September 23, 2009

“Moms’ Crying Need” for Better Maternity Care

Women’s eNews currently features a piece, Black Infant Mortality Points to Moms’ Crying Need, which outlines the health disparities and systemic forces that stand between Black women and their babies and health. Author Kimberly Seals Allers argues that “If African American, Latino and Native American babies are too often in jeopardy, that means that this country is miserably failing women of color, and black women in particular, in the process of birthing healthy babies.”

She explains:

African Americans have 2.3 times the infant mortality rate as non-Hispanic whites, according to the Atlanta-based Centers for Disease Control, or the CDC. In 2000, the United States had a national average of 6.9 deaths per 1,000 live births, but the rate among blacks was 14.1 deaths. Compared to non-Hispanic white infants, black babies are four times as likely to die as infants due to complications related to low birth weight, the CDC also said.

Compounding this problem, she writes, is “what isn’t known about black maternal health” including ob/gyns “who aren’t aware that their black patients are at a greater risk during pregnancy, regardless of their socioeconomic status,” and “a woeful lack of research on the racial and ethnic differences affecting certain diseases and their treatment.”

The entire essay is well worth a read.

In addition to the moral or social justice argument for eliminating health disparities, a recent report on the economic burden of these disparities makes a money-saving argument for eliminating them, estimating that doing so “would have reduced direct medical care expenditures by $229.4 billion,” money that some suggest could be used to pay for health reform. HHS Secretary Kathleen Sebelius reportedly responded to the findings: “There is no question that reducing the health disparities can save incredible amounts of money. But more importantly it saves lives and it makes us a healthier and more prosperous nation.”

The agency released it’s own brief report on health disparities earlier this year, “Health Disparities: A Case for Closing the Gap.


4 Responses to ““Moms’ Crying Need” for Better Maternity Care”

  1. Jessica A Says:

    Interesting. At the same time I feel face this Caucasians as well that should have been included in this as well. At least in the department at the local hospital that was an clerical volunteer for some time until they no longer needed me and etc. At the same time I’m still at that hospital, but in another department.

    Hope I made sense here.

  2. MomTFH Says:

    Excellent post. I have been writing about this as well.

    Jessica, I am not sure I am understanding you. Caucasians are included in this. They are the “normal” or standard. They are listed above as “Non-Latino Whites”. African Americans have more than 2 times the infant mortality rates as Caucasians. I know in Florida maternal mortality rates show similar trends.

  3. Jessica A Says:

    momtfh,

    Its was my fault and guess that I should have read the whole thing before commenting on this.

  4. Christine Says:

    Unfortunately, it’s not just Black infants at risk when it comes to pregnancy and childbirth. Not to get even more depressing, but the US is facing some real problems with maternal outcomes. And, we know that what affects mothers affects their babies. Our group, the California Maternal Quality Care Collaborative (www.cmqcc.org) has been working to eliminate preventable maternal mortality and morbidity, and associated health care disparities.

    Here in California, we have seen the maternal mortality rate more than double for all women, and like the national data, pregnancy-related deaths among African-American women in California were 3.3 times higher than rates for whites or Latinas (37.6 deaths per 100,000 live births versus 12.0 and 11.9 respectively). The causes of pregnancy-related mortality in the U.S. cluster into four main categories—hemorrhage, embolism, hypertensive complications and cardiovascular disease. Each of these has a significantly higher condition-specific mortality rate and greater severity of disease for African American women than for other groups (Harper 2007).

    An important study by Tucker et al from the CDC examined the prevalence of five conditions considered major causes of mortality occurring during hospitalization for labor, birth and postpartum. She found that African-American women did not have a higher prevalence of these conditions compared to other racial/ethnic groups, but were more likely to die from them, suggesting either a possible difference in the severity of the disease or the quality of care provided during hospitalization. [Tucker MJ, Berg CJ, Callaghan WM. The black-white disparity in pregnancy-related mortality from 5 conditions: differences in prevalence and case-fatality rates. American Journal of Public Health. 2007;97(2):247-251.] African-American women have consistently had an approximately 40% higher rate of antepartum hospitalization which may represent a greater burden of disease, more severe disease, less access to preventive prenatal or preconception care or a combination of all of these.

    Also, my colleague, sociologist Louise Roth at the University of Arizona has examined the issue of ‘elective ceserean’, and the hype in the media surrounding ‘maternal request’. As you know in the last ten years, the cesarean rate has increased up to over 30% nationally, and cesarean is a major risk factor for babies and mothers. Roth found that Black and Hispanic/Latina mothers are more likely to have a cesarean delivery than white or Asian non-Hispanic mothers, and unmarried and less educated mothers (who are more likely to be low-income) are more likely to have cesarean deliveries than otherwise similar married and more educated women. Maternal request is unlikely to motivate these disparities in cesareans because the most vulnerable mothers, who tend to have the fewest choices, have higher odds of cesarean delivery. In contrast, structural inequality in provider-client relationships may play a significant role in the likelihood of cesarean delivery, with significant health implications for vulnerable populations.

    While the issue of infant mortality and morbidity is critical, it’s striking to me that so much more attention has been paid to infant outcomes while hardly any research has looked at what is happening to the women. Yet we know that a leading cause of fetal/infant death is maternal illness/mortality. Of course, babies are a lot more ‘sympathetic’ characters than mothers, which we as a society are quick to judge for all sorts of things.

    Thanks.
    Christine
    Christine H. Morton, PhD
    Program Manager/Research Sociologist
    California Maternal Quality Care Collaborative

    cmorton@stanford.edu http://www.cmqcc.org

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