Why Are Black and Brown Women More Likely to Die in Childbirth? Exploring the Causes of Maternal Mortality Disparities

Maternal mortality is an issue that has profound implications for both individuals and society. While it is a tragedy when any mother dies during childbirth, the disproportionate rates of maternal death among Black and Brown women are particularly concerning. In many countries, including the United States and the United Kingdom, Black and Brown women are more likely to face serious complications during childbirth and experience higher rates of maternal death compared to their white counterparts. This article will explore why Black and Brown women are at greater risk, and how factors like healthcare disparities, social determinants, and access to antenatal care all contribute to this inequality.

The Disparities in Maternal Mortality

a) Racial and Ethnic Disparities in Healthcare

One of the main reasons why Black and Brown women face higher maternal mortality rates is the disparities within the healthcare system. Antenatal care plays a critical role in monitoring the health of both the mother and baby throughout pregnancy, yet many Black and Brown women face barriers to accessing this care. Whether due to systemic racism, lack of insurance, or geographical limitations, these women are often less likely to receive the antenatal support they need. Studies have shown that Black women in particular are less likely to attend all of their antenatal appointments, and they often receive lower-quality care during these visits. This can lead to missed opportunities for early interventions that could prevent complications, such as pre-eclampsia or gestational diabetes, which are more common in women of colour. Without adequate antenatal care, health issues that could be easily managed may escalate into life-threatening situations during childbirth.

b) Institutional Racism and Implicit Bias in Healthcare

Another significant contributor to the higher maternal mortality rate among Black and Brown women is institutional racism and implicit bias in healthcare. Healthcare providers may have unconscious biases that influence their treatment of patients. For instance, studies have found that Black women’s pain is often underestimated or dismissed, leading to delayed treatment for serious complications. Additionally, Black and Brown women are more likely to experience poor communication with healthcare professionals, which can result in a lack of trust and dissatisfaction with care. When antenatal scans or other assessments indicate potential risks, these patients may not be taken as seriously, leading to inadequate care or missed diagnoses. This bias is not always overt but often manifests through subtle assumptions and generalisations about Black and Brown patients. These biases can have dire consequences, especially when they affect the quality of care during pregnancy and childbirth. With appropriate antenatal education, which includes awareness of these issues, healthcare providers can work toward reducing the impact of racial biases in maternal care.

c) Social Determinants of Health

Beyond the medical system, social determinants of health also play a crucial role in the maternal mortality disparities faced by Black and Brown women. These determinants include factors such as income, education, housing, employment, and access to nutritious food. Black and Brown women are more likely to experience poverty, inadequate housing, and food insecurity, all of which can affect their health during pregnancy. Prenatal care is more accessible to women with higher socioeconomic status, and those who have a higher education level are more likely to engage with antenatal appointments and adhere to recommended treatments. In contrast, those facing economic instability are more likely to experience stress, poor nutrition, and limited access to quality healthcare. These factors combine to increase the risk of complications during pregnancy and childbirth, disproportionately affecting women of colour.

Why Are Black and Brown Women More Likely to Experience Complications During Pregnancy?

a) Pre-existing Health Conditions

Certain pre-existing health conditions are more prevalent in Black and Brown populations, and these conditions can significantly increase the risks associated with childbirth. For example, conditions like hypertension, diabetes, and obesity are more common among these women, and they can lead to complications such as pre-eclampsia, gestational diabetes, and cardiovascular disease during pregnancy. Additionally, Black women have a higher likelihood of experiencing complications like severe bleeding after birth (postpartum haemorrhage) or blood clots, which are known to contribute to maternal death. While these conditions can often be managed with proper antenatal care, their higher prevalence in Black and Brown women exacerbates the risks they face during childbirth.

b) Higher Rates of C-sections and Surgical Complications

Black and Brown women are more likely to undergo C-sections compared to their white counterparts, and they are at higher risk of complications related to these surgeries. C-sections are often seen as safer options in some high-risk pregnancies, but they also come with increased risks for infection, blood clots, and complications in future pregnancies. The higher rates of C-sections among Black and Brown women may be influenced by both medical decisions and systemic issues, such as being more likely to receive care from healthcare providers who are less experienced or less supportive during vaginal birth. C-sections, while medically necessary in some cases, are associated with longer recovery times and greater risks, both during and after the birth process. Inadequate support during recovery, especially if the woman is sent home too soon or without proper post-operative care, can further compound the risks of mortality.

c) Mental Health and Stress During Pregnancy

The mental health of expectant mothers plays an integral role in their overall wellbeing, and chronic stress can significantly affect pregnancy outcomes. Black and Brown women often face higher levels of stress due to racial discrimination, financial instability, and social isolation, which in turn can increase the likelihood of complications like preterm birth or high blood pressure. Mental health support is crucial, and antenatal support should include mental health screenings and access to resources that promote emotional wellbeing. Stress and mental health challenges are often overlooked or inadequately addressed in antenatal care, but it is increasingly recognised that untreated mental health conditions can have profound effects on both the mother and the baby. Providing better access to antenatal education about mental health and coping strategies is vital to reducing the impact of these factors.

Addressing the Maternal Mortality Crisis: What Needs to Change?

a) Improving Access to Quality Antenatal Care

One of the most crucial steps to addressing the racial disparities in maternal health is to ensure that all women, particularly those from Black and Brown communities, have access to high-quality antenatal care. This means making antenatal clinics more accessible, expanding insurance coverage, and providing transportation assistance for women in underserved areas. Additionally, efforts to reduce wait times and ensure that women can easily attend all of their antenatal appointments are necessary. Healthcare systems must prioritise training medical professionals to recognise and address the unique needs of women from diverse racial and ethnic backgrounds. This includes better training in antenatal massage and pregnancy care, as well as increased awareness about how racial biases can affect the treatment of pregnant women.

b) Building Trust and Reducing Healthcare Bias

For Black and Brown women to have better health outcomes, there must be a concerted effort to build trust between healthcare providers and these communities. This can be achieved through more representation of Black and Brown professionals in the medical field, culturally competent care, and by ensuring that all pregnant women feel heard and supported. Antenatal education that specifically addresses the concerns of these women is essential for empowering them to advocate for themselves during pregnancy and childbirth.

c) Supporting Mental and Emotional Health

Given the significant impact that stress and mental health challenges have on pregnancy outcomes, mental health support must become a central part of antenatal care. Healthcare providers should screen all pregnant women for mental health concerns, and provide resources such as therapy or support groups for women who need additional help managing their mental health during pregnancy. Creating a supportive environment where women feel comfortable discussing their mental health can reduce the risk of complications and improve the overall birth experience. The maternal mortality crisis among Black and Brown women is a deeply complex issue rooted in systemic racism, healthcare disparities, and social determinants of health. It is essential that efforts be made to improve access to antenatal care, reduce healthcare bias, and provide better mental health support for expectant mothers. By addressing these underlying issues, we can begin to close the gap in maternal mortality rates and ensure that all women, regardless of their race or ethnicity, have the opportunity to experience a safe and healthy pregnancy.