Racism Is a Social Determinant of Black Maternal Health

I am fierce; I am furious; I am fibroids; I am fertility
silent screams; silent screams
I am finances; I am stress; I am super woman, I am shamed
silent screams; silent screams
I am subtle; I am silenced; I am dismissed; I am discounted
silent screams; silent screams
I am hidden; I am pained; I am my ancestors; I am strength; I am maternal and non-maternal
the Black Maternal Health crisis encompasses Black women and people without children too
silent screams; silent screams
We need not die.

–Michelle A. Albert, MD, MPH, President, Association of Black Cardiologists, Inc. for #FacesOfBlackMaternalHealth

Given the remarkable advances we've made across nearly every aspect of healthcare in the past quarter-century, it's mind-boggling that so many people continue to die in pregnancy and childbirth. In the past several decades, the United States continues to see rising rates of mortality during pregnancy, childbirth, and even up to 1 year postpartum. These rates are more than twice as high as those of nations of comparable wealth, with most deaths largely preventable and 1 out of 3 due to cardiovascular disease.

Maternal Health Affects Us All

Pragmatic research consistently shows racial and ethnic disparities in maternal health outcomes, with Black women two to three times more likely to die during pregnancy and childbirth as compared with their White counterparts. This remains, despite consideration for socioeconomic status and other traditional risk factors such as health behaviors and chronic comorbidities. In recent years, we have come to acknowledge race as a social rather than a genetic construct, with an ever-increasing discussion on racism as the social determinant of maternal health outcomes.

For Black Americans, psychosocial stressors, including racism, are part and parcel of daily lived experiences from birth, childhood, adolescence, and adulthood. Black women of reproductive age face multiple, simultaneous sources of chronic stress, stigma, and discrimination that are tied not only to their race/ethnicity but also to their identity as women.

As a result, these women experience rising death rates from cardiovascular disease, occurring at younger and younger ages. With an upsurge in risk factors such as obesity and hypertension, nearly 60% of Black women above the age of 20 have some form of cardiovascular disease. Similarly, Black women are experiencing greater reproductive and fertility challenges than other races/ethnicities. For Black women choosing to be childless, the stigmatized burden of the historical portrait of Black women chiefly as motherly nurturers can and does take a toll on their hearts and minds. Maternal health is a critical matter for everyone. Its impact encompasses people with and without children.

This is the core take-home message for the We Are the Faces of Black Maternal Health campaign, launched during February — Heart Month and Black History Month — by the Association of Black Cardiologists, Inc. (ABC) in media partnership with OWN Digital, LLC.

Community-Focused Solutions

With maternal health intimately tied to cardiovascular health, and pregnancy a window to future health, this campaign featuring ABC members displays a unique representation of the Black maternal health crisis from clinicians of color who are patients, relatives of patients, and/or care for this population. Most notably, this campaign gives voice to those most affected and highlights ways to improve outcomes on the heels of the 1-year anniversary of the publication of ABC's position paper for which I was lead author: Working Agenda for Black Mothers (Circulation: Cardiovascular Quality and Outcomes).

The paper helped to framework innovative, collaborative, and community-focused solutions. These include the use of trusted community collaborators; encouragement of perinatal-care teams through cardio-obstetrics, doulas, and midwives; deployment of a healthcare workforce that displays diversity of backgrounds and experiences; modification of medical education and curriculum; support of legislative and policy reform, including the expansion of postpartum care through adequate insurance coverage and paid maternal leave; and increased use of and identification of barriers to coverage of remote monitoring devices such as ambulatory blood-pressure cuffs and glucose monitoring machines.

One of the unique suggestions was the inclusion of pediatricians in the collaborative care team. This form of pre-prenatal care highlights the link between pediatric cardiovascular health and wellness and maternal health. Black mothers are first Black girls. Cardiovascular disease is largely preventable; what is learned and experienced in childhood can and does impact one's adult health.

Although ABC is not the first organization to create such a campaign, our intention is to increase awareness so that it will not be the last. With nearly 700 people in the United States of America dying during pregnancy or in the year after, despite 2 in 3 of those deaths being preventable, all Americans must take responsibility and understand how maternal mortality impacts all aspects of development, not just health. And Black women, who face the greatest likelihood of poor maternal outcomes, deserve to live safe and healthy lives, including a safe and healthy pregnancy and childbirth.

To meaningfully improve Black maternal health outcomes, we need systemic change that starts with the healthcare system, improves access to care, and makes the places Black women live and work healthier, more fair, and more responsive to their unique needs. We need to listen to these women and encourage them to speak up. Only then will Black women be able to achieve their optimal health and well-being throughout their lifespan, including if they choose to have children.

Please follow #FacesOfBlackMaternalHealth, #ABCardio4MOMS and check out powerful messages each weekday for the month of February at wearethefaces.abcardio.org.

The opinions expressed in this blog are solely my own and do not necessarily reflect the views and opinions of my affiliations.

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Rachel M. Bond. Racism Is a Social Determinant of Black Maternal Health - Medscape - Feb 07, 2022.