Death by Birth: Race and Maternal Mortality

By Michelle Chen Mar 17, 2010

On December 14 2004, Tameka McFarquhar became a mother. On Christmas morning, the Jamaican-born 22-year-old was found dead in her apartment after bleeding to death. A later investigation found that part of the placenta had been lodged inside her body—a complication that might have been prevented if she had received adequate postpartum medical care. On any given day in America, a number of births will result in tragedy. But misfortune doesn’t strike randomly. The chances that a mother will survive till tomorrow is tragically tied to the color of her skin. Amnesty International has released a report maternal death in America showing appalling differences in maternal mortality rates of white and Black women. The prevalence of the disparities, which persist even across different socioeconomic levels, expose one of the deepest scars of a failed health system:

African-American women are nearly four times more likely to die of pregnancy-related complications than white women. These rates and disparities have not improved in more than 20 years.

From a human rights standpoint, that statistic places the United States behind many other industrialized countries despite the enormous amount the country spends on health care. The high rate of maternal deaths among Black women—along with the shockingly high Black infant mortality rates—are a haunting testament to stark inequalities in health insurance coverage and access to prenatal care and family planning services. Drawing on federal data in the context of international human rights mandates, Amnesty reports:

Despite representing only 32 percent of women, women of color make up 51 percent of women without insurance. Women of color are also less likely to have access to adequate maternal health care services. Native American and Alaska Native women are 3.6 times, African-American women 2.6 times and Latina women 2.5 times as likely as white women to receive late or no prenatal care. Women of color are more likely to die in pregnancy and childbirth than white women. In high-risk pregnancies, African-American women are 5.6 times more likely to die than white women. Women of color are more likely to experience discriminatory and inappropriate treatment and poorer quality of care.

Despite some Medicaid-based prenatal programs for poor women, the lack of comprehensive health coverage means that many women fall through the cracks. Moreover, the private insurance market is rigged to restrict women from purchasing affordable maternity coverage. The Centers for Disease Control has suggested that obesity (another health problem linked to race and class) along with increased use of C-section operations, could be contributing to maternal deaths. But the problems may begin long before a woman becomes pregnant. Women may live in an isolated rural area with no access to quality health care, they may be undocumented immigrants and therefore generally barred from Medicaid, or they may live in one of the vast majority of underserved communities lacking a Federally Qualified Health Clinic, a frontline health system for low-income households. Then there are the roughly 8 million women who should qualify for affordable public family-planning services but somehow never receive the aid they need. Other barriers are harder to detect, quietly eroding women’s health in their everyday struggles:

Women interviewed by Amnesty International also cited lack of transport to clinics, inflexible appointment hours, difficulty in taking time off work, lack of child care for other children, and the absence of interpreters and information in languages other than English, as major barriers to health care.

Eleanor Hinton Hoytt, president of the Black Women’s Health Imperative, comments in the report on the untenable choices pregnant women face in an unforgiving economy:

We’ve had women tell us that they’re afraid to miss time from work when they have prenatal appointments. They are faced with the choice of coming to work or missing work and losing their jobs. that is their reality.

Health care reform could expand the range of prenatal and maternity care resources available to low-income women. According to the Kaiser Family Foundation, the plans under consideration would, despite severe limitations in the proposed subsidized insurance system, provide for basic "maternity and well-baby care" in the proposed insurance exchange plans, along with "support for nurse midwives and free-standing birth centers, as well as tobacco cessation programs for pregnant women on Medicaid." But Amnesty calls on Washington to go further to close racial disparities in maternal mortality: establishing a White House office of Maternal Health; engaging the Justice Department and the Department of Health and Human Services’ Office of Civil Rights to combat medical discrimination, and easing the Medicaid enrollment process for pregnant women. Those measures could go a long way toward preventing avoidable maternal deaths. Yet until we push forward a real overhaul of the health system, so that all women have access to the resources they need for safe childbirth, many more mothers of color will die at the moment when life should begin.