African American maternal Health Care Crisis Look Like

Amnesty International recently released a maternal health graphic, bringing attention to the country’s maternal health care crisis, as well as legislative developments in the last year that could signal some progress on the issue.

It shows that despite spending more money per capita on healthcare than any other country, we rank 50th in the world for our maternal mortality ratios. To make matter worse, while care for childbearing women and newborns is the number one reason for hospitalization in the U.S., preventable deaths of both newborns and mothers in relation to childbirth are alarmingly high, especially for women of color.

Amnesty International found that African American women are 3 to 4 times more likely to die from pregnancy related causes than white women. Maternal mortality ratios are especially high for black, American Indian/Alaska Native and Asian/Pacific Islander mothers. However, no racial or ethnic group met the government’s Healthy People 2010 goal for reducing maternal mortality - in fact, the ratios were all 2 and a half times higher.

Miriam Zoila Pérez previously reported for Colorlines on the industry-driven shift over the years to American women giving birth almost exclusively in hospitals, and the cost, health, safety, and access concerns this system has engendered, especially for women of color and those without resources. Pérez outlined the benefits of the alternative of home birth, and legislation that would make the option of home birth more accessible for those covered by Medicaid.

So why are moms of color dying in such high numbers in the U.S.? The reasons are varied: Aside from the issues of high costs and insurance coverage, lack of access also makes women of color more likely to die from pregnancy related causes. A shortage of health care professionals in the U.S., particularly specialists for women, creates a serious obstacle to timely and adequate maternal healthcare, especially for those in rural areas and in inner cities. Gaps in family planning is also a major factor. Nearly half of all pregnancies in the U.S. are unintended, and rates are significantly higher for low-income and communities of color. Such pregnancies are more likely to develop complications and face worse outcomes for both mother and child.

Obesity and hypertension are the major contributors to the African-American maternal mortality rate, leading to death from strokes, renal failure and other complications associated with obesity, Lewis says.

“We have to look at the reality of where we practice,” he says. “Obesity is much greater among African Americans. I deal with a gamut of high-risk problems, but complications from obesity are an underlying problem in all of them.

“Even young patients when they come in for prenatal visits have very elevated rates of high blood pressure. It really starts with obesity, so when they become pregnant, it places them at a higher risk for infections and other complications.” To a lesser extent, sickle-cell disease, a genetic disorder more common in people of color, also causes complications, he says.

Lewis, who also chairs the District of Columbia section of the American Congress of Obstetrics and Gynecology, says the increase in C-sections has compounded the problem because they can lead to hemorrhage, infections and pulmonary embolisms, or blood clots in the lungs. One-third of births in the United States are now by C-section compared with 20 percent a decade ago.

“Women who have C-sections have higher rates of complications and maternal mortality than with vaginal deliveries,” Lewis says.

The CDC issued a report in 2001 calling for comprehensive, broad-based public health surveillance of pregnancy-related deaths to identify factors, from pre-pregnancy through six weeks after birth, that affect a woman’s chance of survival and that place minority and older women at increased risk of death. The report said surveillance must include reviewing the causes of deaths, analyzing the findings and coordinating action among public health agencies.

“Too often, surveillance stops after identifying and counting deaths,” the report states. “With the resources available today, we should be able to eliminate this gap in such an important health outcome.”