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To Reduce Racial Disparities in Maternal Mortality, Listen to the Data
More mothers die from pregnancy-related causes in the United States than any other high-income country. And maternal health outcomes in the U.S. are only getting worse. From 2010 to 2014, our pregnancy-related mortality ratio jumped from 15.2 to 18.0 deaths per 100,000 live births (for comparison, during the same time period, the ratio in the U.K. decreased from 10.1 to 8.8).
We know that stark racial disparities in maternal mortality are a large part of why the U.S. is so far behind other countries. For example, Black women are 3 to 4 times more likely to die from pregnancy-related causes than white, non-Hispanic women. And research has shown that Black women are still more likely to die as a result of pregnancy even after controlling for things like gestational age at delivery, maternal age, income, and receipt of prenatal care. This trend holds true for other racial groups of women, including Native American women who are 4.5 times more likely to die during pregnancy than white, non-Hispanic women. These numbers show that addressing racism in health care is key if we want to see real improvements to maternal mortality and pregnancy-related deaths by making this country a safer and more equitable place to give birth.
Lately, the federal and some state governments have been paying attention, thanks in part to recent media attention surrounding this pressing health equity issue. And as policy interventions are beginning to be designed, it’s important to remind policymakers at all levels of government that more comprehensive data collection will help reduce racial disparities in maternal mortality. From this researcher’s perspective (along with a growing number of maternal health experts), gathering more data on mortality and morbidity – or health complications women experience during pregnancy – is a critical first step if we want to improve maternal health outcomes in this country.
National data on maternal mortality come from two sources: the National Center for Health Statistics and the Pregnancy Mortality Surveillance System. Both have helped researchers understand just how far the U.S. lags behind other countries when it comes to maternal health and the scope of racial disparities in maternal health outcomes. However, these data sources rely on birth and death certificates to calculate maternal mortality rates and pregnancy-related death ratios, which unfortunately provide an incomplete picture of each maternal death. For example, a death certificate can’t tell us if a woman had health complications that put her pregnancy at high-risk, or if her death actually could have been avoided in the first place (in fact, studies have estimated that about one-third of maternal deaths in the U.S. are preventable).
Importantly, death certificates also can’t tell us if a Black woman’s pain was ignored when she sought emergency care during pregnancy – which happens more often than it should – or if she died as a result of receiving culturally incompetent or inadequate postnatal care. Information about maternal morbidity and women’s experiences with racism in the health care system is widely under collected. So, we need to do a better job of asking the right questions and listening to Black women’s experiences during pregnancy and childbirth to identify areas for intervention and prevention.
So, how can we get more comprehensive data on women’s (and especially Black women’s) experiences before, during, and after giving birth? Some states have tried to do this by forming Maternal Mortality Review Committees (MMRCs) which collect data on the factors contributing to maternal deaths and identify areas for intervention and prevention. A handful of states have seen promising results from these Committees: California’s MMRC helped reduce its maternal mortality rate by 55 percent in less than a decade by pooling records from 90 percent of hospitals in the state to create a “maternal data center”. But so far, only half of states have formed a MMRC or have pending legislation to do so, and even those states that do have MMRCs have been slow to beef up data collection efforts.
Though MMRCs will be helpful in identifying future areas for intervention and prevention, Black mothers are still dying at extremely high rates. And researchers know enough about the data for policymakers to put policies in place that will address racism in health care and prevent unnecessary deaths right now. For instance, cultural competency courses at medical schools have been shown to help medical professionals in training overcome their implicit biases and provide more equitable care to patients. The Maternal CARE Act, introduced by Senator Harris last summer, would create implicit bias training grants for health professional training programs with special emphasis on obstetrics and gynecology. Such a program could go a long way to reduce racial disparities in maternal health, but Congress needs to get on board as soon as possible.
The numbers clearly demonstrate that the U.S. is one of the most dangerous high-income countries for Black women to give birth. To eliminate racial disparities in maternal mortality in this country, we must make a commitment to learn from every single maternal death and near-death that occurs. And while we need comprehensive data collection, it should not come at the expense of enacting real policy solutions that will make a difference in maternal mortality today.
