The shameful secret is out: Although the number of women who die in childbirth globally has fallen in recent decades, the rates in the U.S. have gone up. Since 1987 maternal mortality has doubled in the U.S. Now approximately 800 maternal deaths occur every year. One of the most striking takeaways from examining the data is racial disparity: Black women are three to four times more likely to die from pregnancy-related conditions such as cardiac issues and hemorrhage and to bear the brunt of serious complications as well. That risk is equally shared by all black women regardless of income, education or geographical location. In other words, the factors that typically protect people during pregnancy are not protective for black women.

Fortunately, most of these deaths are considered preventable, and therefore, much more can be done to stop them. First, everyone—from doctors to the media to the public—needs to stop blaming women for their own deaths. Instead we should focus on better understanding the underlying contributing factors. These include a lack of data; not educating patients about signs and symptoms—and not believing them when they speak up; errors made by health care providers; and poor communication among different health care teams. Finally, studies have shown that interventions such as wider access to midwifery, group prenatal care, and social and doula support are effective in improving maternal health outcomes.

Progress has been slow and uneven. Deaths from hemorrhage, for example, have been reduced by half in some states because of standardized tool kits for care. And California has led in the pursuit of understanding root causes of maternal mortality. Still, structural racism is proving to be an intractable force.

The high maternal mortality rate (MMR) in the U.S. is often blamed on the poor health of mothers, but a comparison with other wealthy countries undermines this argument. MMR—shown here using two estimates, one by the World Health Organization (WHO) and one by the Institute for Health Metrics and Evaluation (IHME)—is not rising in countries with similarly increased rates of cardiovascular disease, obesity, diabetes and other conditions during pregnancy. Other factors must therefore be contributing to the rise in MMR in the U.S. As a 2018 paper in Obstetrics & Gynecology concluded, “the increased mortality ratios seen in the United States in recent years reflect significant social as well as medical challenges and are closely related to lack of access to health care in the non-Hispanic black population.” 

https://www.scientificamerican.com/article/to-prevent-women-from-dying-in-childbirth-first-stop-blaming-them/

Even Serena Williams was not believed when she developed problems.

In 2016, the New York City Department of Health and Mental Hygiene published an analysis of five years’ worth of data, which revealed that black college-educated mothers who gave birth in local hospitals were still more likely to suffer serious pregnancy- or childbirth-related complications compared with women of other races or ethnicities who never graduated from high school.

https://www.washingtonpost.com/news/morning-mix/wp/2018/08/07/beyonce-serena-williams-open-up-about-potentially-fatal-childbirths-a-problem-especially-for-black-mothers/

The pandemic is exposing a lack of attention to health care issues in several communities. We need to do better.