By Hwaa Irfan
In 2010, the mainstream media was plentiful with reports that black women were more likely to die in childbirth. This was not the typical media reports about African women who are of course all poor and impoverished so the media likes to paint, but African-American women in America. It seems a bit obvious to add “in America, because attention is paid to the fact that they are black, not they are American, and that this is 21st century.
Given the demands of modern living: education and employment that women in general seek to have a more active life in the public sphere; it is frightening to hear that African American women are 3 times more likely to die in childbirth than the example given, Hispanics. The source of the information was from the reputable British medical journal, The Lancet before it hit mainstream news in the U.S. The intention of the study was to discover if newly developed nations like India, were trailing behind the developed Western nations, but the researchers found surprising results on its own doorsteps. The blame has been put on the lack of healthcare insurance, but has one commentator for Black Women’s Health responded:
- “This is partially true, but I think it’s also generally true that people of color receive worse medical treatment, even when they do have access to health care, as several studies have suggested”.
Eleanor Hinton Hoytt, president and CEO of the Black Women’s Health Imperative commented:
- “The United States cannot ignore the fact that healthy pregnancies and births require a strong investment in prenatal and postnatal health care,”
“When we make this commitment, we will then begin to see an improvement in maternal mortality rates among Black women that we have not seen in 25 years.”
Amnesty International condemned the poor outlook for African-American, and indigenous American women, with a 26th global ranking for the U.K., and a 41st ranking for the U.S., but unfortunately assuming that it is only poverty related. With a risk five times greater than Greece, the U.S.
- “Good maternal care should not be considered a luxury available only to those who can access the best hospitals and the best doctors. Women should not die in the richest country on earth from preventable complications and emergencies” said US Amnesty executive director Larry Cox.
The response from the medical profession evolved around pregnancy complications, not the standard of the hospital, which implies that it has little to do with health insurance. The Centers for Disease Control and Prevention, CDC, reported that from 1991 -1999, the leading cause of maternal death following a live birth was no different for black women as it was for white women, yet for each cause of death (embolism, 21%, pregnancy induced hypertension, 19%, and other medical conditions, 17%) the rate was 3-4 times higher for black women than it was for white women, and increased in cases of cardiomyopathy, anesthesia to 6 times higher for black women. When hemorrhaging occurred, African-American women were more likely to be given surgery, whereas white women had a simple curettage. This again is not indicative of a health insurance issue considering the cost of surgery, though one explanation given, of which there is evidence is that African-American women are more likely enter into pre-natal care late into the pregnancy! Not exploring the reasons why, the tendency has been to fall on certain studies which places the blame at the state of health of African-American women. That notwithstanding, the next explanation has been something to do with genetics, and then a final admittance that
- “Nursing has long recognized the need to understand the culture of those seeking care, but it is critical that providers also be aware of their own possible biases,” said Dr. Camillo Associate Professor of Nursing, Minnesota State University, and Private Consulting Practice, Eden Prairie, Minnesota.
As the CDC, prepares to investigate the problem, studies already published have already done so. A study published in the American Journal of Public Health in 2007, by M. Tucker, et al widens the approach on the issue. It did find that African-American women were not more likely to have pregnancy related complications (preeclampsia, eclampsia, placental abruption, placenta previa, and postpartum hemorrhage), but they were more likely to die; however, this had nothing to do with the level of education of African-American women, their age or their socioeconomic status. Other studies confirm and contradict the above findings depending on the level of objectivity, and the scope of the research, however to add to the conundrum Associate Professor of Nursing in the Family at the University of Texas at Austin, Sharon Dormire, made the following observations as a Maternal-Fetal Nurse, and researcher along with other researchers: there is a difference in mortality in the U.S. between African-American women, and African women. An African woman from the continent of Africa, and from the Diaspora who gives birth in the U.S. is less likely to die, but the daughter who is born and raised in the U.S. has a similar rate of mortality as her African-American counterpart. The CDC, has had a difficult time collating comprehensive data when The New York City Health and Hospitals Corporation — a coalition of city-owned care and treatment facilities that represents the majority of the city’s maternal deaths along with the largest population of African- American patients withdrew from the review process in 2006! In 2004, the Health and Hospitals Corporation had 13 maternal deaths, which represented almost 50% of New York’s maternal deaths for 2004, and by 2007, the number of maternal deaths in the State dropped to 6! New York is the leading U.S. city for maternal deaths. The New York-Presbyterian Healthcare System, a major network of private hospitals has also withdrawn. Medical records can only portray half the picture, and cannot portray the standard of service, the care, and the cultural sensibilities which provides the other half of the picture, along with the fact that CDC is known for de-contextualizing the data that it does collect!
African-American Traditions in Childcare
In the U.S. as a whole in the 1900s, midwives were in attendance of most childbirth. By the 1930s, only 15% nature of childbirths had midwives in attendance. Those midwives in attendance were mainly African-American, or old women from the working class, as the competitive masculine nature of modern medicine in the U.S. took over. With the decline of midwifery, came the increase of both maternal and infant deaths.
By the 1960s, there were approximately 70 practicing nurse-midwives in the U.S. In that period, well-educated, middle-class white women played an important role in their demand for midwives, which led to an increase in lay midwives, or direct entry midwives, in their attempt to regain control over their bodies, and the birthing process from the male dominated medical profession. Home births were back in fashion amongst practicing Christian and Muslim sects, despite the fact that today most U.S. citizens go for hospital births as the safer option as “guided” by the medical profession. Today, there are Certified Nurse-Midwives who are trained to provide:
- • Support to pregnant women through to childbirth
• Primary care
• Pre-conception counseling
• Family planning
• Menopausal care and general women’s health care
• To care for newborns during the first month of life
The hospital is a cold clinical place for any mother expecting her first child, and to cope with negligence and bigotry on top of that compromises the health of the mother and the delivery process.
African-American women were not included in any major fertility studies until 1960. Before that we can look to a period when African-American midwives were commonplace, and held a special place in the African-American communities. These midwives had other jobs like anyone else, but were there for their womenfolk during life-giving and life-threatening occasions. If a midwife was not present for whatever reason, women would attend the childbirth as attendants, to provide assistance and encouragement. It was commonplace for African-American women to give birth at home in the early part of the 20th century, and during slavery African-American midwives were called upon by both white and African-American women about the give birth. A young midwife of the 21st century summed it up as follows:
- “When I was a child, my mother and grandmother often shared stories about my great-aunt and great-great-grandmother, who were ‘granny midwives.’ These women worked tirelessly to provide care to both blacks and whites in the community. Without the ability to read or write, these strong, wise women dedicated their lives to birthing the babies of entire communities and teaching generations of women. Midwifery in the African American community is a legacy that I am proud to call my own. As a descendant of two granny midwives, I claim this legacy as one of change, hope and optimism.” —Trickera Sims, MSPH, RN
Today Certified Nurse-Midwives who are African-American are willing to serve low income families, those on Medicaid, and the uninsured. Their clients include African Americans, indigenous Americans, and young mothers. In 1988, the CDC referred to Certified Nurse-Midwives as serving those who are at a greater risk of having problematic delivery process more than the physician. If public and private healthcare has a problem in providing a suitable level of maternity care for expectant mothers as a whole, it should seriously consider honoring and respecting the practice of midwifery, with a department of midwifery attached to every general hospital providing the kind of quality service that would make any expectant mother feel at ease at going for full pre-natal care. This would ease the pressure off the hospital where hospital care has been reduced down to time and money – in goes one patient, and out goes another!
Amnesty International U.S.A. Urged to Confront Shocking Maternal Mortality Rate http://www.amnestyusa.org/document.php?id=ENGPRE010882010&lang=e
Amusa, M. Black Women More Likely to Die in Childbirth than Whites or Latinas http://colorlines.com/archives/2008/08/black_women_more_likely_to_die.html
Black Women Three Times More Likely to Die in Childbirth http://www.blackwomenshealth.org/index.php?src=news&srctype=detail&category=Women%20Health%20News&refno=80
Boseley, S. Amnesty Report Condemns US Death Rates of Women in Childbirth http://www.guardian.co.uk/world/2010/mar/12/amnesty-us-maternal-mortality-rates
Camillo, P. Is Childbirth More Dangerous for Black Women Than for White Women? http://www.medscape.com/viewarticle/577505
Ellerby-Brown, A. Nurse-Midwives: Continuing the Legacy. http://www.nursing.vanderbilt.edu/msn/pdf/nmw_midwiferyforAA.pdf
Frankel, N. From Slave Women to Free Women: The National Archives and Black Women’s History in the Civil War Era Federal Records and African American History (Summer 1997, Vol. 29, No. 2) , http://www.archives.gov/publications/prologue/1997/summer/slave-women.html
Rodgers-Rose (Ed.) The Black Woman Sage Publications. London. 1980.
Rooks, J. The History of Childbearing Choices in the United States. http://www.ourbodiesourselves.org/book/companion.asp?id=22&compID=75
Tucker et al The Black–White Disparity in Pregnancy-Related Mortality From 5 Conditions: Differences in Prevalence and Case-Fatality Rates
Am J Public Health, Feb 2007; 97: 247 – 251. Why are Black Mamas Dying in Childbirth?http://www.mamasonbedrest.com/2010/03/why-are-black-mamas-dying-in-childbirth/