As healthcare providers we strive to provide the same care to all of our patients and see good health outcomes across the lifespan, income level and educational status. Mostly, we have been successful – more mothers are insured, home visiting programs have shown promising results and more infants getting their vaccines on time. But as many health disparities are shrinking, one is growing. African American mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women’s health. Compared to a white woman, an African American woman is 22 percent more likely to die from heart disease, 71 percent more likely to die from cervical cancer, but 243 percent more likely to die from pregnancy- or childbirth-related causes.
In a national study of five medical complications that are common causes of maternal death and injury, African American mothers were two to three times more likely to die than white women who had the same condition. African American mothers are 49 percent more likely than whites to deliver prematurely (and, closely related, their infants are twice as likely as white babies to die before their first birthday). And the number of complications is rising.
The high maternal mortality rate of African-Americans is the main reason the U.S. maternal mortality rate is so much higher than that of other developed countries. African American pregnant and new mothers in the U.S. die at about the same rate as women in countries such as Mexico and Uzbekistan, according to the World Health Organization.
Experts do not know why African American mothers and babies are dying more than others. In the past, the researchers have assumed poverty, lack of education or low access to quality health care as some of the culprits. But educated African American mothers also have poor outcomes too. One study done in NYC showed college educated African American mothers had worse outcomes than white mothers that had never graduated from high school. According to the CDC affluent and educated black women are more likely to lose their newborn than uneducated white women who’ve had little or no prenatal care. African American women suffer the highest infant and maternal-mortality rates of any race, according to the CDC.
As public health experts try to pinpoint the reason for the disturbing difference in health outcomes, some researchers are taking a new look at racism and the stress it causes across the lifespan. Arline Geronimus, a professor at the University of Michigan – School of Public Health, coined the term “weathering” for stress-induced wear and tear on the body. Weathering “causes a lot of different health vulnerabilities and increases susceptibility to infection,” she said, “but also early onset of chronic diseases, in particular, hypertension and diabetes” — conditions that disproportionately affect African American mothers. Her research even suggests weathering accelerates aging at the molecular level; in a 2010 study Geronimus and colleagues conducted, the telomeres (chromosomal markers of aging) of African American women in their 40s and 50s appeared 7 1/2 years older on average than those of whites.
Weathering may play a part in pregnancy complications too. Pregnancy is the most physiologically complex and emotionally vulnerable time in a woman’s life. As we get older, our risk for complications goes up. The data shows the rate of complications increases for white women in their 40s and for African American women in their 30s. This means that many high risk pregnancies are not monitored as closely as they should be, and more pregnancy complications go undiagnosed in African American mothers.
The risks to mother’s health do not disappear with delivery, according to the most recent CDC data, more than half of maternal deaths occur in the postpartum period, and one-third happen seven or more days after delivery. For mothers with hypertensive disorders, diabetes and peripartum cardiomyopathy the postpartum period should be closely monitored. African American mothers have 25% higher rates of C-section than white mothers and are more than twice as likely to be readmitted to the hospital in the month following the surgery. They are also twice as likely as white women to have postpartum depression, which contributes to poor outcomes, but they are much less likely to receive mental health treatment for the condition. For all of these reasons, new African American mothers need careful monitoring as they recover from childbirth, establish breastfeeding and adjust to motherhood.
Poverty, access to care, culture, communication and decision-making all contribute to health outcomes for mothers and their infants. As researchers continue to discover more about the differences in health outcomes for mothers from all backgrounds, watch for more recommendations to best help our patients.
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