Maternal mortality in the United States is the highest of any developed nation. Even more striking is that Black women die at three times the rate of white women. Racial disparities in health outcomes are well-known and well-documented, and maternal health is no exception. However, little has been mentioned about the effect of systemic racism on mothers that contribute to their high rates of death and morbidity. In fact, racism isn't mentioned much in medical journals at all; in the top four medical journals in the world, less than 1 percent included the word "racism," and 90 percent of those were opinion pieces.
Racism isn't mentioned much in medical journals at all; in the top four medical journals in the world, less than 1 percent included the word "racism."
The root causes of these racial disparities need to be examined in order to address the public health crisis that maternal health has become. Dismissing these racial disparities through the "social determinants of health" explanation allows us to accept these disproportionally high deaths as an acceptable side effect. However, the research has shown that racial and ethnic differences exist even when controlling for education, income, comorbidities, and other variables. In fact, a white woman with no high school diploma has a better chance of survival than a college-prepared Black woman.
Race is not biology, but a metric of social hierarchy
Recently, Community Solutions’ Racial Equity Media Club watched a documentary that described how race is a human-designed construct, using our biology as an excuse for social hierarchy. Historically, different races were seen as having varied physiologic structures that aided each group in different physical aspects, such as having advantages in certain sports.
Published in 1898, Fredrick Hoffman's Race, Traits, and Tendencies of the American Negro found enormous disparities between Black individuals and whites through flawed data. He concluded that, "In contrast to today's belief in Black physical superiority…African American's were innately infirm. As such, attempts to improve their housing, health, and education would be futile. Their extinction was inevitable, encoded in their blood.” It is easier for people to scrutinize the physical being of an individual and use it as an explanation for disparities rather than address the external forces that cause them. And racism is one of these forces.
Disparities are systemic, not individual failures
As appalling as these historical comments are, these sentiments are still widely in place and sometimes perpetuated today, even here in Ohio. We hear public officials make incorrect, misleading, and sometimes overtly racist statements, such as the well-publicized instance of equating COVID-19 infection rates to the completely untrue assumption that some populations "do not wash their hands as well as other groups."
Placing blame on the patient for dying are, by nature, racist diversions that allow for these disparities to remain intact without acknowledging the role of systemic discrimination.
Statements about maternal health are no different. Very recent comments blame individuals for the disparities in health outcomes, suggest that we remove Black and brown mothers from official statistics, or deny that pregnancy and childbirth can be dangerous are just some examples. Placing blame on the patient for dying are, by nature, racist diversions that allow for these disparities to remain intact without acknowledging the role of systemic discrimination.
Creating a healthier environment for people to live, grow, work, and play is extremely important, and that healthier environment must include equity for all. In order to move towards a more equitable environment in health care, we must be willing to recognize when our system perpetuates and encourages disparities along racial identity and work against those forces.
