health disparities

Why are black Mamas dying in childbirth?

March 19th, 2010

Why are Black mamas dying at nearly 3 times the rate of their white couterparts during childbirth? This staggering statistic is only beginning to be addressed as the public health emergency that it is. Being an African American woman, it has not only alarmed me but saddened me to learn that African American women continue to die during childbirth and it seems to have nothing to do with age, education, job or career status or socioeconomic status. African American women are dying in childbirth now, today, in 2010. So what is causing this crisis?

Currently, The state of California is doing intensive research to identify why maternal mortality rates have nearly tripled from 1996 to 2006 and are now 4.5 times the benchmark set for Healthy People 2010. Part of their investigation is focusing on why African American women in that state  and nationwide are at a 2-3 times increased risk of pregnancy related death compared to white women for similar complications.

While there is limited data available to fully explain the disparity, there have been a few studies done to investigate this problem. In 2007, Myra Tucker et al. conducted a study which was published in the American Journal of Public Health*. Tucker and her colleagues found that while African American women did not have higher rates of 5 specific pregnancy related complications (preeclampsia, eclampsia, placental abruption, placenta previa, and postpartum hemorrhage), they died at 2-3 times the rate of white women. Further, this disparity was independent of how many children African American women had previously had, their level of education, age or socioeconomic status. So in short, African American women are not having these complications any more frequently, they are just more likely to die from them than their white counterparts. In 2004, Margaret Harper, MD and her associated concluded that,“there is a strong association between race and pregnancy-related death, even after adjusting for potential predictors and confounders.”**

So is being an African American Woman a risk factor for maternal mortality during childbirth? It would seem so. I spoke with Sharon Dormire, PhD, RN, an Associate Professor of Nursing in the Family, Public Health and Nursing Systems Division at the University of Texas at Austin about this disparity. Dr. Dormire is a certified Maternal-Fetal Nurse and also does research in Maternal-Fetal Health. Dr. Dormire and others have noted there is a difference in mortality for African American Women even when compared to women of African descent who come from other countries and have children in the US. Dr. Dormire relates that several researchers have noted, yet not fully studied and published data,  that an African woman who comes to the United States and becomes pregnant does not have the same rates of morbidity and mortality that African American women have during childbirth. However, if that same African woman has a daughter and that daughter is raised in the United States, when the daughter becomes pregnant, her morbidity and mortality mimic those of African American Women. Additionally, similar findings have been noted in women of African descent who come from other countries to the US and their daughters born and raised in the US. As a result of these findings, more research is being done to determine what, if anything, is occurring in the upbring, lifestyles and health maintenance of African American women to cause these disparities.

In 2007, Dr. Harper and her colleagues published another study in the Annals of Epidemiology*** which looked at why African American Women are at greater risk of pregnancy-related death. Their research yielded these findings:

African-American women had more severe hypertension, lower hemoglobin concentrations preceding hemorrhage (they were more often anemic), more antepartum hospital admissions, and a higher rate of obesity. The rate of surgical intervention for hemorrhage was lower among African-Americans, although the severity of hemorrhage did not differ between the two racial groups. More African-American women received eclampsia prophylaxis. After stratifying by severity of hypertension, we found that more African-Americans received antihypertensive therapy. The rate of enrollment for prenatal care was lower in the African-American group. Among women receiving prenatal care, African-American women enrolled significantly later in their pregnancies.”

Dr. Harper and her colleagues concluded that the differences in the severity of the diseases, associated co-morbidities such as obesity and the disparity in patient care all contribute to the disparity of maternal mortality between African American women and white women, yet, they are all MODIFIABLE, and as such could be modified in order to reduce maternal mortality amongst African American women.

I am convinced that not only these factors but others exist and are contributing to the higher rate of maternal mortality in African American women. We don’t have all the answers yet, but thankfully researchers are beginning to ask “Why” and are actively seeking answers. I’ll keep you posted.

*Myra J. Tucker, Cynthia J. Berg, William M. Callaghan, and Jason Hsia
The Black–White Disparity in Pregnancy-Related Mortality From 5 Conditions: Differences in Prevalence and Case-Fatality Rates
Am J Public Health, Feb 2007; 97: 247 – 251.

**Harper MA, Espeland MA, Dugan E, Meyer R, Lane K, Williams S.  Racial disparity in pregnancy-related mortality following a live birth outcome.  Ann Epidemiol 2004; 14: 274-9.

***Harper M, Dugan E, Espeland M, Martinez-Borges A, Mcquellon C. Why African-American women are at greater risk for pregnancy-related death. Ann Epidemiol 2007; 17: 180-5.

If you know of any research related to maternal mortality in African American women, please post it in the comments section. We all need to be aware of what’s going on.

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