Maternal Mortality and Race

Maternal Mortality and Race

            One of the significant challenges that women face is maternal related complications. There is a growing threat to the women and newborns’ wellbeing because of difficulties, before, during, and after birth. With this public health issue in mind, the healthcare system has been at the forefront of ensuring that the affected women get the needed assistance they need. However, these health services providers have fallen under the realm of care disparity, with women from minority communities experiencing more healthcare challenges compared to women for European descent. Statistics are continually showing that African American women are more prone to end up losing their lives due to maternal related complications compared to white women. These statistics are an indication that the healthcare measures put in place to curb maternal mortality are more accessible to white women and compared to women of color and other members of the minority communities. This is a public health concern that calls for immediate interventions because healthcare is universal and therefore needs to be accessible to all people regardless of their background. Despite the difference in income levels, it is essential to ensure that the services are affordable to all people. This paper focuses on the prevalence of the problem, potential causes, the interventions that never worked, and those with the potential of being a permanent solution.

The Prevalence of Maternal Mortality among African Americans

            In general, the problem of maternal mortality has been a growing concern in the America despite the efforts put in place by the state and federal departments of health and human services. Notable is the fact that despite these measures, the rates have been increasing over the years. The rate actions between 2008 and 2009 were at 20.6 deaths per 100,000 population. There was an additional increase of 23.3% when the same rates were measured between 2013 and 2014, with a recorded rate of 25.4 deaths per 100,000 people (MacDorman, Declercq&Thoma, 2017). This increase was indicative of the fact that women are always faced with more and more health-related challenges as far as maternal care is of concern. The growing healthcare challenges faced by women are increasing at a faster rate despite the measures established to curb them. Hence the need for reducing these rates becoming more and more of a challenge. Another worth mentioning trend that cuts across all the races and is an essential factor worth considering when coming up with intervention is the age. The most affected women are those above the age of 30 years. In the period between 2008 and 2009, women between the age of 35 and 39 years recorded the highest rates of mortality that is 29.8 per 100,000. The same statistic was observed for the women in this same age group, where the recorded rate was at 32 per 100,000 people (MacDorman, Declercq&Thoma, 2017). The statistic is an indication that women in their late childbearing ages are faced with more maternal health issues compared to those that have children earlier.

The most concerning issue, however, is the current statistics that show how prevalent the issue of racial disparity in the delivery of maternal care is displayed in the entire country.  There are significant racial and ethnic disparities as far as the subject of morbidity and mortality is of concern. Those that are at a higher risk are women of color. According to the findings by Howell (2019), Black women are three to four times more prone to suffer from maternal mortality compared to white women.  The quality of care offered to these women from the time of conception to postnatal care is delivered with some racial disparity. The problem for many centuries, but the ethnic disparity has been more pronounced over the past few decades (Howell, 2018).  It is very saddening to note that the country is moving in the wrong direction as far as the management of this issue is of concern. This is because the mortality rates fell from 850 per 100,000 live births to just 7.7 per 100,000 live births between 1900 and 1997. However, the rates have so far increased 17.8  per 100,000 live births, according to PDF2. In the 1900s, there was a sharp rise in the population, but the healthcare system was yet to be advanced, and this is the reason behind the high rates of maternal mortality. However, with time, family planning was adopted, and healthcare improvements were made, and these two factors ended up making childbirth a process that is safe for both the mother and the children.

Nonetheless, these rates have been increasing of late despite the improvements made towards the health care system; when the rates are expected to be lowered further. Severe maternal morbidity has been observed to affect over 600,00 women annually in America with women of color, that is, the Non-Hispanic Black women being the most affected with being the highest affected with rates ranging between 22 and 25 per 100,000 population (Howell, 2018).  The rates are alarming in some states, these states have been identified as being as high as those in some developing countries, and this has been one of the wakeup calls creating a need for immediate intervention.

A study by MacDormn, Declercq, and Thoma (2017) focused on understanding the disparity among the different ethnicities in the state of Washington D.C. The findings from the study showed an increase in maternal mortality rates increase from 20.6 in the period between 2008 and 2009 to 25.5 between 2013 and 2014 per 100,000 live births. Notable, however, was that these rates were way more excellent among Non-Hispanic Black women compared to Non-Hispanic White women. The women of color had a rate of 46.7 and 56.3 per 100,000 live births in the two years, respectively, compared to the 15.9 and 20.3 per 100,000 live births for the two years, respectively among the Non-Hispanic white women (MacDorman, Declercq&Thoma, 2017). These findings are indicative of how women of color are being subjected to poor health standards and quality, which ends up putting them at the risk of losing not only their children but also their lives.

The same trends have been reported by the New York Times, where African Americans, Native Americans, and Alaska Women have been observed to be at a higher risk of dying due to pregnancy and other pregnancy-related complications compared to white women. The women from the minority communities were noted to be three times more likely to lose their lives or that of their infants to maternal complications compared to white women (Rabin, 2019).  It was also observed that 60% of the complications that end up leading these women into losing their lives are issues that could be prevented if all the measures were effectively implemented (Rabin, 2019).  More to this is that the United States has been observed to have the worst rates related to maternal mortality compared to other developed countries. In as much as the trends have dropped between 2000 and 2015, the rates are still high compared to other developed countries.  These findings are indicative of the measures put in place for the protection of the affected population, but the challenge has been on the implementation process.

Factors Leading to Increased Maternal Mortality

            Several factors have been responsible for the increased maternal mortality among African American women. One of the significant contributors for African American women to face this challenge is the growing racial and ethnic discrimination in the provision of care. While women of color have access to healthcare systems, African American women are exposed to several barriers that make them lack healthcare services for their wellness and that of their children (Rabin, 2019). Approaching the issue from this point of view, that is, looking at the healthcare system as being designed to be more beneficial to white women than African American women and other women of color is effective because it allows one to approach this public health issue through both a sociological and clinical way. It should be noted, however, that some of the mortality cases are a result of other causes aside from racial discrimination. The cause of these trends can be classified into three, that is, genuine clinical factors, discrimination in healthcare provision, and lastly, demography related.

Genuine clinical factors are the expected health challenges that women face as far as pregnancy is of concern. One of these is on cardiovascular diseases. The most common disease is cardiovascular disease, which is presented in the form of stroke and heart diseases. It should be noted that about a third of African American women that end up losing their lives is due to the diseases (Rabin, 2019). Cardiovascular diseases are not related to young women, and that is why in the prevalence of the maternal mortality rates, women above the age of 35 years were observed to be among those leading with having high rates of mortality. It should not come as a surprise that these diseases are very common among African American women. This is because cardiovascular diseases are diseases associated with obesity and overweight and these are also high among people of color. In as much as obesity prevalence has been observed to cut across all people from different demographics in the US, the prevalence rates are much higher among people of color, and other minority communities are the most affected and this can be viewed as one of the indirect causes of the growing maternal mortality among African American women (Rabin, 2019). Another diseases that were closely associated with the growing trend of women losing their life after delivery is unattended renal diseases, which are slowly becoming a significant threat (Jeseph et al., 2017).

The state of the healthcare facilities where these women deliver is another reason behind the growing maternal mortality. In understanding this factor better, one has to understand that the state of a healthcare facility plays a crucial role in the quality of care being delivered. There has been convincing data that the state of healthcare facilities has been a reason behind the ethnic and racial disparity in the delivery of quality care which has ended up causing maternal morbidity and mortality that is more prevalent among women of color. One of the means through which the quality of care delivered in these facilities is the congestion where many patients are supposed to rely on limited resources. It was noted that 75% of deliveries by African American women took place in just 25% of all the healthcare facilities with just 18% of white women delivering in such facilities (Howell, 2018). More to this is that the facilities that most of the African American women relied on delivery have the lowest scores as far as safety was of concern, and this exposed more of them to maternal morbidity and mortality (Howell, 2018).

Another primary reason behind African American women being more prone to maternal mortality than women of color is because they come from people of minority communities and a common characteristic of people from this community is the low literacy level (Somer, Sinkey&Thoma, 2017). Young African American mothers lack the experience of having a baby, and when such mothers are not equipped with high levels of education, there is a concern that they will end up putting themselves at mortality risk. His is because they do not have a better understanding of how to take care of their wellbeing and that of their unborn babies. More to this is that they usually fail to understand the need to have regular medical checks. By thus, therefore, they end up not getting adequate medical attention from the caregivers, with some opting to deliver at home. This is worrying because it limits the efforts that are in place for the aim of minimizing maternal mortality.  The method of delivery impacts the health state of the mother after delivery, and this has an impact on their risk of mortality. Home delivery in the absence of a healthcare expert is a threat to the quality of care being delivered and a risk to the baby and the mother (Main, McCain, Morton, Holtby& Lawton, 2015).

Intervention Measures

One of the measures that need to be put in place is by adopting effective monitoring approaches for women, even during their postpartum period. There exist healthcare programs that are aimed towards ensuring that women can recover to their best after delivery. However, these approaches of recovery are faced by one major challenge, that is, the lack of effective support system. The recovery process is based on the assumption that these women are in a good capacity of taking care of themselves and by this; therefore, less nursing support is offered to them, especially in their later postpartum period. However, most of the African American women have been observed to experience maternal mortality in their late postpartum period when most of the healthcare providers and even family members are of the assumption that the mother needs less support (Rabin, 2019).

It should be noted therefore that the women need consistent support. The support should not come from healthcare providers only because this may end up increasing the already high cost of healthcare services. However, family members, including spouses to the mothers should be provided with adequate training that will equip them with the needed skills aimed towards helping the new mothers to deal with any incoming healthcare-related challenges they face.

The state of healthcare facilities is another concern regarding the quality of care that is offered to mothers in need of maternal care. With congestion being the leading reason behind poor quality services (Howell, 2018). It is evident enough that the state governments, through the Department of Health and Human Services, towards ensuring that there are adequate healthcare facilities for all the people, they all have failed in ensuring that these facilities are equitably distributed to all the people in need. The inequality has put African America women and other minority communities congested in few healthcare facilities than others and therefore lowering the quality of care that they should benefit from. In the process of ensuring that healthcare is provided for all, the facilities in high-density communities should have more capacities and the cost of their services more affordable for all including low-income earners to afford.

Literacy levels and awareness of the important role of seeking medical attention on time were identified as being the reason behind the growing maternal mortality among women of African American descent (Somer, Sinkey&Thoma, 2017). The lack of knowledge and information will continually be a threat, and this not only puts the women at risk but also makes it difficult for them to appreciate the intervention mechanisms. In as much as there exist community-based approaches aimed towards providing awareness and training programs targeted mainly for young mothers, these approaches appear not to be as effective as they are supposed to be. This therefore, there is a need for the programs to be more diversified and pointed towards specific communities that are needed for the awareness. The role of social workers in public health will come in handy in this case.

Conclusion

            One of the significant health issues that US is dealing with is the growing trends of maternal mortality. In as much as the government through the health department is working tirelessly towards ensuring that mothers are receiving the best maternal care, there has been a growing concern because of these trends are continuously increasing over the past two decades. Between the 1900s and the late 1990s, the rates were effectively managed. However, it is very ironical that these rates are growing steadily at a point in time where the technology involved in healthcare, the understanding of diseases, and the enhanced training are all expected to ensure that these rates are low. Most concerning, however, is that the prevalence of maternal mortality is more pronounced among African American women and this is indicative of the healthcare disparity experienced against minority communities. The rates are so pronounced such that in some states, they are as high as it is the case in some of the developing countries. The rates are also the highest among most of the high income countries. Discrimination in the provision of quality care, prevalence of other diseases such as cardiovascular diseases and the lack of awareness and knowledge are the factors that lead to high maternal mortality among these women. Enhancing equity in the provision of healthcare services, and the promotion of awareness through social workers are some of the most reliable measures towards dealing with this problem.

References

Howell, E. A. (2018). Reducing Disparities in Severe Maternal Morbidity and Mortality. Clinical obstetrics and gynecology, 61(2), 387-399.

Joseph, K. S., Lisonkova, S., Muraca, G. M., Razaz, N., Sabr, Y., Mehrabadi, A., &Schisterman, E. F. (2017).Factors Underlying the Temporal Increase in Maternal Mortality in the United States. Obstetrics and gynecology, 129(1), 91–100. doi:10.1097/AOG.0000000000001810

MacDorman, M. F., Declercq, E., &Thoma, M. E. (2017).Trends in Maternal Mortality by Sociodemographic Characteristics and Cause of Death in 27 States and the District of Columbia. Obstetrics and gynecology, 129(5), 811–818. doi:10.1097/AOG.0000000000001968

Main, E. K., McCain, C. L., Morton, C. H., Holtby, S., & Lawton, E. S. (2015). Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities. Obstetrics & Gynecology, 125(4), 938-947.

Rabin, R., C. (2019). Huge Racial Disparities Found in Deaths Linked to Pregnancy. The New York Times.Retrieved from: https://www.nytimes.com/2019/05/07/health/pregnancy-deaths-.html

Somer, S. J. H., Sinkey, R. G., & Bryant, A. S. (2017, August).Epidemiology of racial/ethnic disparities in severe maternal morbidity and mortality.In Seminars in perinatology (Vol. 41, No. 5, pp. 258-265). WB Saunders.