Black Maternal Mortality and Resilience

Content warning: This piece contains information regarding racism in obstetric healthcare and can be traumatizing for our Black community members. Please prioritize your own well-being when choosing to read (or not read) through this piece.


Included in the article are two community-based organizations that you can access without reading the post: the Black Mamas Matter Alliance and Mommy Monitor. For allies, it is important that we continue to learn about how systems in place today perpetuate harm through racist ideas and policies. Hopefully, this piece will contextualize how Black maternal health and well-being are jeopardized in what is currently known as the U.S. and Canada and provide tangible, anti-racist solutions suggested by Black leaders in obstetric health.

Positionality Statement: Hi all, my name is Emily and I am the author of this post! I am a white, thin- and able-bodied, cis-gendered, non-parent, settler woman working, living and playing on the beautiful traditional, unceded and ancestral land of the Coast Salish, Musqueam, Tsleil-Waututh, Squamish, Stó:lō, and Stz’uminus peoples, in what is known as Vancouver, BC. I do not intend to convey that I understand the complexities and feelings of those facing racial discrimination in the healthcare system, regarding maternal health issues. Rather, I aim to utilize my education, experience in research, and this platform to bring further attention to this issue, while amplifying the incredible work that has been championed by Black women in both the U.S. and Canada. As a person passionate about reproductive justice, it is vital to understand the impact of racism on Black mothers in the U.S. and Canada, and I hope that this piece can help others learn, as well. Thanks for reading!


An overview of Black maternal mortality

Current healthcare systems in what is currently the U.S. and Canada have been shaped by white patriarchy, which has dire impacts on reproductive health for pregnant people. Black women have been facing a disproportionate risk for adverse obstetric outcomes, which has been well-chronicled by many Black feminist champions. Importantly, factors which are traditionally known to improve such outcomes, including socioeconomic status and access to health resources, have not been able to overcome this disparity between Black people and their white counterparts when it comes to obstetric health. Marsha Jones, the Co-founder and Executive Director of the Afiya Center, a reproductive justice organization serving Black women and girls in Texas, told Bustle:


“Historically racist ideology and practices continue to dictate how black women are treated, so even when we present with resources and access we are treated no differently than if we had no access or resources because we are still black."

As Jones highlights, racism impacts the quality of care Black women receive and threatens the lives of pregnant Black folks and their babies. In the U.S., Black mothers are 3-4 times more likely to die from complications during pregnancy or childbirth than white mothers, where the disproportionate risk of death is greatest in the late postpartum stage, according to the Center for Disease Control (CDC) (1, 2). This risk is further exacerbated for pregnant people in larger bodies who have been diagnosed as obese. Black women are 1.3 times more likely to be diagnosed as obese versus white women which can be attributed to structural racism impacting Black women’s access to healthy food. Poverty and food deserts disproportionately affect racialized communities and chronic stress-related to racism has a negative impact on overall metabolism and health (3-6).


The National Vital Statistics Reports from August 2019 reported that Black babies are twice as likely to die before their first birthday, relative to white babies, regardless of the mother’s income or education level (7). The CDC Morbidity and Mortality Weekly Report from May 2019 recommends mothers to follow up with their doctor within the first three weeks postpartum and “recognizes postpartum care as an ongoing process tailored to each woman’s individual needs” (2). However, this report fails to examine how Black women, as well as other people who have consistently been left out of healthcare, do not have the same access to safe healthcare. This report does not consider that the recommended individualized postpartum care is systemically lacking for Black women, racialized people and LGBTQ2S+ folks.


While the conversation surrounding the maternal mortality of Black folks often centres on the U.S, Canada shows similar inequities in reproductive healthcare that can disproportionately put Black mothers in harm’s way. Black women in Canada face increased rates, and decreased diagnosis and treatment of fibroids (8), endometriosis (9), and receive less screening for breast and cervical cancer (10). All of these gynecological issues can impact fertility and safety in pregnancy, childbirth and the postpartum period (11). In Canada, Black women also have greater risks of preterm birth versus white women (12), which can lead to a plethora of health and development issues in the baby, such as breathing issues, digestive problems, and bleeding in the brain (13).


Importantly, these disparities in obstetric wellbeing are due to the intersecting barriers and discriminations that Black pregnant people in Canada face when accessing healthcare, not genetic differences. Intersectional discrimination can have harmful impacts on financial security, risk of chronic health issues, access to safe and judgment-free healthcare and mental health (14). “Assessment of the Needs of Black Parents in Ontario” informs on the intersections of discrimination that harm Black mothers and parents who are LGBTQ2S+ by noting;


“Black Canadians who identify as LGBTQ+ continue to experience profound social, economic, and cultural marginalization compared with the broader LGBTQ+ and African Canadian communities. Anti-Black racism perpetuated in LGBTQ+ communities coupled with homophobia and transphobia within Black communities help to maintain and further this marginalization.”

It is crucial to note that academic research, which often provides health statistics, is a predominately white-man-led institution, historically ignoring the health disparities impacting racialized people (check out @notsoivorytower on Instagram, @BlackintheIvory on Twitter). Race-based data is still sorely lacking in what is currently Canada (even more so than in the U.S.), which limits our ability to do race-based analysis and address inequities faced by racialized folks accessing healthcare. Unfortunately, the race-based data that does exist is often used against Black communities as a tool of prejudice, rather than a tool of equity (15). This highlights the importance of having Black scholars and scientists analyzing and interpreting this data.


Still, Black and other racialized folks continue to find ways to tell their stories. Personal narratives that Black women share in various forms, one popular example being social media, are vital to exposing the racism embedded in our healthcare systems. Maya Basudde, a TEDx speaker and Spoken Word poet, recounted her experience with medical racism on Twitter earlier this month. Basudde answers her self-directed question “What does medical racism look like for a pregnant Black woman in Ottawa?” in a 22-tweet long thread, contextualizing the health disparity Black women are all too familiar with, and maternal health academia (led mostly by white women) has barely recognized.


“It is to have the most beautiful experience of your life tainted by racial biases and discrimination. It’s placing your most sacred experience in the hands of those who do not value you or your life because of the color of your skin.”

Whether it is reading Serena Williams’ story in Vogue or Jennifer Carroll Foy’s (who is running to be the first Black woman elected as Governor of Virginia) in Elle, or reviewing maternal health statistics, it is impossible to not identify this racial disparity in maternal health as a crisis. However, it is crucial for us living in Canada to recognize these issues in our home as well. It is essential that we listen to the Black women and gender-diverse folks around us, that we stand with them as allies, and that we make our own efforts to dismantle the racism present in our healthcare institutions.


Community-led Resilience

Black Mamas Matter Alliance (U.S.)

There are various organizations, led and championed by Black leaders, physicians and healthcare workers, that have been actively combatting the maternal mortality crisis. One of these organizations is the Black Mamas Matter Alliance (BMMA), established in 2015 out of the Center for Reproductive Rights and the Sistersong Women of Color Reproductive Justice Collective to focus on obstacles Black Southern women face while accessing maternal healthcare. In 2016, BMMA became a separate entity with goals to:


1) change and advance policy that is grounded in human rights to address Black maternal health inequity and improve health outcomes

2) cultivate research to inform policy

3) advance care for Black Mamas, enhancing holistic and comprehensive care

4) shift culture to amplify the voices of Black mamas.


As quoted from the BMMA website:


“BMMA was created out of a need to form an entity that can hold space and serve as a platform for Black women-led initiatives that are working to address the issues that impact maternal health disparities and inequities using the human rights, reproductive justice, and birth justice frameworks across all sectors.”

Since its conception, BMMA has inspired innovative conversations and highlighted tangible evidence of health inequities in the US healthcare system, while with partnering/supporting groups (including the American College of Obstetrics and Gynecology and the Congressional Black Maternal Health Caucus) to advocate for policy shifts. From the BMMA 2020 Donor Report (which you can read here), BMMA held various educational and empowering events, centring Black mothers and their experiences. Events and achievements included the webinar “Centering Black Mamas to Revive, Restore and Reclaim Their Breastfeeding Power.” Additionally, this year will mark the third annual National Black Maternal Health Week from April 11-17, 2021. In 2021, BMMA is also supporting the Black Maternal Health Momnibus Act of 2020 and 2021, which is being introduced by Congresswoman Lauren Underwood, Congresswoman Alma Adams, Senator Cory Booker, and other Congressional leaders. This Act aims to “end [preventable] maternal mortality in the U.S. and close racial and ethnic disparities in maternal health outcomes” (17).


Mommy Monitor (Canada)

Located in what is currently Canada, Mommy Monitor is a maternal health social enterprise, launched in 2018 by founder Elsie Amoako. Mommy Monitor aims to “meet all mothers at their INDIVIDUAL NEEDS and to provide solutions for a SAFE and HAPPY pregnancy,” providing culturally safe and anti-racist education, services/programs/resources to protect racialized mothers. Mommy Monitor provides recommendations and connections to support racialized pregnant folks, filling an essential gap for parents-to-be.


Some resources offered include:

  • Birth plans

  • Free mental health support for Black parents (group and individual therapy)

  • COVID-19 resources (such as education on COVID-19 and perinatal care)

  • Free doula services for Black parents

  • Birth justice workshops

  • Database of Black maternal health professionals in Ontario.


You can also check out the Mommy Monitor Report podcast to learn more about maternal health in Canada.


Limitations of Race-based analysis in Canada

Canadian research reflects the aversion to collecting and reporting on racial health disparities. There is significant inadequacy in race-based data and research, limiting the accountability for racism and discrimination in our healthcare system. This has been a consistent recommendation for research from various Black activists, including the United Nations Working Group of Experts on People of African Descent:


“[T]here is a serious lack of race-based data and research, which could inform prevention, intervention and treatment strategies for African Canadians. The authorities acknowledged that disaggregated data along racial and ethnic lines was necessary to understand the human rights concerns of African Canadians.”

As described by the United Nations Working Group of Experts on People of African Descent, race-based data shines the light on these issues and gives a platform upon which change can occur. The absence of race-based Canadian research has tangible and life-threatening impacts on racialized pregnant people, including perpetuating ignorance and inaction about health risks for racialized folks in what is known as Canada. In Black maternal health research re-envision: Best practices for the conduct of research with, for, and by Black Mamas, the BMMA highlights scientific research’s historical exclusion of “Black Mamas due to the inaccurate and harmful notion that there are default humans—White men—that serve as the standard for the rest of the human population” (18). While this is true for the broader research community, Canadian research must take this into account when addressing the absence of race-based data analysis.


In 2010, the Canadian Institutes of Health Research (CIHR) implemented mandatory Sex and Gender-based analysis (SGBA) questions in all grant applications in efforts to ensure government-funded research is “relevant and impactful for Canada’s diverse population” (19). However, it is vital to not draw the line at investigating the impact of sex and gender, but also intentionally examine race and systemic racism to identify and address gaps in care.

A framework for change

Academic research has a long way to go to properly and responsibly investigate health disparities in what is currently Canada. BMMA published the following as best practices and guidelines to ameliorate the maternal health crisis plaguing Black mothers:

Following these guidelines, as described by Black maternal health champions, gives the opportunity to re-envision research and healthcare in an anti-racist manner in order to prevent maternal death.


References

  1. Pregnancy Mortality Surveillance System | Maternal and Infant Health | CDC [Internet]. 2020 [cited 2021 Feb 25]. Available from: https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm

  2. Petersen EE. Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. MMWR Morb Mortal Wkly Rep [Internet]. 2019 [cited 2021 Feb 25];68. Available from: https://www.cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm

  3. Cozier YC, Yu J, Coogan PF, Bethea TN, Rosenberg L, Palmer JR. Racism, Segregation, and Risk of Obesity in the Black Women’s Health Study. American Journal of Epidemiology. 2014 Apr 1;179(7):875–83.

  4. Saucedo M, Esteves-Pereira AP, Pencolé L, Rigouzzo A, Proust A, Bouvier-Colle M-H, et al. Understanding maternal mortality in women with obesity and the role of care they receive: a national case-control study. International Journal of Obesity. 2021 Jan;45(1):258–65.

  5. Obesity and African Americans - The Office of Minority Health [Internet]. [cited 2021 Feb 25]. Available from: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=25

  6. Hilmers A, Hilmers DC, Dave J. Neighborhood Disparities in Access to Healthy Foods and Their Effects on Environmental Justice. Am J Public Health. 2012 Sep;102(9):1644–54.

  7. National Vital Statistics Reports Volume 68, Number 10 August 1, 2019. :20. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_10-508.pdf

  8. Fibroids | Canadian Women’s Health Network [Internet]. [cited 2021 Feb 25]. Available from: https://www.cwhn.ca/en/node/40783

  9. How race/ethnicity influences endometriosis [Internet]. Contemporary OB/GYN. [cited 2021 Feb 25]. Available from: https://www.contemporaryobgyn.net/view/how-raceethnicity-influences-endometriosis

  10. Nnorom O, Findlay N, Lee-Foon NK, Jain AA, Ziegler CP, Scott FE, et al. Dying to Learn: A Scoping Review of Breast and Cervical Cancer Studies Focusing on Black Canadian Women. Journal of Health Care for the Poor and Underserved. 2019;30(4):1331–59.

  11. Poovathi M & Ramalingam R. Maternal and Fetal Outcome in Pregnancy with Fibroids: A Prospective Study. International Journal of Scientific Study. 2016 Feb;3(11).

  12. McKinnon B, Yang S, Kramer MS, Bushnik T, Sheppard AJ, Kaufman JS. Comparison of black–white disparities in preterm birth between Canada and the United States. CMAJ. 2016 Jan 5;188(1):E19–26.

  13. CDC. Premature Birth [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2021 Feb 25]. Available from: https://www.cdc.gov/reproductivehealth/features/premature-birth/index.html

  14. An assessment of the needs of Black parents in Ontario: Evaluation of the innovative supports for Black parents initiative [Internet]. [cited 2021 Feb 25]. Available from: https://www.blackparenting.ca/uploads/2/9/5/6/29562979/report_1_-_needs_assessment_-_final_-_june_15.pdf

  15. The Disturbing Resilience of Scientific Racism [Internet]. Smithsonian Magazine. [cited 2021 Mar 20]. Available from: https://www.smithsonianmag.com/science-nature/disturbing-resilience-scientific-racism-180972243/

  16. Government of Canada CI of HR. 2019 CIHR Early Career Investigators in Maternal, Reproductive, Child and Youth Health Grant Profiles - CIHR [Internet]. 2020 [cited 2021 Feb 25]. Available from: https://cihr-irsc.gc.ca/e/51923.html

  17. Black Mamas Matter Alliance. 2020 Donor Report [Internet]. [cited 2021 Feb 25]. Available from: https://blackmamasmatter.org/wp-content/uploads/2020/12/BMMA-2020-Donor-Report.pdf

  18. Black Mamas Matter Alliance. Black maternal health research re-envision: Best practices for the conduct of research with, for, and by Black mamas [Internet]. Harvard Law & Policy Review. 2020 [cited 2021 Feb 25]. Available from: https://harvardlpr.com/wp-content/uploads/sites/20/2020/11/BMMA-Research-Working-Group.pdf

  19. Government of Canada CI of HR. How CIHR is supporting the integration of SGBA - CIHR [Internet]. 2018 [cited 2021 Feb 25]. Available from: https://cihr-irsc.gc.ca/e/50837.html

  20. Immigration R and CC. Gender-based analysis plus (GBA+) [Internet]. aem. 2020 [cited 2021 Feb 25]. Available from: https://www.canada.ca/en/immigration-refugees-citizenship/corporate/publications-manuals/departmental-plan-2020-2021/gender-based-analysis-plus.html

  21. Woitowich NC, Beery A, Woodruff T. A 10-year follow-up study of sex inclusion in the biological sciences. Sugimoto C, Rodgers P, Shansky R, Schiebinger L, editors. eLife. 2020 Jun 9;9:e56344.


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