Addressing Maternal Mortality in the

Black Community.

Nancy Antwi

March 11, 2024

Intern Mentor G/T

Dr. Melissa Kiehl

1
 Abstract

The focus of this study is racial disparities pertaining to pregnant black women in America.

Black women are 3 times more likely to die while giving birth than any other racial group,

this is due to socioeconomic status, ongoing racial biases in healthcare provision, cultural

ignorance regarding conditions more prevalent among Black patients, and stereotyping

tendencies. This study aims to provide more insight about this issue by using information

from primary sources and comparing and contrasting various interviews. Additionally, this

study will tap into the other underlying complications that plague the black community and

other social determinants that affect the maternal health of black women.

2
Introduction

Black women are three times more likely to die while giving birth than any other

racial group in America (Hoyert, 2021). Tracing back to slavery, Black women’s bodies have

been experimented on and exploited by the medical community without consent. A long

history of residential segregation and hospital policies barring care for Black patients created

underfunded, inadequate healthcare facilities to serve minority communities. There are still

present examples of stereotyping of Black women as hyper-fertile leading to forced

procedures that had traumatizing impacts. Ongoing racial biases are the main contributor to

the rising mortality rates of pregnant Black women as there has been minimal effort in

attempts to accommodate their needs. This paper will explain how the detrimental effects of

slavery have paved the way for modern-day maternal care while also touching base on the

lack of representation in the healthcare system. Other social determinants will also be

highlighted by looking at statistics and evidence collected. Lastly, this paper will address

possible effective solutions to decrease the amount of maternal mortality in the black

community.

Review of Literature

Slavery is arguably one of the most horrific things to happen in America's history. It

has not only stripped the black community of its identity but has also established

long-lasting systemic inequality. Due to the contemporary discrimination faced, the black

community has higher rates of chronic illness, stress, and mental health problems. Sadly

health care outcomes are still impacted by this history today. Racial disparities in medical

3
care should be understood within the context of racial inequities in societal institutions.

Systematic discrimination is not the aberrant behavior of a few but is often supported by

institutional policies and unconscious bias based on negative stereotypes (Williams, 2000).

This directly connects to the lack of efforts made to accommodate the needs of black women

seeking maternal care, and how this mindset was used to perpetuate outrageous standards in

the hands of the care of black women. J. Marion Sims, the “father of modern gynecology”,

performed experimental surgeries without anesthesia on enslaved black women to develop

medical techniques and procedures to treat women’s reproductive systems. Conclusions such

as black women don't feel pain and “inherent racial weakness" were drawn from such

experiments. This led to present-day traumas and derogatory terms used against black

women such as “breeders”. Taking a look at this history and the inherent long-standing

trauma that has and continues to plague African Americans can assist in addressing systemic

racism (Stephanopoulos, 2022). Since the healthcare system was founded by hetero-white

men, how black women are perceived in the healthcare system is often marked by biases and

systemic disparities. Hence, the healthcare system needs to take it upon itself to foster

inclusivity, promote diversity, and address medical protocols.

In recent years, research and news reports have raised attention to the effects of

provider discrimination during pregnancy and delivery. News reporting and maternal

mortality case reviews have called attention to a number of maternal deaths and near misses

among women of color where providers did not or were slow to listen to patients (Hill,

2022). Black women's health issues receive insufficient attention and are too frequently

disregarded especially when it comes to a mother’s intuition about her body. Serena

4
Williams, one of America's greatest tennis players, suffered this experience firsthand. As she

was in labor with her first child, she recalls experiencing chest pain. Williams constantly

expressed her concerns to her nurses and doctors and even tried to use her white husband as

a mediator to express her concerns but failed. Her doctors later came to figure out that there

were blood clots forming in her chest that could have been fatal. Without her constant

“nagging” and determination, Williams' outcome could have varied. This shows that even

someone with such a high status as Serena Williams is still susceptible to experiencing fatal

complications while giving birth solely because of the color of her skin. Therefore, it is

important that healthcare professionals don't let the influence of unconscious bias affect

their decision-making in caring for their patients.

Diversity in healthcare professionals is also a large contributor to the care of pregnant

black women. African Americans are still underrepresented in the medical field, especially as

physicians, despite advancements. This is one of the reasons for cultural barriers in maternal

care. The number of black physicians is very low, about 2-3 percent. Black people make up

more than 2-3 percent of the population and the studies do show that when you are taken

care of by a Black physician your output does improve (Johnson-Weaver, 2024). Without

sufficient representation of black physicians, black women have a higher chance of

encountering providers who lack cultural sensitivity or are unable to adhere to their specific

needs and concerns. This disconnect can lead to misunderstandings and failure to adequately

take cultural perspectives into account, as well as not having the ability to address the

particular obstacles that black women encounter when trying to access healthcare services.

Diversity and inclusion in healthcare result in better daily care for diverse populations (Toll,

5
2023). Having employees from different ethnic backgrounds will ensure the quality of care

for whoever seeks it. This creates a relationship where communication is encouraged, which

allows vulnerability between the physician and the patient. Something as small as dietary

recommendations may cause a barrier between a provider and the patient because they don't

share the same religious background. Making these small changes can help emphasize the

importance of diversity in healthcare.

Factors driving racial disparities in maternal health expand beyond just racism and

prejudice but have a direct relationship with its long-lasting effects. Social determinants such

as access to quality health care, education, economic stability, and environment can work

hand in hand to negatively affect the experience of a black woman giving birth. Women of

color find it more challenging to obtain routine prenatal checkups, due to their higher

likelihood of being underinsured. A large swath of people continue to struggle to find

affordable coverage during pregnancy and the critical postpartum period because they do not

have access to employer-sponsored healthcare (Gai, 2023). Since the Black community is a

largely marginalized group in America, they are often found in low-income settings with

low-wage paying jobs. With births being so outrageously expensive in the U.S., ranging from

$15,000 - $20,000, those who don't have health insurance as a benefit, are left with no choice

but to seek unreliable medical attention. In addition, with the recent overturn of Roe V. Wade

the clinics that provide low-cost reproductive care are rapidly being shut down. Black women

are faced with having to travel longer distances and wait more time to receive reproductive

care. This disruption in accessing adequate prenatal services only increases the risk of

6
pregnancy complications for a demographic of people who are already suffering from high

rates of maternal mortality.

Black women have higher labor force participation rates than the overall population,

but typically work in lower-paying jobs or with limited benefits, still making up a

disproportionate share of family breadwinners in the United States (Gai, 2023). This lack of

economic stability is detrimental to maternal health as it is more difficult to afford quality

prenatal care, nutritious food, and other pregnancy needs. Furthermore, many black women

bear the burden of being the main breadwinner in their family causing them to prioritize

others over themselves. An example of this is compelling themselves to work long tiresome

hours, raising the probability of premature death. The combination of physical and financial

strain creates immense stress which can lead to more issues that plague the black

community.

Safety and general community factors related to the physical environment continue

to have an impact on the health of pregnant women and their children. Living in

neighborhoods with higher rates of gun violence or intimate partner violence (IPV)

negatively affects the mental and physical well-being of inhabitants, particularly during

pregnancy, for whom social and economic stability is particularly critical (Hill, 2022).

Frequent exposure to neighborhood violence and trauma raises the risk of developing

chronic stress, which raises the risk of diseases like postpartum depression, gestational

diabetes, and hypertension, all of which can complicate pregnancies. Living under constant

fear of violence makes it more difficult for black mothers to feel safe using community

resources or even going to prenatal appointments. The supportive environment required for

7
a healthy pregnancy is undermined by the lack of social and economic stability. Therefore,

investing in neighborhoods that have been historically segregated, lacked access to

government services, and subjected to racism will help to improve not only severe maternal

morbidity but also a host of other health outcomes for patients (Hill, 2022). Improving

access to secure facilities for physical activity, nutritious food, high-quality prenatal care, and

other government services in these areas can assist in removing obstacles and stressors that

are harmful to a mother's health.

To address the urgent problem of maternal mortality in the black community, it is

crucial to investigate possible and effective solutions. Educating the general public, proper

physician training, and creating organizations to help those affected are all interventions that

can work towards decreasing maternal mortality in the black community. Implementing

cultural awareness and holding training seminars in medical schools better prepares doctors

to give black women unbiased care during pregnancy and childbirth. A medical school in

New Zealand explored the integration of a cultural competency training program. The

objectives included enabling students to learn by observing another local community and

supporting them to reevaluate their own beliefs, assumptions, and prior prejudice. It

increased students' comfort level in cross-cultural engagement and emphasized the

importance of patients' perspectives in health care provision. Student's self-reported

knowledge about Pacific cultural values, protocols, traditional beliefs, and the main health

challenges increased significantly after the programme (Sopoaga, 2017). Gaining first-hand

experience with Pacific families’ cultural beliefs and health challenges increased the students'

comfort level, helping them connect with the community. Similarly, giving doctors training

8
on black American cultures, childbirth problems, and particular maternal health disparities

can help them develop the cultural competence needed to provide more high-quality

prenatal care. Healthcare workplaces should strive to mirror the races, ages, genders,

ethnicities, and orientations of the population they serve. This will result in better care for

the patients and higher employee morale (Toll, 2023). Such cultural immersion experiences

can give healthcare professionals the tools they need to establish trust and foster open

communication that meets the needs and values of black women throughout their

pregnancies.

Destroying systemic barriers also requires establishing organizations and services

specifically designed to meet the needs of black women. Better monitoring of new mothers

during their postpartum phase will help prevent complications and deaths during this critical

period. Research has shown that mental health care services are most effective when they are

integrated into maternity services to reduce poor health outcomes, especially for Black

women (Roberts, 2021). With the ability to access these vital resources, the constraints that

tie down the black community are now reduced. It provides care and increases convenience

by addressing the direct relationship between the physical and mental health of black

women. A present-day example of an organization that positively impacts black women is a

program Dr. Onukagha started after her horror birth story. The program offers participants

group therapy designed specifically for Black women, and it is led by community health

workers, including doulas, who can guide Black expectant and new mothers through

different parenting-related stressors (Cohen, 2023). Having members of their community

support them as they navigate parenthood builds trust and guarantees that the services are

9
provided efficiently. This doesn't only affect mothers and their newborns, but it also

positively affects the family's well-being. Programs such as this one have the potential to

reduce risk factors, improve maternal mental health outcomes, and ultimately decrease the

unacceptably high rates of maternal death among Black women.

Lastly, raising awareness about the high black maternal mortality rates in America is a

simple yet powerful step to enacting change. Educating the people around such as friends,

families, neighbors, and community can shine a light on this critical public health issue. As

more people understand the severity of this issue, it will encourage different healthcare

facilities to hire those who feel comfortable working in diverse settings and promote annual

training programs to end biases in the healthcare system. Such basic conversations lay the

groundwork for dismantling the disparities that allow preventable deaths among black

mothers.

Everyone has a role to play in ending structural racism. Acknowledging the history

behind black maternal disparities is the first step to combating this issue. As a community,

individuals coming together to pave the way for the future of black women can be the start

of change. Whether it’s creating awareness through advocating for policy change or simply

educating others, each is a step closer to bringing justice to the healthcare system.

10
Methods and Data Collection

Participants:
The list of interviewees include:
Julius J. Johnson-Weaver, Ph.D. (They/Them)
Princeton University
Founder and Cheif Physician of Resolve MD: Direct Primary Care

Doreen Kyere, Ph.D. (She/Her)

University of Maryland School of Medicine
OB/GYN in Kaiser Permanente

Both interviewees are African American doctors working in the healthcare field. Dr.
Johnson-Weaver runs their private practice working as a family physician. Being in the
progressive Howard County community they have worked with many demographics of
people, allowing them to have insight on this issue. Due to their racial and gender identity,
they have had first-hand experiences working with patients who may have suffered from
medical malpractice. Dr. Kyere is an OB/GYN therefore she works directly with pregnant
women especially black women because of her racial background making her a quality
candidate to be interviewed. While conducting interviews with black health care
professionals regarding racial disparities in maternal health can provide insightful
information, the results may be biased. Stereotyping could oversimplify their experiences,
while confirmation bias could affect their questions and interpretations. Validity may be
impacted by pressure to fit into preconceived notions about the issue. Biases based on culture
may influence the conversation. Sensitivity and awareness are essential when interviewing to
guarantee a thorough comprehension of racial disparities in maternal health.

Materials:

I needed to formulate an interview in order to answer my resaerxch question and confirm

my hypothesis. I searched for professionals using my personal connectyions and the
authors and names from my secondary research. The materials used to conduct the

11
interviews were a recording device, and a phone, as they were both over-the-phone
interviews and a Google doc with the questions.

The Two healthcare professionals that were interviewed for this synthesis paper

included Dr. Johnson-Weaver who is a black family physician in Columbia, Maryland with

their private practice. They were interviewed on January 10, 2024. The second person

interviewed was Dr. Doureen Kyere who is an African-American OB/GYN and a part of

Kaiser Permanente. She was interviewed on February 22, 2024. The research question and

hypothesis they were intended to respond to was why are black women more prone to

experiencing complications while giving birth than any other racial group? Black women

who have sought medical attention especially when pregnant run more of a risk of

experiencing complications during childbirth due to American history including systemic

12
racism and discrimination against women. To confirm this a series of questions were asked,

for example… What do you believe healthcare providers can do to address and reduce the

racial biases that may impact the care of pregnant black women, or black women as a whole?

How do factors like chronic stress, trauma, or systemic racism factor into risk for Black

pregnant women, and how can we start addressing upstream factors like these? What effects

do you believe medical myths (stronger bones, fewer nerves…) have had on physicians’

approach to black mothers such as treatment plans, medication, and pain management

approaches? How do you think that the lack of cultural awareness/competency affects how

medical professionals relate to/care for their black patients? What do you believe would be

the most beneficial/effective solutions to end this disparity? Etc.

Although conducting interviews with a Black family physician and a female OBGYN

regarding racial disparities in maternal health can provide insightful information, the results

may be biased. Stereotyping could oversimplify their experiences, while confirmation bias

could affect their questions and interpretations. Validity may be impacted by pressure to fit

into preconceived notions about the issue. Biases based on culture may influence the

conversation. Sensitivity and awareness are essential when interviewing to guarantee a

thorough comprehension of racial disparities in maternal health.

Results and Data Analysis

13
Discussion and Conclusion

14
 Works Cited (use this title if APA)

Cohen, J. (Director). (2023). A broken healthcare system: Racism and maternal health [Film].

TEDx Talks.

Gai, S. (Director). (2020). The fear of giving birth while being a black woman [Film]. CBS.

Hill, L., Artiga, S., & Ranji, U. (2022). Current status and efforts to address them. Racial

Disparities in Maternal and Infant Health. 30 (11), 202-230

Hoyert, D. (2021). Maternal mortality rates in the United States. Centers for Disease Control and

Prevention. 10 (9), 102-13

Johnson-Weaver, J. (1/10/24). Personal interview

Roberts, R. (Producer). (2021). How maternal medical disparities affect women of color [Film].

Good Morning America.

Sopoaga, F., Zaharic, T., Kokaua, J., & Covello, S. (2017). Training a medical workforce to meet

the needs of diverse minority communities. BMC Medical Education.

Stephanopoulos, G. (Producer). (2022). New documentary looks at high maternal mortality rates

among black women [Video]. ABC News.

Toll, E. (2023). Diversity training for health care workers. Diversity Resources. 30 (10), 100-120

Williams, S. (Producer). (2023). Why pregnancy is so dangerous for black women [Video]. PBS

Vitals

15
 Appendix A

(delete if not using appendices; each item gets its own title and letter - Appendix A,

Appendix B, etc.)

16