Can the United States fix Black women's maternal mortality crisis?

• Black women at higher risk of maternal, infant death
• Pandemic widens long-standing racial disparities
• Expanded Medicaid, doula services seen key to saving lives

RICHMOND, Virginia - When Giovanna Andrews recalls her traumatic labor, one of the worst things is remembering how her calls for help were ignored by medical staff at the hospital in the eastern U.S. state of Delaware.

Her daughter's heart briefly stopped beating during labor, prompting staff to pump Andrews' abdomen to get it going again - a procedure that dislodged her epidural catheter and eventually left her in "unbearable" pain, she said.

"That experience opened my eyes to other things that moms may not be being heard about," said Andrews, 27, who has since founded Harper's Heart, a nonprofit named after her daughter, Isabella Harper.

Andrews did not file a complaint against the hospital, which she said had since shown willingness to address concerns raised by advocates including herself.

Still, she said delivery room ordeals like hers are all too common among Black women in the United States, a country with a poor record on maternal and infant mortality - particularly among Black women who are at significantly higher risk of both.

"We need to be talking about that wave of racism that has been threaded throughout our communities and medicine that keeps the ideologies alive that Black women (have) a higher threshold for pain," she said by video call.

Black women in the United States are about three times more likely to die from pregnancy-related causes than white women, according to a 2022 report from the federal Centers for Disease Control and Prevention (CDC).

Despite being one of the world's wealthiest countries, the United States lags far behind other developed nations on curbing maternal deaths, with race strongly associated with risk, research shows.

Calls for action to tackle the long-running issue have grown amid an ongoing reckoning over race in the country, and both the federal government and states are looking at ways to reverse the historic trend.

'Last by miles'

A recent first-of-its-kind study found that racial disparities in maternal and infant health were much wider than income disparities, with other early evidence suggesting COVID-19 exacerbated underlying race gaps in maternal health.

Using data from California from 2007-2016, researchers found the maternal mortality rate for the wealthiest 20% of Black mothers was similar to that of the poorest white mothers in the study: about 2.7 deaths per 10,000.

"The racial inequities we observe in terms of maternal and infant health are not purely explained by differences in just income," said Maya Rossin-Slater of the Stanford University School of Medicine, one of the co-authors.

The paper received renewed attention in February after being published last month by the National Bureau of Economic Research (NBER).

The research highlights limited progress in reducing maternal deaths in the United States, exposing inadequate social safety nets and inconsistent access to medical care.

"It's not just that we're last. We're last by miles," said Eugene Declercq, a professor at the Boston University School of Public Health who studies women's health. "We're about 70%-80% higher than any other wealthy industrialized country."

Between 2000 and 2020, the global maternal mortality ratio declined by about 34%, according to a report released last week by the World Health Organization.

At the same time, it nearly doubled in the United States – one of eight countries and territories the report flagged as "at great risk."

The pandemic is partly to blame for the widening race gaps in outcomes, advocates say.

"COVID, as it did with a lot of things, exacerbated and continues to exacerbate the racial disparities that already exist," said Tina Sherman with MomsRising, a social advocacy group.

Human rights issue

Spurred on in part by pandemic-related concern about health inequalities, the federal government and various states are evaluating ways to reverse historic racial disparities.

They are considering initiatives including expanding access to doulas and extending postpartum coverage through Medicaid, the federal-state health program for lower-income Americans, for at least a year.

Doulas can be vital advocates for women during childbirth, studies have shown, helping to shorten labor time and reduce the number of cesarean sections.

Advocates say such measures are particularly important for Black women, who face persistent stereotyping that can adversely affect how doctors handle their pregnancies and labor.

Nicole JeanBaptiste, founder of Sésé, Birthing Freedom in the Bronx, New York, described seeing laboring clients being asked questions that, she said, should never be asked of someone experiencing contractions.

She said she has previously heard questions like "Are you mentally well?" and even "Are you high?"

"These are experiences I would bet money do not happen to folks ... who are not Black women," said JeanBaptiste, whose cooperative offers doula services and educational workshops.

Medicaid priority

A handful of states now offer reimbursement for doula services provided through Medicaid, and more than half of U.S. states are offering expanded postpartum coverage for 12 months via Medicaid.

"From the president on down, maternal health is a priority," Chiquita Brooks-LaSure, administrator of the federal Centers for Medicare and Medicaid Services (CMS), said at an event this month in Washington, referring to Joe Biden.

She said CMS was implementing new reporting requirements for hospitals and collecting data about unnecessary C-sections and excessive bleeding at delivery. It has also launched a "birthing-friendly" hospital designation to help inform patients seeking maternal care services.

New York City is among the localities to take an interest, starting a citywide doula initiative that is open to Medicaid-eligible individuals and those who live in shelters.

It is estimated that Black women in New York City are between nine- and 12-times more likely to die from pregnancy-related causes than white women.

"One of the huge myths is that there isn't a doula for everybody – and there is one," said Latham Thomas, founder of Mama Glow, a New York-based organization that trains and supports doulas.

Birth in Color RVA, a nonprofit with multiple locations in Virginia, also facilitates doula support and provides classes on issues such as racial bias training for providers.

There needs to be broader recognition of racism within systems like healthcare for things to truly change, said Kenda Sutton-EL, the group's executive director.

"When we look at systemic racism and realize that these systems were never designed for people of color - dismantling it from the root and restructuring it (is) when we're going to see that it really has (changed)," she told Context in her Richmond, Virginia, office.

Thomas said Black History Month, which is drawing to a close, is an opportunity for people to educate themselves about long-standing maternal health disparities, and move toward solutions.

"We can get there, but it's going to take more than just Black people. It's going to take more than just women," she said. "We have to see this as more of a human rights issue - and also that it affects all of us."

(Reporting by David Sherfinski; Editing by Helen Popper)