The rate of maternal mortality in the United States, already higher than in other wealthy countries, has risen by more than half since 1990. The grim increase is largely because of alarmingly high rates among black women, who nationally are three times as likely to die in pregnancy or childbirth as white women.
In New York City, the numbers are even more staggering. Black women here are 12 times as likely to die from childbirth-related causes as white women. They experience severe, life-threatening complications from pregnancy and childbirth in about 387 out of every 10,000 births, according to city data. That is triple the rate of white New Yorkers, and roughly comparable to complication rates in Sierra Leone.
The disturbing phenomenon has been closely examined by The New York Times Magazine and ProPublica, which in recent months have laid out the shameful details of how we have failed to protect the lives of black women in pregnancy and childbirth. One stunning find: Wealthier, more educated black women in New York City are also dying or almost dying in childbirth at a far higher rate than their white neighbors. One city study found that black college-educated women were more than twice as likely to experience severe complications from childbirth as white women without a high school diploma.
Latinas and Asian women also experience higher rates of severe and potentially life-threatening complications. But some researchers and city officials believe that the higher rates of death and complications among black women are caused only partly by longstanding disparities in poverty, obesity and lack of access to top-rate health care. The dangers black women face in pregnancy and childbirth, they say, are compounded by racism, unconscious biases in health care and the long-term anxieties, regardless of economic status, that come with being an African-American woman.
“She is subjected to a lifetime of stressors,” said Arline Geronimus, associate director of the Population Studies Center at the Institute for Social Research at the University of Michigan. Ms. Geronimus’s research connected the toxic pressures of racism faced by black women in America to their health during childbirth, and the health of their babies. Of wealthier black women, she said, “Being the first generation to graduate, being subject to stereotypes in the classroom or the boardroom, feeling socially excluded — these aren’t just things that make you feel bad, they are stressors that can impact your health.”
Doctors, midwives, researchers and health officials nationally and in New York City are rightfully alarmed, and they have come together over the past several years to better understand the complex causes of this deadly disparity and search for solutions.
The American College of Obstetricians and Gynecologists in 2013 started a “Safe Motherhood Initiative,” working with hospitals across New York State to help implement best practices that can save lives. A similar, federally funded initiative run by the group has helped reduce the rate of near-fatal childbirths between 8.9 percent and 22.4 percent across eight states. The entire budget for that initiative, known as the Alliance for Innovation on Maternal Health, is just $1 million.
New York City formed a committee in December to study each childbirth-related death to learn how to prevent them. Earlier this year, New York State followed suit.
One key to addressing the crisis, doctors say, is streamlining and improving the response of some of the city’s hospitals to three leading causes of childbirth-related death in New York City: hemorrhage, hypertension and blood clots.
Doctors say these medical emergencies are largely preventable, but they are often approached differently by different hospitals, and with varying degrees of success. One 2016 study found that women who deliver at hospitals that serve a higher proportion of black women are more likely to suffer severe complications or death, even while adjusting for other factors like a mother’s general health.
As the research plows on, there are several things we can do to protect black women, and all women, right away.
First, New York State and City could publish up-to-date data on the rate of severe childbirth-related complications at every hospital in the city, as well as how women fared in those emergencies. The information could be made easily accessible online so women could make informed choices about where they wanted to give birth. That data would need to be adjusted to account for hospitals that serve high-risk populations. But if the city’s Department of Health can rate restaurants, it can find a way to grade hospitals.
Second, it’s past time for care for the leading causes of childbirth-related death to be standardized, with every hospital in the city adopting as its baseline the best practices outlined by leading medical associations — something many have already begun to do. The American College of Obstetricians and Gynecologists should help the state create a certification program, allowing the public to know which hospitals have fully implemented best practices for responding to hemorrhages and other childbirth-related emergencies.
Third, the city and state should consider expanding funding for doula programs, which many researchers say have shown great promise in helping women of all backgrounds have safe births.
These are things the city and state, their hospitals, and the larger health community in New York can do right now, and must. They would help all women, but would be crucial for black women, who need them the most.
The challenges faced by black mothers are complicated, and will take years to fully address. But the prospect of motherhood should be a source of joy for black women, as it is for others, without the fear that their race will threaten their life.