In the United States (US), African-American women and infants are currently suffering from a major health crisis that continues to be ignored by the government. This crisis is the black-white divide that exists in both infant and maternal mortality. A comparison of most statistics displays just how disturbing and wide this black-white divide has become. In 1850, when an infant’s death was so common that most parents avoided naming their children until their first birthday, the African-American infant mortality rate was 340 per 1,000; the white rate was 217 per 1,000. Today, the data of the current US government shows that infant mortality is at 11.3 per 1,000 for African-American infants and 4.9 per 1,000 for white infants. This data shows that African-American infants in the US are now more than twice as likely to die than white infants – a racial disparity that is wider than it was in 1850 (15 years before the end of slavery) and when most African-American women were considered as chattel under the law.
This crisis of high African-American infant mortality is also interwoven with another one – the death of African-American mothers themselves. The US is one of the only 13 countries in the world where the rate of maternal mortality has worsened over the past 25 years. African- American mothers are three to four times more likely to die than a white mother, a statistic which is higher than Mexico’s, where almost half of the population live in poverty. A growing body of research suggests that the root cause of this disparity is the impact of systematic racism on African-American women. Thus, the impact of racism is manifesting itself in African-American women’s health, and ultimately killing them and their children.
The US response to this crisis has currently been little to nothing. In 2014, Monica Simpson, executive director of SisterSong, the US’s largest organization dedicated to reproductive justice for women of colour, testified in Geneva before the United Nations Committee on the Elimination of Racial Discrimination. Simpson stated that the US had failed to address the crisis of African-American maternal mortality and was, therefore, violating an international human rights treaty. 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.’ Unfortunately, no such measures to address the issue have been forthcoming by the US. Only about half the states and a small amount of cities maintain maternal mortality review boards to analyze individual cases of pregnancy-related deaths.
The response from several researchers, medical professionals and experts regarding the black-white disparity has been riddled with debate until recently. When the difference first became the subject of research over two decades ago, the majority of experts widely believed that the disparity was caused by only poor and less-educated women. This assumption led to experts blaming mothers and concluding that they were either too poor, uneducated or lived unhealthy lifestyles. However, the Center for American Progress recently reported that a growing body of research suggests that even with good education, income and health, African-American women and their infants are still dying at significantly higher rates than other groups in the United States. Many experts are now suggesting that the root cause to this crisis is systematic racism and longstanding racial basis in the health industry. Doctor Arline Geronimus, from the University of Michigan’s School of Public Health, was the first to link stress and African-American infant mortality with her theory of ‘weathering.’ Geronimus believes that toxic stress triggers the premature deterioration of African-American women’s bodies due to the repeated exposure to discrimination and insults. The ‘weathering’ of the body then leads to conditions such as hypertension and pre-eclampsia that result in higher rates of infant and maternal death. Geronimus stated in the American Journal of Public Health that “persistent racial differences in health may be influenced by the stress of living in a race-conscious society. These effects may be felt particularly by black women because of [the] double jeopardy of gender and racial discrimination.” In short, it could be said that racism is contributing to the deaths of African-American women and their children.
Racism is deeply embedded into the US health system. A study conducted by Cardiff Garcia revealed that African-American women are nearly four times more likely than white women to report worse experiences than other women when seeking health care. The National Public Radio and ProPublica found that African-American mothers in the health system have reported “being devalued and disrespected by medical providers.” Professional Tennis player Serena Williams recently told her pregnancy story and stated that “doctors aren’t listening to us, just to be quite frank.” Williams suffered from life-threatening complications and was bedridden for six weeks after giving birth. Furthermore, the ground-breaking report “Unequal Treatment: Confronting Racial and Ethical Disparities in Health Care” published by a division of the National Academy of Sciences, reported that people of colour were less likely to be given appropriate medications for heart disease, or to undergo coronary bypass surgery, and received kidney dialysis and transplants less frequently than white people. It was also found that African-American women were 40 percent more likely to have a caesarean section than a white woman. It is clear that structural racism, especially in the United States health system, is making this crisis persist. As reported by New York Times Magazine, Dr Sanithia L. Williams stated that “actual institutional and structural racism has a big bearing on our patients’ lives, and it’s our responsibility to talk about that more than just saying that it’s a problem.”
A Possible Solution
The US needs to employ systematic policy changes that focus on the equal treatment of African-American women and ensure that policies are targeting racism at its core. An approach that the US should consider is a policy that will provide more funding to doula services, as doula support has been linked with decreased infant and maternal mortality. These services are likely to ensure the equal treatment of African-American women and their infants. Doulas play an important role as an advocate in the medical system for their clients. Dána-Ani Davis, the director of the Center for the Study of Women and Society at the City University of New York, describes their important role: “At the point a woman is most vulnerable, she has another set of ears and another voice to help get through some of the potentially traumatic decisions that have to be made.” Doulas, she continues, “are a critical piece of the puzzle in the crisis of premature birth, infant and maternal mortality in black women.” A scientific study by Cochrane found that pregnant women who received continuous support that doulas provide were 39 percent less likely to have a C-section and that women, in general, tended to have healthier babies at birth. The American College of Obstetricians and Gynaecologists noted that “evidence suggests that, in addition to regular nursing care, continuous one-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labour.” Therefore, policies need to be implemented that ensure African-American women have a voice and on-going support within the health system.
History, research, and data also prove that racism must be addressed directly. As there is evident racism within the US health system, further training needs to be given to health professionals. A University of Virginia study found that white medical students and residents often believed incorrect and often ‘fantastical’ biological fallacies about racial differences in patients, especially African Americans. Such examples of fallacies are that African-Americans have less-sensitive nerve endings than whites, that African-American blood coagulates more quickly and that darker skin is thicker and tougher than lighter skin. The researchers did not blame individual prejudice for the belief of these fallacies, but deeply ingrained unconscious stereotypes about people of colour, as well as medical professional’s difficulty in empathizing with patients of different races and backgrounds.
As such, ingrained racism runs deep in the US health system and is resulting in poor outcomes and deaths. By raising awareness and implementing policies for training that extinguish and prevent such racial fallacies arising within the health system, African-American patients and people of colour will begin to feel more valued, respected, and receive better treatment. Policies should also be implemented that encourage medical professionals to embrace diversity and the positives of understanding and respecting people of different races, cultures, and backgrounds. People who understand and respect others implies higher emotional intelligence; it is concerning that many highly educated medical professionals lack this emotional intelligence. Therefore, further training should be implemented to promote the importance of understanding one’s patients. Finally, if the United States wishes to close its disturbing and shocking infant and maternal mortality gap – which it unquestionably should wish to – systematic policy changes must be implemented, and most focus on African-American mothers and infants but also policies that target racism at its core. A failure to do so will indefinitely further entrench the crisis.