The reasons behind the racial disparity in maternal health, which is apparent across class lines, have long been debated. In 1903, one doctor blamed the gap on blacks' "mass of imperfections" and "their own behavior," NPR reported last year. But research from social scientists and those in the medical field has shown that "the problem isn't race but racism."
The Yale report on Georgia's maternal mortality and racial disparity also found that structural racism, along with access to obstetric care and insurance and funding decisions were significant barriers for black women.
“Actual institutional and structural racism has a big bearing on our patients’ lives, and it’s our responsibility to talk about that more than just saying that it’s a problem,” Dr. Sanithia L. Williams, an African-American OB-GYN in the Bay Area and a fellow with the nonprofit organization Physicians for Reproductive Health, told the New York Times. “That has been the missing piece, I think, for a long time in medicine.”
A report from the National Academy of Sciences in 2002 found that people of color were less likely to receive appropriate medications for heart disease or undergo coronary bypass surgery compared to white people.
And according to the CDC, black women are 22 percent more likely to die from heart disease than white women. Furthermore, heart disease and high blood pressure are two of the leading causes of maternal death. And over the past two decades, such hypertensive conditions in pregnancy have been on the rise.
The National Academy of Sciences report found that people of color were also less likely to receive kidney dialysis and transplants, resulting in higher death rates. Black women were also 40 percent more likely to have cesarean sections.
"Some of us on the committee were surprised and shocked at the extent of the evidence," the researchers wrote.
Researchers at the University of Virginia conducted a study in 2016 to observe why black patients receive inadequate treatment for pain compared to white patients and relative to global guidelines. They found that white medical students and residents "often believed incorrect and sometimes 'fantastical' biological fallacies about racial differences in patients," the Times reported. Such fallacies included the belief that black people have less-sensitive nerve endings compared to white people or that their skin is thicker.
To bring the racial disparity of maternal and infant mortality rates down, community health workers have started adopting interventions that have worked in other parts of the world.
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One such worker is Rachel Zaslow, a midwife and doula in Virginia whose nonprofit Mother Health International recruits individuals in Uganda to give them medical training as midwives and nurse-midwives and matches them up with local pregnant women.
In Uganda, a woman has a one-in-25 lifetime chance of dying in childbirth, according to the New York Times. But since 2008, no mother in Zaslow’s program has died. The infant mortality rate in her program is 11 per 1,000, compared with the country’s 64 per 1,000.
Zaslow created a similar model to address the high rates of infant and maternal mortality in areas of Virginia. The U.S. program, Sisters Keeper, offers free birthing services to women of color.
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Forty-five black and Latina doulas are currently part of Sisters Keeper and since 2015, the doulas have assisted in approximately 300 births. There have been no maternal deaths and only one infant death.
“It is really hard for American health care professionals to get their heads around that when you have an organized community-based team that connects technical clinical issues with a deep, embedded set of relationships, you can make real breakthroughs,” Dr. Prabhjot Singh, the director of the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, told the New York Times. “In the U.S., doulas can’t do it by themselves, but based on work that’s taken place globally, they can help reduce infant and maternal deaths using what is essentially a very simple solution.”
Read more from the New York Times' coverage.