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Maternal Health’s Ongoing Mandate for Women of Color: The Call for Wholistic Health Equity  

 

     Last month’s CDC declaration that Racism is a public health crisis was long overdue. Yet, vital health and mental health disparities for women of color rage on amid this latest societal call to arms. Too many women of color, their families, and friends lay victim to gaping wounds, residual scars, and profound trauma from egregious maternal health experiences. Current facts speak volumes.

  • The U.S. has the highest rate of maternal mortality among developed nations, rising steadily the past 40 years.
    • Reported pregnancy-related deaths in the US increased from 7.2 deaths per 100,000 live births in 1987 to 17.3 deaths per 100,000 live births in 2017.
  • Ratios across ethnic and racial groups are unconscionable to consider:
    • 41.7 deaths per 100,000 live births for non-Hispanic Black women.
    • 28.3 deaths per 100,000 live births for non-Hispanic American Indian or Alaska Native women.
    • 13.8 deaths per 100,000 live births for non-Hispanic Asian or Pacific Islander women.
    • 13.4 deaths per 100,000 live births for non-Hispanic White women.
    • 11.6 deaths per 100,000 live births for Hispanic or Latina women.
  • Some pregnancy-related death factors have declined, as hemorrhage, hypertensive disorders of pregnancy (e.g., preeclampsia, eclampsia), and anesthesia complications. Yet, chronic diseases on the rise, especially for minority communities; these diagnoses factor heavily into maternal morbidity and mortality rates, including chronic heart disease, diabetes, and cerebrovascular events.
  • Reviews from Maternal Mortality Review Committees 25 states are a must to review. Having sat on Virginia’s state MMR committee I can attest to the rigor and commitment of those engaged in the review of all pregnancy-related deaths, including deaths occuring within one year of women giving birth.
  • 2 out of 3 pregnancy-related deaths occur outside of the day of delivery or week postpartum.
  • The leading causes of pregnancy-related deaths varied by race/ethnicity. Black mothers are almost three times as likely to die in childbirth compared to other racial and ethnic groups.
  • 2 out of 3 deaths were determined to be preventable.
  • Mental health needs of these women are an equal mandate:
    • Black women are twice as likely as Whites to suffer from perinatal mood and anxiety disorders (e.g., postpartum depression) and less likely to receive treatment, as high as 40% of the population compared to 20-25%
    • Immigrants have an increased risk of postpartum depression with low satisfaction of acknowledgment and support by providers. These women are at greater risk for behavioral health issues during their pregnancies (e.g., depression, schizophrenia, post-traumatic stress) due to the interaction of psychosocial determinants as, forced migration, insecurity associated with refugees and asylum seekers, human trafficking, as well as frequent low-income employment with limited security.
    • Other barriers to healthcare access obstruct a migrant woman’s ability to access appropriate health and mental health, from language, mobility, and legal status, to country of origin, health care provider attitudes, culture, and other occupational factors. These social determinants of health and mental health (SDoH, SDoMH) contribute to increased vulnerability of immigrant women during pregnancy and emergence of psychopathological complications pre and post-birth, as postnatal depression and psychosis.
    • Indigenous women are at far greater risk of mental health problems (e.g., depression, anxiety, substance misuse) during the perinatal period, prevalence rates from 17% to 47% of the population.

The U.S. Department of Health and Human Services set the following thresholds to improve maternal health by 2025:

  1. Reduce maternal mortality rate by 50%, and
  2. low-risk cesarean deliveries by 25%.
  3. Control blood pressure in 80% of reproductive age women.

The White House Proclamation for Black Maternal Health Week 2021 also set a strong tone moving forward, “the United States must also grow and diversify the perinatal workforce, improve how we collect data to better understand the causes of maternal death and complications from birth, and invest in community-based organizations to help reduce the glaring racial and ethnic disparities that persist in our health care system.” These are well-intended words, though, the verdict will be out on this action until outcomes reflect significant change. These words must transcend one established annual week in April only, but receive concerted and strategic effort daily. We must do better to address this population health mandate and forge Wholistic Health Equity.

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