About ten years ago, Black women in Texas had more likelihood of dying from pregnancy and childbirth complications, than white women. That has remained the case in recent times.
While at a meeting of Texas’ maternal mortality review committee, Nakeenya Wilson received a call that her sister was having a stroke. Wilson’s sister recently put to birth.
Wilson had to rush to the hospital. As she left the meeting in a rush to go be with her sister, she also left behind several files detailing the cases of women who had lost their lives as a result of pregnancy and childbirth complications.
Most of the women that their stories were contained in those files were black. In fact, Wilson herself also had a traumatic delivery.
According to Wilson, who is the committee’s community representative, the whole scenario reminded her that the name on those files could have been she or her sister.
As at when the Maternal Mortality and Morbidity Review Committee was established ten years ago, Black women were twice as likely to die from pregnancy and childbirth complication than white women and four times as likely than Hispanic women.
From the recent report of the committee, the numbers have not changed much.
For the year 2020, pregnant Black women were more likely to have critical health issues such as sepsis, preeclampsia and hemorrhage.
Despite the fact that recently, complications from obstetric hemorrhage has been generally reducing in Texas, for black women there was an increase of about 10%.
Wilson is of the view that these numbers depict the effect of a health care system that is unfair to Black women.
According to her, this condition did not just remain the same but it actually became worse. An example she gave was that while everyone else is getter better with regards to hemorrhage, black women are still being greatly affected and dying from it.
This disparity is really much and the reason is not that easy to pin point. It is as a result of poor access to health care and systemic racism. It is also due to the social determinants of health, which is the condition in which someone is born, grows up, works and lives in.
She went on to add that she and her sister are good examples as they grew up in poverty and without steady access to healthy food. They also had no health insurance and had to do without routine doctor’s visits. All these had a role to play when it came to the state of their health by the time they had gotten to childbearing age.
According to Maternal health advocates in Texas, handling these disparities will require much more than just taking care of labor and delivery practices. To properly handle the issue, what is required is a comprehensive health care system that takes care of a community’s needs long before pregnancy.
Although Wilson’s sister survived, the experience made her remember yet again, the reason why she volunteers to do her part in reading and analyzing the case of women who breathed their last due to pregnancy and childbirth complications. In her own words, “we have to advocate for our own safety”.
Implicit bias
Afiya Center is a Black-led reproductive rights organization in North Texas and D’Andra Willis, a vocal advocate for Black maternal health is a doula here.
For those who may not know, doulas are trained professionals who help pregnant women during childbirth, both physically and emotionally.
She stated that her clients who need to go the hospital are sometimes skeptical about going there. This is because they have had bad experiences at the emergency room and are bothered that that will remain the case should they go there again.
The review committee has taken discrimination into consideration as a contributing cause of maternal death. They discovered that it was a contributing factor in about 12% of deaths recorded in 2019.
According to Wilson, this does not account for it all, and it is probably more.
According to Dr. Rakhi Dimino who is an OB-GYN in Houston, discrimination can be happening in ways that may not be obvious to a health care provider, but will still have serious impact on the patient.
She said that this discrimination is often noticed in the notes, charts and conversations. Sometimes, a patient can be recorded as leaving against medical advice or being noncompliant. But on a closer look, it could be because they did not have a means of transportation to recommended specialist.
To tackle this issue, one of the committee’s recommendations is to have diversity in the maternal health workforce.
Access to Health care
While less than a third of white women are on Medicaid after they put to bed, in the case of Black women it is about two-thirds of them that have need for Medicaid.
From the report it was discovered that women that do not have private-pay health insurance were at a higher risk for severe maternal morbidity.
Women that do not have access to steady health insurance, will find it more difficult to get timely prenatal care. This is a contributing factor to not just pregnancy and childbirth complications but also other health complications such as gestational diabetes and obesity.
Not so long ago, woman who gave birth on Medicaid in Texas had no health insurance by the time two months had elapsed. The report has it that 15% of maternal deaths occurred more than 43 days after the date of childbirth.
The Texas House voted to increase postpartum Medicaid for 12 months in 2021. This was a major recommendation of the maternal mortality committee. However, the Senate reduced it to six months. The federal government is of the belief that the proposal cannot be approved in its present form.
Because of the pandemic public health emergency, people are not taken off of Medicaid at the moment. This has provided lawmakers with another chance to pass 12 months of postpartum Medicaid before coverage is lost.
According to Thierry, this will be a win not just for black women but also for lawmakers. She is also preparing a package of bills that is geared towards generally making maternal health much better, particularly for black women.
