Intersectionality and Maternal Mortality: African- American Women and Healthcare Bias is a well-researched Art and Humanities Thesis/Dissertation topic, it is to be used as a guide or framework for your Academic Research
When Serena Williams, the famous tennis player, gave birth to her first child in September of 2017, everything seemed to go perfectly (Haskell, 2018). Williams was in fantastic physical shape at the time of giving birth, having competed at professional tennis meets early on in her pregnancy, and having had excellent prenatal care.
While she required a C-section to deliver her daughter, Alexis Olympia, immediately after surgery everything seemed to be fine. However, when she experienced shortness of breath the day after birth, before being released from the hospital, she knew that something was horribly wrong.
Williams had a history of blood clots, and thus she knew the signs of a pulmonary embolism. However, when she attempted to tell the nurse she was having a medical emergency, her pleas were not taken seriously.
The nurse completely disregarded her. Williams had to insist on the doctor running tests, at which point blood clots were found in her lungs, followedshortly thereafter by a hematoma in her abdomen at the site of the C-section.
She proceeded to have two more surgeries in the next six days before finally being allowed to leave the hospital. This case caught a great deal of attention as Serena Williams had every indicator of having a healthy pregnancy and delivery.
She had the advantages of power and wealth, yet when she went to what was undoubtedly a high-income-area hospital she was nearly denied the medical care that ultimately saved her life.
Williams’ story is thought-provoking for its unfortunate normality. Thousands of women each year die, or nearly die, of post-pregnancy complications. This worldwide epidemic is prevalent within the United States as well, as it has a higher maternal mortality rate than almost every other developed country in the world.
With the enormous amount of money the United States pours into healthcare, and the technological innovation involved, it is surprising that the maternal mortality rate is so high. And unfortunately, black women have an extremely high rate of death after pregnancy that is far above the general population.
There are many contributing reasons for this, such as the historical role of sexism and racism in the American Healthcare system and healthcare provider implicit bias, but ultimately these women are being oppressed from many different sides.
The maternal mortality rate of black women in the United States is an
important case study as to why the physical effects of intersectional oppression needs to be factored into the health determinants in the healthcare system, and this lack of awareness is a major reason as to why the maternal mortality rate in the United States greatly exceeds international goals.
Maternal mortality is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes” (WHO, n.d.).
Additionally, there are also ‘near misses’, or where women had significant complications that nearly lead to their death.
The most likely causes of death for women after giving birth are preventable: “cardiovascular conditions [which account for] (15.5%) [of deaths] followed by other medical conditions often reflecting pre-existing illnesses (14.5%), infection (12.7%), hemorrhage (11.4%), and cardiomyopathy (11.0%)” (Creanga, Syverson, Seed & Callaghan, 2017).
Worldwide, there has been an enormous reduction in maternal mortality: “[i]t is estimated that, between 1990 and 2008, 147 countries experienced a decline in maternal mortality ratio, 90 of which showed a decline of 40% or more.
In 2 countries there was no change, and in the remaining 23 countries, including the United States, the maternal mortality ratio actually increased” (APHA, 2011).
In many impoverished countries, the deaths of pregnant women and new mothers might have easily explainable causes such as a lack of hygiene or access to proper medical care, but this is not the situation in the United States.
All the easy explanations—a lack of resources or insufficient access to medical care—are nowhere to be found. The reason for this death rate is not one of medical lack. Unfortunately, the statistics only get worse.
The maternal mortality rate of the United States has increased significantly over the past three decades, from 7.2 deaths per 100,000 live births in 1987, to 18.0 in 2014 (CDC, 2018).
In 2017 there were a reported 17.0 deaths per 100,000 live births (Creanga, Syverson, Seed & Callaghan, 2017). In comparison, Greece, Iceland, Poland, and Finland all have only 3.0 deaths per every 100,000 live births (CIA, 2015). While there are significant distinctions between the healthcare processes of these countries and the United States, the numerical differences in deaths are staggering.
In the same study, it was found that the United States is ranked 46th in the world for maternal mortality (CIA, 2015). Approximately 700 women die from pregnancy and birth complications in the United States every year, and 60% of these deaths are preventable (CDC, 2019).
Of these deaths, 31% occur during pregnancy, 36% occur at birth or within the week after birth, and 33% occur between one week and one year postpartum (CDC, 2019). Women’s lives are continually in danger from the time they become pregnant to a year after they give birth.
Even more strikingly, “non-Hispanic black women hav[e] a 3.4 times higher mortality ratio than non-Hispanic white women” (Creanga, Syverson, Seed & Callaghan, 2017).
This is an astoundingly high mortality ratio, and one that deserves attention. In a developed country where women are still at serious risk for pregnancy and birth complications, black women are especially vulnerable.
The World Health Organization and the United Nations have set goals in order to assist countries in ensuring that their maternal mortality rate is reduced. Millennium Development Goal #5, established by the United Nations in 2000, was to reduce maternal mortality by 75% between 1990 and 2015 (WHO, 1990);
when this was not achieved, the 2030 Agenda for Sustainable Development gave a goal of eliminating all preventable maternal mortality deaths before 2030 (UN, 2015). Additionally, these organizations set several guidelines to assist countries in lowering their maternal mortality rate.
It is not the intent of this paper to analyze all of these guidelines and how they are upheld or abandoned, but it is important to address two in particular that the United States is violating.
These are “addressing inequalities in access to and quality of reproductive, maternal, and newborn health care services,” and “ensuring accountability in order to improve quality of care and equity” (WHO, 2017).
These two issues are vital when addressing black women’s maternal mortality rate in the United States, as black women lack access to quality, comprehensive medical care, and face a system that allows doctors’ implicit biases to make judgements that produce said lack of access.
The most astounding fact about this seeming epidemic of deaths is that “most deaths are preventable, no matter when they occur” (CDC, 2019). Another source indicates that approximately half of all maternal deaths and 30-40% of near-misses in the United States are preventable (APHA, 2011).
The causes of death are treatable as long as women receive quality medical care in time. Indeed, as a past president of the International Federation of Obstetricians and Gynecologists states, “Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving” (Fathalla, 2006).
The issue is not in the technological capability for doctors to save women’s lives; rather, it is in their willingness to do so, and the priorities undermining their care for them.
Unfortunately, black women are more likely to die because of the oppression they face in society based upon the intersections of their social identities, and a lack of value placed upon their lives within the healthcare system.