User:TakeYourMarks/Black maternal mortality in the United States

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Historical Context

An article in the American Journal of Public Health identified the effects of slavery on current maternal mortality. The authors describe that laws making enslavement an inheritable status increased the scrutiny of black women and forced them into bearing children for the economic gain of their enslavers. In addition, many medical and surgical techniques were developed by exploiting the bodies of enslaved black women. An example of this is Sarah Baartman, a Hottentot woman who was paraded around in circuses, measured and then dissected after the end of her life. A cast of her body, her skeleton, brain, and wax mold of her genitalia were once on display in a museum. After enslavement, black women were still exploited as their bodies were taken advantage of for medical gain. Henrietta Lacks was a black woman who had samples taken off her cancerous cells without her knowledge. They then gave some of that tissue to researcher George Gey without Lacks’ knowledge. It was found that Lacks' cells have a remarkable capability to survive and reproduce. The results and the tissue were shared with other scientists, and became an important part of biological research. For instance, they were essential in the development of the polio vaccine. For years after her death, scientists continued to use her cells, released her name, and released medical records to the media without her family's consent. Additionally, as touched on in Medical Apartheid, medical exploitation of black individuals also transpired in the Tuskegee Syphilis Experiment and forced sterilization efforts. This legacy has persisted into modern times and has made black women less likely to trust the medical community. The racism experienced occurs not only on a social level, but also a systemic one, due to Black women not having access to proper sexual and reproductive healthcare.

The practice of redlining, in which governments identified neighborhoods deemed to be risky investments, effectively blocked black neighborhoods from accessing federal and bank loans. Due to this designation, only lower-quality hospitals persisted in these redlined neighborhoods, affecting the access of black women to quality care to this day. Although legal segregation ended in the 1960s, hospitals for black people are still generally lower-quality than those targeted to higher-income, white people.

The historical context of institutionalized racism in the United States has also had the effect of making the black community less likely to trust medical institutions and professionals.

Intersection on Race, Socioeconomic Status, and Disability

Income has been well studied as a social determinant of health, and it has been found that worse health outcomes at all-time points surrounding pregnancy are associated with lower socioeconomic status and income levels. Lack of insurance/using Medicaid and experiencing homelessness are associated with severe morbidity rates, and are all more likely to apply to black women and increase their risk of maternal death.

Systemic racism contributes to the greater likelihood of black women to belong to lower socioeconomic classes. However, it is important to note that Black women across all socioeconomic statuses and education levels experience the same extent of racism both during the birthing process and after, as noted in Black women’s experiences in the Neonatal Intensive Care Unit following birth. A study from the Nature Public Health Collection journal pointed out that the COVID-19 pandemic increases the vulnerability of black women who are more likely to work at jobs that carry greater exposure risks to COVID-19, and more likely to lose income due to unemployment. This is in addition to the pandemic making accessing perinatal care more challenging, and making income disparities even more stark. The researchers who authored this study recommend that the interlocking factors affecting black mothers during the COVID-19 pandemic be specifically addressed in order to see tangible improvements in maternal health outcomes.

More and more women with disabilities are becoming mothers, but few federally-funded programs or support services to women with disabilities. Black mothers with disabilities have increased barriers to accessing maternal services, which increases health and mortality risks for the mother. Women with disabilities also have higher pregnancy complications, preterm deliveries, and low birth infants.

Racism

Anti-black racism in America is deeply rooted in colonialism and slavery. Historically, black women have been dehumanized and characterized as “savages." These tropes have been perpetuated through harmful stereotypes of black women, such as the Mammy and Jezebel. These stereotypes have lasting impacts today and contribute to systemic racism throughout the United States. The medical field is equally affected by these subhuman, “savage” stereotypes, contributing to medical racism, such as through decreased quality of healthcare and the false perception that black women experience less pain than other women. Additionally, the medical institutions have historically used black bodies as testing grounds, often against people’s consent, in part justified through these stereotypes. These racist injustices and human rights violations have created deep distrust of medicine by black Americans, further exacerbated by such high black maternal mortality rates.

The Metcalfe, et al study analyzing trends in maternal mortality in the US over time cited evidence of the effect of structural racism on increasing black maternal mortality. One manifestation of this is in the lower quality of hospitals that black women tend to visit in comparison to white women, and the hospitals black women frequent tend to  report higher rates of maternal morbidity. In addition, black and white patients are treated differently by healthcare professionals. Black women, in addition to other racial minorities such as Native American women, are less like to be treated with induced labor than white women.

Another phenomenon contributing to black maternal mortality is the dismissal of black women's pain by medical professionals. , which has its roots in the historic “savage” stereotypes of black women. A Harvard School of Public Health publication discussed this phenomenon by collecting numerous examples of medical professionals being dismissive or providing delayed care to black mothers expressing pain or problematic symptoms. The publication tells the story of Shalon Irving, a black woman who experienced symptoms such as high blood pressure, blurry vision, and hematoma after childbirth. However, her doctors advised her to not take further action, and Irving died soon after. According to the author, this was just one instance of medical caregivers being less likely to take black women's concerns seriously, contributing to maternal death.

Maternal morality is connected to racism, with black women dying from medical issues that are preventable yet not being listened to when they complain about pain. Although the likelihood of poor black women are more susceptible to the reality of maternal mortality, The risk still exists for other black women with better resources. For example world-renown tennis athlete Serena Williams almost suffered a fatality postpartum when she got a pulmonary embolism. This was a result of the doctors not listening to her when she expressed her health concerns, and not considering those concerns serious enough to be acted upon urgently.