center for American Progress, and the United States of Care. Even insurers have recognized the urgency of addressing these disparities.

Pre-existing chronic conditions, such as hypertension and diabetes, are strongly correlated with higher severe maternal mortality and poorer pregnancy outcomes, says Dr. Adam L. Myers, MD, director of clinical transformation at the Blue Cross Blue Shield Association. To achieve better outcomes, we must ensure that pre-pregnancy care is easily accessible and equitable for all women, in addition to strong prenatal care and ongoing postpartum care to ensure future pregnancies are safe.

After decades of data collection and eloquence, black mothers no longer need summits and meetings. We are saturated with data, claims and theories regarding disparate outcomes, whether it be weather, medical bias or the impact of social determinants of health. It is not enough to attribute these deaths to racism. Black mothers need urgent intervention to address the drivers of maternal mortality. Black mothers need action.

I interviewed dozens of pregnant and recently pregnant women to better understand the social context and the factors of maternal mortality. I also interviewed some of their doctors. These conversations revealed crucial information beyond our inability to hear from black mothers.

Health education is insufficient. Mothers described knowledge gaps spanning all stages of pregnancy, including preconception. For example, some mothers were unaware of the impact of hypertension and anemia on pregnancy outcome. A mother who gave birth three weeks early due to preeclampsia expressed her frustration: When I went to my first prenatal visit, they told me everything was fine. No one told me that my numbers might change later in my pregnancy.

Additionally, mental health support throughout and beyond pregnancy is urgently needed. Mothers consistently cited mental health, particularly during the third trimester and postpartum period, as their highest priority for support. Neglecting the mental well-being of mothers puts them at risk of adverse outcomes. Mental health support for Black mothers is also essential, as many of them suffer from chronic toxic stress and the cumulative effect of chronic stressors like poverty and discrimination on physical health and mental health, which ultimately lead to a higher risk of disease. Accessible behavioral health resources can offset the impact of these stressors during pregnancy.

Most health care providers have recognized the clinical and social biases that influence the care provided to Medicaid-insured mothers. We get implicit bias training, but that doesn’t solve the problem, said Southern Missouri-based obstetrician Dr. Carrie Carda.

When asked to explain the root causes of maternal health disparities, physicians highlighted the need for upstream prevention, education and social support, especially for mothers of children. underserved and low-resource communities. My conversation with a geographically diverse group of obstetricians from Georgia, Maryland, and Colorado reinforced these perspectives. These physicians were also less enthralled with the impact of bias training and cited the need for motivational interviewing training.

Black mothers need social, clinical and community support, says Dr. Kameelah Phillips, board-certified obstetrician-gynecologist and practitioner on the frontline of black maternal mortality in New York City. Phillips deals with the needs of black mothers on a daily basis and believes that social support begins with pregnancy and childbirth education, home visits, and social connections with other families and others. The need for consistent and easy access to education, community and clinical services cannot be understated, she says.

Most Influential African Americans in 2020. The Root

Dr. Phillips believes healthcare executives must be willing to listen and implement the changes needed to attract mothers to care. We need insurance companies to make it easier for mothers to access care without the hurdle of routine denials, referrals and pre-authorizations, she says. She cites the frequent inability to access basic and standard health care tools such as blood pressure monitors, fetal monitoring and nutritional consultations. Her philosophy for addressing the maternal health crisis is to envelop mothers in a safety net during the third trimester and postpartum period, during which they receive the education and support needed to identify and manage physical and mental complications of pregnancy.

To continue to sensationalize the issue of black maternal death without taking meaningful action guided by existing data is a blatant indictment of our health care system. Healthcare leaders and decision makers need to be curious, demand accountability and implement change regardless of the return on investment. Otherwise, people die in the name of profit.

We may never fully understand the circumstances and background that led to Tori Bowies’ death. Her story likely depicts many unseen and unknown mothers struggling with no clear direction on where and when to turn for help. I hope this tragedy will create a sense of urgency among health executives and policy makers to address the root causes and take targeted action to eliminate disparities in maternal health. As Dr. Phillips says, Enough talk. When are we going to act?

Unfortunately, after more than 30 years and considering everything we know, it’s probably now or never.

Follow me on Twitter or LinkedIn. Check out my website.

I am an infectious disease physician, CDC-trained medical epidemiologist, former medical director of DC Medicaid, and CDC Global Health Diplomat. A health activist with a Masters in Public Administration from Harvard Kennedy School and has worked in the health sector for over 20 years. Other affiliations include Aspen Institute Global Leadership Network and Aspen Health Innovator Fellow, Milken Institute Lecturer George Washington School of Public Health and Medical School Preceptor George Washington University School of Medicine. I have been writing about infectious diseases, health care in low-income urban communities, and patient-centered care for 10 years. Passionate about health literacy, patient engagement and health innovation. The opinions expressed here, and often the photography, are my own. @askdrfitz on Twitter. http://promotingpracticalhealth.org

Read moreRead less

[ad_2]