Black women are more likely to be uninsured outside of pregnancy, when Medicaid kicks in, and thus more likely to start prenatal care later and to lose coverage in the postpartum period. They are more likely to have chronic conditions such as obesity, diabetes and hypertension that make having a baby more dangerous. The hospitals where they give birth are often the products of historical #segregation, lower in quality than those where white mothers deliver, with significantly higher rates of life-threatening complications.
Those problems are amplified by unconscious #biases that are embedded in the medical system, affecting quality of care in stark and subtle ways. In the more than 200 stories of #African-American mothers that ProPublica and NPR have collected over the past year, the feeling of being devalued and disrespected by medical providers was a constant theme.
There was the new mother in Nebraska with a history of hypertension who couldn’t get her doctors to believe she was having a heart attack until she had another one. The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair. The Chicago-area businesswoman with a high-risk pregnancy who was so upset at her doctor’s attitude that she changed OB/GYNs in her seventh month, only to suffer a fatal postpartum stroke.
Over and over, black women told of medical providers who equated being African-American with being poor, uneducated, noncompliant and unworthy. “Sometimes you just know in your bones when someone feels contempt for you based on your #race,” said one Brooklyn, N.Y., woman who took to bringing her white husband or in-laws to every prenatal visit. Hakima Payne, a mother of nine in Kansas City, Mo., who used to be a labor and delivery nurse and still attends births as a midwife-doula, has seen this cultural divide as both patient and caregiver. “The nursing culture is white, middle-class and female, so is largely built around that identity. Anything that doesn’t fit that #identity is suspect,” she said. Payne, who lectures on unconscious bias for professional organizations, recalled “the conversations that took place behind the nurse’s station that just made assumptions; a lot of victim-blaming — ’If those people would only do blah, blah, blah, things would be different.’”
But it’s the discrimination that black women experience in the rest of their lives — the double whammy of race and gender — that may ultimately be the most significant factor in poor maternal outcomes.
“It’s chronic stress that just happens all the time — there is never a period where there’s rest from it. It’s everywhere; it’s in the air; it’s just affecting everything,” said Fleda Mask Jackson, an Atlanta researcher who focuses on birth outcomes for middle-class black women.
It’s a type of stress for which education and class provide no protection. “When you interview these doctors and lawyers and business executives, when you interview African-American college graduates, it’s not like their lives have been a walk in the park,” said Michael Lu, a longtime disparities researcher and former head of the Maternal and Child Health Bureau of the Health Resources and Services Administration, the main federal agency funding programs for mothers and infants. “It’s the experience of having to work harder than anybody else just to get equal pay and equal respect. It’s being followed around when you’re shopping at a nice store, or being stopped by the police when you’re driving in a nice neighborhood.”