Black Women and Maternal Health Disparities

One of my biggest pet peeves in school is when professors throw up health disparity statistics without any explanation. They quote the numbers and don't ever mention how or why minorities are 2x, 3x, 4x worse off than other people. When you don't explain why these disparities exist, you imply that it is black folks themselves that are to blame for this situation, instead of a complex myriad of factors (including poor choices we make.) In fact, what you've done is blamed the victim.

If you look at this chart, you will see that black women are more likely to have unwanted pregnancies and less likely to receive early prenatal care. Our children are twice as likely to die after birth, and we are almost FOUR TIMES more likely to die in childbirth or right afterwards. We are more likely to be uninsured and about 2.5x more likely to be living in poverty. Ok, I gave you the stats...but I am not walking away...

This is not new information. In fact, the differences in maternal and child health between black and white women was documented starting way back in the early 1900s. So why is this still haunting us? If you're not afraid to hear what I have to say, keep reading. If you're not in the mood, or you want to stay in your happy go-lucky mood, come back later. But right now, I'm about to tell the truth as I see it, and sometimes the truth hurts.

As I see it, maternal health disparities can be "blamed" on a combination of these three things: history, resources, and education. Historically black women have had less control over their reproductive rights in this country. As slaves they were forced breeders, and after slavery they were routinely sterilized without their consent. There were times in this country when black women believed that birth control (such as pills) were really methods of sterilization that white people were trying to trick them into using. This is our (American) history. Is it any wonder why we are less likely to seek out care from the medical establishment? And then when we do, we are treated differently. There are many, many articles about the difference in care black people receive when they do seek medical attention. So here is the moment of truth...is it not possible that the reason our outcomes are worse is because our treatment is worse? Of course it is. But this requires people to step up and claim their bias, and who wants to do that? Why are we expected to continually subject ourselves to sub-standard care, pregnant or not? People will say "substandard care is better than no care," but I say not always. If the only thing you can offer me is your brand new med student who really didn't want this site in the first place, a 2 hour wait in a crowded waiting room with absolutely no privacy, a 5 minute glance over after a MA takes my vitals and a nurse takes my history, thank you but no thank you. I'll skip the stress and take my chances.

Why am I putting up with this? Because I don't have much of a choice...I am lacking resources. Why am I lacking resources? Because, still, in 2007, black people are three times more likely to live in poverty than white people. (24.3% vs 8.2%) What does this have to do with health care? Well, there might not be a community clinic in my neighborhood, and if there is one I might not be able to get to it. The most poisonous facilities are in my neighborhood, the food is not as fresh in the grocery store, and there are no parks nearby. What are you going to tell me when I get to my appointment (if I get to my appointment)? Eat well, walk around/exercise, get fresh air! I'm being facetious, but you get the point. In case you don't, let me say it simply: It's frustrating to go to an appointment when you know what you're supposed to do but can't really get it done because you're overwhelmed with life in general. The provider thinks, "she only had to get some prenatal vitamins, that was the only goal of the visit!" but the girl starts in with this story..."see, my boyfriend/mama/uncle/best friend brought me here today and I told him/her it would be an hour at the most, but really it was two, and so when I went outside I couldn't ask him/her to take me to get the vitamins because (s)he was already mad and...." and on and on and on. The hood sets you up to internalize this never-ending cycle of hopelessness/helplessness/victimology that is really hard to shake. I think some of the disparities we describe in racial terms are really disparities based on socioeconomic status, but because black people are disproportionately poor, it comes out as racial statistics.

Could our maternal mortality be higher because we receive higher number of unnecessary c-sections? If women on medicaid are more likely to receive unnecessary c-sections and we are disproportionately represented...wouldn't that put us at higher risk for maternal death? We need to educate ourselves about our bodies and our rights. We must take responsibility for some of the problem because we do not take the time to educate ourselves. Maybe we just have to acknowledge and accept that being pregnant is a sacrifice in terms of working a little harder to eat a little better and walk a little more, because some of this is due to to our lifestyle, and no even if we can't eat the best, we can eat better, and even if there is no park, there is indoor movement. Now is not the time to be complacent and frustrated, no matter how true it is that the odds are against us. Complacent and frustrated does not find you a good provider.

I am becoming a midwife because I believe no one is going to rescue my community. I believe the community has to rescue itself. One day in my journal I wrote "wake up girl, the cavalry ain't comin." That's a hard truth to swallow because it means you stop expecting your equal rights, your access to good care. You hope for it, but you prepare for what's in front of you (or better yet, you prepare based on the history that's behind you) and you stop waiting for someone to come and say "I'm sorry, here's that shyt I owe you. Your fertility, your right to a safe birth, your dignity." Instead, you break your back trying to become somebody, anybody, so that you can pick up a broom, a pen, a case file, a stethoscope or a speculum and rescue your community your damn self.

Maternal health disparities exist because we allow them to. We allow them to because the women who are dying are no longer valuable to us. History says if we still needed them to plow our fields, clean our houses, or feed our babies from their breasts, they would not be dying.

We would not allow it.