Em-URGE-ing Voices

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Black Maternal and Mental Health

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March 9, 2023

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The Texas Maternal Mortality and Morbidity Review Committee (MMMRC) recently released their biennial report on pregnancy-related deaths in the state. Consistent with national trends, the maternal mortality rate for Black women and birthing people in Texas is 2-3 times higher than that of our non-Black counterparts. 

Studies for maternal mortality use various measurements, with similar yet differing language to analyze maternal deaths. Below are common terms used to calculate maternal mortality: 

  • Pregnancy-associated mortality looks at death during or up to one year after the end of a pregnancy, whether or not the death was directly caused by pregnancy. 
  • Pregnancy-related mortality is a death “during pregnancy or within one year after the end of a pregnancy due to a complication from pregnancy, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiological effects of pregnancy” (Declercq and Zephyrin 2020). These deaths are directly linked to pregnancy and are measured per 100,000 live births. This is the measurement primarily used by the CDC to report U.S. trends. 
  • Maternal death or the maternal mortality ratio looks at deaths “during pregnancy or within 42 days of the end of pregnancy, regardless of the duration or site of pregnancy” (Declercq and Zephyrin 2020). This ratio is used by the World Health Organization and internationally, it is measured per 100,000 live births.

The Texas MMMRC has its own method of measuring maternal mortality utilizing an “enhanced four-step case identification method to identify cases of pregnancy-associated death.” This practice aggregates the number of maternal deaths indicated with death certificates matched with birth and/or fetal deaths and records that have been reviewed for any indication of pregnancy or miscarriage for unmatched records. This total is summated with all other female deaths in the state matched with birth and/or fetal deaths and all other female deaths that have ‘pregnancy’ checked on the death certificate after records have been reviewed for evidence of pregnancy or miscarriage to identify additional maternal deaths. For this reason, mortality rates represented in the report may differ from nationally reported rates.

The most recent report figures the state of Texas’ pregnancy-related mortality rate (PRMR) at 18.1 per 100,000 live births. Non-Hispanic whites experienced mortality at a rate of 20.3 and Hispanic mothers perished at a rate of 10.8. Non-Hispanic Black people giving birth in the state of Texas had a PRMR of 47.6. Nationally, Black birthing people have a maternal mortality rate of 55.3. Hispanic birthing people sit at 18.2 with non-Hispanic whites at 19.1 per 100,000 live births. This data represents a larger epidemic amidst the United States when it comes to an ever-present maternal health crisis.

The Texas MMMRC also noted 90% of the deaths they reviewed were preventable. The leading causes of death were a mix of medical complications such as hemorrhage and heart problems, mental health conditions, and injury by suicide and homicide (especially due to intimate partner violence). 

Disproportionate disparities experienced by Black and Indigenous mothers have persisted for many years. Black people have been more likely to die during childbirth at a higher rate than white birthing people for well over a century. For Black birthing people, there are no protective factors. Black birthing people continue to die during childbirth at exorbitant rates despite controlling for location, education, or wealth status. Like their mothers, Black infants in Texas also perish disproportionately to their peers. New research explains even the wealthiest of Black mothers are at risk of poor maternal and infant health outcomes. “High-income Black mothers, for example, have the same risk of dying in the first year following childbirth as the poorest white mothers” (Crawford 2022). These figures should be frightening.

There are many factors that contribute to such disproportionate mortality rates. An interlocking combination of systems that work effectively to systematically disempower and disconnect birthing people from their own physiological birthing processes sits at the nexus of this maternal health crisis. Social and structural impediments interfere with the care Black birthing people should receive during this vulnerable time in their motherhood journeys. 

The MMMRC cited failures on behalf of the patient (birthing person), providers, facilities, system, and community as a whole. Major takeaways from the list of contributing factors to poor maternal health outcomes provided by the MMMR Committee is that birthing people need robust support in understanding their rights as individuals and accessing affirmative care. Providers and their respective facilities would benefit in ensuring their care is appropriate to the experiences of the birthing person and culturally sensitive. Poor standard procedure and embedded practices of discrimination allow for systemic harm to occur. Community problems include lack of unstable and unaffordable housing, lack of support system, and lack of resources. All sectors mentioned point to a lack of knowledge in regards to how important an event, treatment or follow up was to the mother’s health. It would seem fruitful to understand, it is all serious. It is too big a risk to undervalue or overlook any experiences of birthing people and their infants.

Black women have always sat at the forefront of the birthing and reproductive justice movements. Early 19th and 20th century midwives, Black women who traditionally helped deliver babies for Black and white families alike, supported nearly all pregnancies in their local communities. They were community stakeholders who were tasked with supporting families as they planned, birthed, and raised their children. Due to the medicalization of birth and government regulation of midwifery, the number of Black midwives has significantly decreased. In modern days, organizations such as the Shades of Blue Project work to fight against poor maternal health outcomes for Black people giving birth in Texas. They create programming that supports maternal mental health and wellness, offer resources for infant loss, as well as provide innumerable resources for Black birth workers.

Disparities in maternal and infant health outcomes signify many failures within society. Through a blend of holistic wellness and medical resources, there is much work to be done in improving maternal health outcomes for all.

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