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Opinion: Black mothers expected to fare worse in pandemic

Portable medical tents are set up outside a Philiadelphia hospital. Pregnancy and deliveries are creating care challenges during the pandemic, and African American women are said to be especially at risk. (Elizabeth Robertson/The Philadelphia Inquirer/TNS)
Portable medical tents are set up outside a Philiadelphia hospital. Pregnancy and deliveries are creating care challenges during the pandemic, and African American women are said to be especially at risk. (Elizabeth Robertson/The Philadelphia Inquirer/TNS)

The Centers for Disease Control and Prevention (CDC) report that about 700 women die from complications related to pregnancy or childbirth every year, putting the U.S. in last place among all developed nations in terms of maternal mortality.

Black Maternal Health Week is an opportunity to raise awareness and center Black women’s voices in the conversation not only on Black maternal health in the United States, but in the conversation around coronavirus (COVID-19) disparities.

According to the Centers for Disease Control and Prevention, Black mothers are three to four times more likely to die from pregnancy-related complications than White women. Currently, we are seeing similar trends with the effects of COVID-19 on the Black community. Compared to majority White counties, Black counties have infection rates nearly three times higher and death rates that are about six times higher. Data also shows that Black people are overrepresented and, in some cases, make up most of COVID-19 deaths within certain states. For example, in Louisiana, where Black people make up 32% of the population, about 60% of people that have died from COVID-19 across the state are Black.

While disparities around maternal mortality and COVID-19 death rates are impacted by pre-existing conditions that Black people are more likely to experience (i.e. hypertension, cardiovascular conditions), it is important to understand that these pre-existing conditions do not happen spontaneously or in a vacuum. Social and structural inequalities that Black communities continue to face influence the prevalence of these pre-existing conditions and health disparities.

Black communities experience multiple structural inequalities such as access to quality healthcare, poverty, underfunded education, environmental factors, lack of affordable and quality housing, nutrition, childcare, and necessary social services — all of which impact their health status.

For example, hospitals in Black neighborhoods are more likely to close than those in White neighborhoods, making it difficult to find the care needed to stay healthy. Additionally, the quality of care that Black people receive is greatly affected by how they are treated by providers. Research has shown that many health care providers still hold false beliefs, such as beliefs of biological differences between Black and White patients, which influences how they treat them differently. This has potentially deadly consequences for Black patients whose experiences of pain or concern may be dismissed due simply because of the color of their skin.

While national attention has focused on the onset of the COVID-19 pandemic, limited focus has been placed on how this impacts pregnant and postpartum women’s health and experiences, and specifically Black women. Given the presence of multiple social and structural barriers and the higher rates of maternal mortality Black women already face, there are several concerns regarding how COVID-19 will impact Black maternal health:

  • Patients not seeking care for prenatal or postpartum concerns due to fear of exposure
  • Mothers and infants released from the hospital earlier than usual
  • Limitations to the number of support persons mothers can have in the delivery room
  • Providers cancelling or limiting appointments
  • Increase in maternal mental health concerns with growing pandemic anxiety and isolation
  • General misinformation surrounding the pandemic

Black women often experience implicit bias in many forms throughout the perinatal period. Their feelings of pain and discomfort may be dismissed by providers, leading to severe life-threatening consequences. In our current health system, which is overburdened with COVID-19 cases, this may be heightened. Additionally, to slow the spread of the virus, many hospitals and other clinical settings across the country are only allowing one support person in the delivery or patient room and some are not allowing visitors at all. Having loved ones or a doula present at birth improves the birthing experience by ensuring that women are supported and even advocated for in a way that Black women need.

In an effort to address these concerns, a number of Georgia-based stakeholders came together to develop a toolkit titled, Navigating Covid-19: Resources for Pregnant and Postpartum Families. Stakeholders wanted to make sure that families felt supported and informed to make decisions around the pregnancy and postpartum period that make them feel empowered. This resource is meant to provide guidance for families on how to plan for pregnancy, labor, and the postpartum period during the COVID-19 (coronavirus) pandemic.

Key Information and Resources

  • Women with COVID-19 can breastfeed if they wear a mask (if available), wash hands thoroughly before, and clean the surfaces they touch.
  • Regardless of visitor limits, a woman and her support person(s) should be treated with dignity and respect throughout the labor and delivery process.
  • If a woman has pregnancy Medicaid coverage, this means coverage can continue beyond 60 days postpartum as long the public health emergency continues.

Due to the current public health emergency, navigating our health system may be difficult at this time. Resources within this toolkit include how to prepare for delivery, postpartum and infant health information, and how to apply for public benefits.

Advancing equity in maternal health and health outcomes requires multifaceted approaches that address systemic barriers. Doing so we will create a society where we will have healthier mothers, healthier children and ultimately healthier families. While some may not consider maternal mortality a priority at this time, given the current global pandemic, focusing on Black maternal health is necessary maybe now more than ever. The issues that face Black mothers have not disappeared and may be exacerbated by the coronavirus (COVID-19) pandemic, creating an even higher mortality rate.

Natalie D. Hernandez, PhD, MPH, is an assistant professor and interim director, Center for Maternal Health Equity at Morehouse School of Medicine. Amber Mack, MSW, is a research and policy analyst at Healthy Mothers Healthy Babies Coalition of Georgia.