The cornerstone of the healthcare system should be trust. The expectation should be that when you go into the hospital, you will be given the very best care regardless of who you are, what your gender or race is, or what beliefs you hold. But in truth, Black babies are dying at twice the average rate of white babies before reaching their first birthday. And in fact, the racial disparity regarding infant mortality is greater than it was pre 1865.
The lack of care calls for three types of direct action: education, advocacy, and legal recourse. The level of care a mother and infant should receive must be demanded, as the health care system does not show equity in patient care. Educating women about what the standard of care is, using that education to advocate for oneself and if the system still fails, legal action can act as an impetus for change. Faced with both systematic racism which causes underlying health issues and further compounded by explicit and implicit racism within the healthcare community, Black women and babies face insurmountable odds while simply trying to receive safe and appropriate healthcare.
Does Race Play a Role in Obstetric Care?
If race did not play a role in obstetric care, there would be no gap in infant mortality rates, let alone this wide wide chasm. Black infants in America are now more than twice as likely to die as white infants—10.8 per 1,000 Black babies, compared with 4.9 per 1,000 white babies, already the worst overall rate in the developed world. According to the most recent government data—the racial disparity today, is actually wider than in 1850, 15 years before the end of slavery.
One unnecessarily lost life is unacceptable, thousands is a crisis. And, education and income offer little protection. In fact, all other variables aside from race do not contribute to these numbers: a Black woman with an advanced degree is more likely to lose her baby than a white woman with less than an eighth-grade education.
Black Babies are Dying
Infant mortality rates this high are intimately intertwined with another tragedy: the death, and near death, of Black mothers, themselves. The United States is one of only 13 countries in the world where the rate of maternal mortality—the death of a woman related to pregnancy or childbirth up to a year after the end of pregnancy—is now worse than it was 25 years ago, for all women, not just black women who experience the most egregious obstetric outcomes.
Each year, an estimated 700 to 900 maternal deaths occur in the United States. In addition, the C.D.C. reports more than 50,000 potentially preventable near-deaths, a number that rose nearly 200 percent from 1993 to 2014, the last year for which statistics are available.
Black women are three to four times as likely to die from pregnancy-related causes as their white counterparts, according to the C.D.C., a disproportionate rate that is higher than that of Mexico, where nearly half the population lives in poverty—and as with infants, the high numbers for Black women drive the national numbers.
These are Preventable Conditions
Following decades of decline, maternal deaths began to rise in the United States around 1990, a significant departure from the world’s other affluent countries. By 2013, rates had more than doubled. The CDC now estimates that 700 to 900 new and expectant mothers die in the U.S. each year, and an additional 500,000 women experience life-threatening postpartum complications. More than half of these deaths and near deaths are from preventable causes, and a disproportionate number of the women suffering are Black.
According to the World Health Organization, the odds of surviving childbirth are comparable to those of women in countries such as Mexico and Uzbekistan, where significant proportions of the population live in poverty.
High blood pressure and cardiovascular disease are two of the leading causes of maternal death, according to the C.D.C., and hypertensive disorders in pregnancy, including pre-eclampsia, have been on the rise over the past two decades, increasing 72 percent from 1993 to 2014. A Department of Health and Human Services report last year found that pre-eclampsia and eclampsia (seizures that develop after pre-eclampsia) are 60 percent more common in African-American women and also more severe.
Stress, the Silent Killer: Systematic Racism to Blame?
The reasons for the Black-white divide in both infant and maternal mortality have been debated by researchers and doctors for more than two decades. But recently there has been growing acceptance of what has largely been, for the medical establishment, a provocative idea: For Black women in America, an inescapable atmosphere of societal and systemic racism are creating a severe physiological stress resulting in PTSD, resulting in conditions such as hypertension and pre-eclampsia, that lead directly to higher rates of infant and maternal death.
Because Black women have been internalizing stress and trauma both generationally and over the course of their own lifetime, it has become a leading cause of premature birth. Toxic stress contributes to conditions like hypertension and pre-eclampsia, which increase the risk of premature birth and its complication—the largest contributors to infant death, globally. In the U.S., one in ten babies were born premature last year, signaling the fourth consecutive annual increase, according to new figures by March of Dimes, a not-for-profit that works to improve the health of women and babies, nationally. The premature birth rate among Black women is 49% higher than it is for white women.
And that societal racism is further expressed in a pervasive, longstanding racial bias in health care, including the dismissal disregard of legitimate concerns and symptoms, that can help explain poor birth outcomes, even in the case of Black women with the most advantages. What this simply boils down to is that Black women are regularly and consistently ignored by healthcare professionals when voicing medical concerns. Being ignored when undergoing a serious medical event—and giving birth is serious even if it is a regular occurrence—often means the death of either the mother or baby.
Racism Ingrained In Healthcare
People of color, particularly Black people, are treated differently from the moment they enter the health care system at birth. In 2002, the groundbreaking report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, “published by a division of the National Academy of Sciences, took an exhaustive plunge into 100 previous studies, careful to decouple class from race, by comparing subjects with similar income and insurance coverage.
The researchers found that people of color were less likely to be given appropriate medications for heart disease, to undergo coronary bypass surgery, and received kidney dialysis and transplants less frequently than white people, which resulted in higher death rates, among many other egregious findings. One study analyzed in the report found that cesarean sections were 40 percent more likely among Black women compared with white women. “Some of us on the committee were surprised and shocked at the extent of the evidence,” noted the chairman of the panel of physicians and scientists who compiled the research.
In 2016, a study by researchers at the University of Virginia examined why African-American patients receive inadequate treatment for pain not only compared with white patients but also relative to World Health Organization (WHO) guidelines. The study found that white medical students and residents often believed incorrect and sometimes “fantastical” biological fallacies about racial differences in patients.
For example, many students and residents falsely thought that Black people have less-sensitive nerve endings than white people, that Black people’s blood coagulates more quickly, and that Black skin is thicker than white skin.
For these assumptions, researchers blamed not individual prejudice but deeply ingrained unconscious stereotypes about people of color, as well as physicians’ difficulty in empathizing with patients whose experiences differ from their own. In specific research regarding childbirth, the Listening to Mothers Survey III found that one in five Black and Hispanic women reported poor treatment from hospital staff because of race, ethnicity, cultural background or language, compared with 8 percent of white mothers.
Global Eyes on U.S. Maternal Mortality Crisis
Monica Simpson is the executive director of SisterSong, the country’s largest organization dedicated to reproductive justice for women of color, and a member of the Black Mamas Matter Alliance, an advocacy group. In 2014, she testified in Geneva before the United Nations Committee on the Elimination of Racial Discrimination, saying that the United States, by failing to address the crisis in Black maternal mortality, was violating an international human rights treaty.
After her testimony, the committee called on the United States to “eliminate racial disparities in the field of sexual and reproductive health and standardize the data-collection system on maternal and infant deaths in all states to effectively identify and address the causes of disparities in maternal- and infant-mortality rates.”
No such measures have been taken. Only about half the states, and a few cities, maintain maternal-mortality review boards to analyze individual cases of pregnancy-related deaths. There has not been an official federal count of deaths related to pregnancy in more than 10 years.
Malpractice: an Agent for Change?
Women and babies are dying simply because of their skin color and being reprimanded by the United Nations has made no impact on the healthcare system. Statistics continue to worsen as lack of accountability does little to incentivize change. When a system will not change for humanitarian and ethical reasons, legal and financial repercussions may serve as better motivators.
By consistently holding racially negligent physicians liable, their medical license may be revoked if it can be proven that they are a threat to society, or that their negligence or recklessness goes beyond what is considered normal. Consistently holding physicians responsible for negligence can cause a lot of negative PR for the offending physician and can be a powerful agent of change. At the end of the day, a physician who is notorious for medical malpractice will inevitably experience professional repercussions.
Can a physician be held liable for medical malpractice because of racial bias?
Across the nation, from simple medical treatment including basic pain management to the death of countless babies, there is a crisis taking place in our country. The extent of which can not currently be adequately followed as there is no current system to track mother and infant mortality. Two years after the last study, the CDC in January of 2020 released yet another snapshot into this crisis. And between the year 2018 and 2020, there was another increase in mother mortality.
All people, all the time, depend on the healthcare system at some point in their life, seeking the hope of healing and relief from their physician. Physicians and health care providers have a legal and ethical duty to treat every patient with the same standard of care. When a physician breaches that duty and a patient suffers injury, adverse health consequences, or dies as a result, the physician can and should be held accountable via a medical malpractice lawsuit.