“Perfect storm” of contributing factors include systemic racism, shortage of care providers in rural areas, experts say
The rate at which Black women in Arkansas die during childbirth or within a year of giving birth rose 110% from 1999 to 2019, according to a study published Monday in the Journal of the American Medical Association.
Nationally, “maternal mortality remains unacceptably high among all racial and ethnic groups,” but American Indian, Alaska Native and Black “individuals are at increased risk, particularly in several states where these inequities had not been previously highlighted,” the study noted.
Researchers at the University of Washington in Seattle gathered data by state and racial group and determined how many of these deaths occurred per 100,000 live births.
“Maternal mortality persists as a source of worsening disparities in many U.S. states, and prevention efforts during this study period appear to have had a limited impact in addressing this health crisis,” the report states.
The collection of data for the study concluded before the onset of COVID-19. The pandemic “hindered some prevention efforts to decrease the deaths of Black women,” and national data has shown that maternal mortality increased in 2020 and 2021, the report states.
Arkansas already has the nation’s highest maternal mortality rate regardless of race, according to the Arkansas Center for Health Improvement.
In 1999, the state saw 42 Black maternal deaths per 100,000 live births. That number stayed above 60 from 2009 onward and reached 89 in 2019, according to the University of Washington study.
A wide range of factors, including systemic racism, create a “perfect storm” for Black Arkansans seeking prenatal and postpartum medical care, said Dr. Gloria Richard-Davis, a reproductive endocrinology professor at the University of Arkansas for Medical Sciences.
Those factors also include a shortage of labor and delivery units in Arkansas hospitals, which requires people in rural areas to travel long distances for care, something that is not always possible due to a lack of transportation or the ability to take time off work, according to medical professionals and advocates for pregnant Black Arkansans.
Arkansas remains one of the few states that have not taken advantage of the option to extend postpartum Medicaid coverage, which currently ends 60 days after birth.
Additionally, Black women might not trust the medical community or see themselves in their care providers, said Nicolle Fletcher, co-founder of the Ujima Maternity Network, a Conway-based nonprofit that seeks to create support systems for Black mothers in Arkansas.
“Those are the cries, if you will, that we’re hearing in the community,” said Fletcher, who has been a doula since 2009. “Mothers are trying to be proactive, but their hands are tied as far as solutions are concerned.”
Issues facing Black women
More than 80% of pregnancy-related deaths are preventable, according to the U.S. Centers for Disease Control and Prevention.
Richard-Davis said the medical field does not listen to Black women in particular when they raise concerns about their pregnancies.
“Many women tell their physicians or providers that they are having problems, but their voices are silenced, so trying to raise sensitivity and awareness among our providers in the obstetrical world is also critical,” said Richard-Davis, who is UAMS’ Executive Director of Diversity, Equity, and Inclusion, as well as a member of the state’s maternal mortality review committee.
Fletcher said Ujima’s focus is “collective work and responsibility” to support Black women during and after pregnancy.
The Arkansas Birthing Project also tries to meet Black mothers where they are and provide whatever support they need, director Dr. Zenobia Harris said.
“Women of color need to be respected, believed, seen and heard,” Harris said. “They need to have the choice to decide when interventions are going to be done to them. They need to have a voice in whether they agree or not with what is happening to them.”
Black Americans’ distrust of the medical community dates back centuries. When COVID-19 vaccines became available in 2021, some members of the Black community were hesitant to get a shot promoted by government officials because of experiments conducted on Black people in the past.
Richard-Davis said vaccine hesitancy or refusal contributed to maternal mortality regardless of race.
“It was very difficult to get women to understand that they were putting their babies at risk by not getting vaccinated,” she said.
Some health conditions disproportionately affect Black women during pregnancy, including high blood pressure, cardiovascular issues and preeclampsia. Black women are also more likely to give birth via Cesarean section, which can increase the risk of postpartum complications, Fletcher and Richard-Davis both said.
Arkansas has 37 hospitals that deliver babies. The Arkansas Birthing Project works primarily in Southeast Arkansas, which has a significant Black population, a high poverty level and long distances between hospitals, Harris said.
The combination of racial and economic inequality plays a role in “the ravages of unequal care” for pregnant Black women, Harris said.
“There’s a belief or a perception that maybe those people don’t work as hard and don’t deserve as much as others, and I think we need to reexamine that as a society,” she said.
More than half of all Arkansas pregnancies are covered by Medicaid. A bill to expand postpartum Medicaid coverage from 60 days to a full year after giving birth did not advance in the Arkansas Legislature earlier this year.
Richard-Davis said the coverage limit does a disservice to pregnant Arkansans on Medicaid.
“These patients are generally resource-challenged, so they are a lot more hands-on and need more attention and are higher-risk,” she said.
Relief efforts
The Arkansas Birthing Project is a volunteer-based mentorship program that does not require a college degree, Harris said. The nonprofit is made up of “local women in a community that want to make a difference” and has partnered with doulas in Southeast Arkansas, she said.
Meanwhile, Fletcher is studying to become a certified professional midwife, which will qualify her as a medical professional who can assist with births outside a hospital setting, she said.
The Ujima Maternity Network received a grant to create a training program for doulas across Arkansas, primarily aimed at regions with high populations of Black people and without enough health care providers, Fletcher said. Doulas are non-medical professionals and patient advocates who provide “physical, emotional and informational support throughout the different stages of pregnancy and postpartum,” she said.
Richard-Davis said she hopes the federal government will take on an active role in reducing Black maternal mortality nationwide.
“If we are going to make any dent in maternal mortality, we have to take a look at some sort of model, and it’s going to be a money loser for the hospital,” she said. “If it’s going to be a money loser, [hospitals] can’t stay open unless they’re subsidized. What is one mom’s life worth? We’re going to have to reflect on that and make some really hard decisions.”
Source: Arkansas Advocate