Black people in America experience racism on an individual and systemic level that affects them in all aspects of life. Implicit bias – a form of bias that is unconscious and unintentional – is the leading cause of discrimination that Black people encounter in healthcare on a regular basis. These factors contribute to the increasing maternal mortality rates of Black women in the U.S., which can be prevented.
“Even with the purest of intentions, implicit bias can influence providers to discredit pain, dismiss symptoms, and ignore best practices, often silencing voices of Black birthing women,” (Josiah et al., 2023, pp. 5781).
The maternal mortality rate of Black women is 3-4 times higher than their white counterparts, reaching as high as 10-12x in some parts of the country (Gillette-Pierce et al., 2022, pp. 1739). The leading cause of death is due to comorbidities, such as preeclampsia and diabetes. However, racism contributes to these deaths by delaying care and failing to address their symptoms.
Implicit bias often presents as harmful stereotypes, such as believing that Black people have a higher pain tolerance. This myth stems from J. Marion Sims, the “father” of gynecology who would operate on Black women with no anesthesia because he believed that they did not experience pain the same way as white people. These dismissive attitudes can lead to improper pain management and the delay of proper treatment of urgent warning signs.
Racism also presents as limited access to quality healthcare. Socioeconomic factors such as access to transportation, unstable housing, or inability to find childcare limit one’s access to healthcare. Even when they are able to get there, the quality Black women receive is often below safe standards (Josiah et al., 2023, pp. 5780).
Black and Latinx birthing people also receive c-sections more frequently compared to White people, some unnecessary and increasing their risk of postpartum complications like hemorrhage (Gillette-Pierce et al., 2022, pp. 1740).
Decreasing the Mortality Rate:
In order to address the increasing mortality rates, there needs to be an effort on all levels, including healthcare providers, hospitals, and within communities.
First and foremost, there is a need to diversify intrapartum care. Midwives are often the primary form of healthcare a pregnant Black woman receives in poor communities. Having Black OBGYNs and midwives is an evidence-based approach that promotes positive health outcomes of Black women. It reduces biased care, increases patient satisfaction and trust, and promotes a better relationship between the patient and the provider (Gillette-Pierce et al., 2022, pp. 1740).
Additionally, healthcare providers must recognize their own biases and work towards eliminating them. Hospitals should also standardize care to ensure that everyone, regardless of race, receives the same level of care and attention.
Lastly, communities need to address social factors that are negatively impacting Black maternal health, such as unstable housing, food insecurity, access to transportation, and violence (Centers for Disease Control and Prevention, 2023).
References:
Centers for Disease Control and Prevention (CDC). (2023). Working together to reduce black maternal mortality. Centers for Disease Control and Prevention, Retrieved December 6, 2023, from https://www.cdc.gov/healthequity/features/maternal-mortality/index.html
Gillette-Pierce, K. T., Richards-McDonald, L., Arscott, J., Josiah, N., Duroseau, B., Jacques, K., & Baptiste, D. (2022). Factors influencing intrapartum health outcomes among black birthing persons: A discursive paper. Journal of Advanced Nursing, 79 (5), pp. 1735-1744. https://doi.org/10.1111/jan.15520
Josiah, N., Russell, N., DeVaughn, L., Dorcelly, N., Charles, M., Shoola, H., Ballard, M., & Baptiste, D.L. (2023). Implicit bias, neuroscience and reproductive health amid increasing maternal mortality rates among Black birthing women. Nursing Open, 10 (9), pp. 5780-5783.
