April 11–April 17 is Black Maternal Health Week, a week dedicated to amplifying the stories of Black mothers and elevating effective policies and solutions to eliminate racism, bias, and inequities in maternal care. To celebrate Black Maternal Health Week, Ready, Set, Soar Ohio has invited members of the Ready, Set, Soar coalition to participate in a Black maternal health Q&A. Throughout the week, we will be sharing Q&A articles featuring different experts on a range of topics related to Black maternal health.
Q: What has been the impact of COVID-19 on Black mothers?
Tara Britton: COVID-19 has impacted us all in countless ways. In particular, COVID-19 has impacted mothers, and especially Black mothers, by limiting in-person medial appointments and the number of support people allowed into labor and delivery rooms. Conducting medical appointments via telehealth has certainly allowed some people to continue their health care visits safely throughout the pandemic, but things can be missed when you’re only seeing a provider on a computer or phone screen. Black mothers have a pregnancy-related mortality rate 2 to 3 times higher than white mothers. Early detection of issues such as preeclampsia or low-birth weight is vital to improve these mortality rates. Many hospitals continue to limit the number of supports – people allowed to be with the mother during labor and delivery. We know that doulas and other birth-support professionals can be a trusted partner during birth and can contribute to reducing negative outcomes for Black mothers. Limiting access for these individuals in the midst of a pandemic likely impacted Black mothers, disproportionately.
Q: How has the COVID-19 pandemic affected conversations around racism, bias, and inequities in health care? In maternal care?
Hope Lane: When COVID-19 entered the United States last year it quickly exposed inequities that were previously largely ignored by those who were not affected. African Americans, for example, are more likely to be diagnosed with chronic health conditions such as diabetes and hypertension, which in turn puts them at greater risk of COVID-19 hospitalization and death. Coincidentally enough, African Americans are also more likely to be frontline workers without health insurance so the possibility of having an underlying, chronic condition without being aware of it is much higher than in the general population. Because of this, conversations around racism, bias and inequities in health care have increased tremendously, especially as it relates to vaccine hesitancy. Further, conversations regarding whether the medicalization and institutionalization of birth is necessary have reemerged because of the pandemic. In hospitals, with the threat of COVID-19 and the stress it places on existing staff, many moms feel attention is shifting away from maternal health efforts and are looking for other options. COVID-19 led to rapid changes in the way health systems and providers care for pregnant and postpartum women and while many of these changes were to protect both patients and staff, some changes exacerbated long-standing inequities, such as disallowing birth support people like doulas in hospital delivery rooms.
Q: During COVID-19 and beyond, how is data collection important in regards to Black maternal health and birth outcomes?
Tara Britton: It’s so important that we continue our push for better data on maternal mortality and morbidity. While Ohio has made progress, there is still a lag in data reporting (the most recent report from the Ohio Department of Health on pregnancy-related deaths includes data through 2016) and we don’t have access to routine reporting on maternal morbidity, or the “near misses” of maternal deaths. Having this data routinely reported would almost certainly quantify the disparities we know exist (these disparities exist in national-level data), but could also help us target resources and supports to the populations most in need. Women, especially Black women who have worse maternal health outcomes in large part due to racism in the health care system, need information to make informed decisions. Policymakers, health care providers and community leaders need this information to identify the best strategies to combat the problem.
Q: From your perspective, where are we as a state when it comes to Black maternal health?
Hope Lane: In my opinion, until the state as a whole - and not just individual municipalities and institutions -recognizes racism as a public health crisis, Ohio is and will continue to perform poorly when it comes to Black maternal health. While the disparities between the mortality and morbidity of Black and white mothers and their babies are clear and accepted, state resources are spent focusing on determining the cause - when the cause has been well known to Black women in our state for decades. Communities around the state have been forced to take matters into their own hands and have excelled in saving hundreds of women and their babies by providing social services, support and implementing strategies to address the root cause of the social determinants of health. Additionally, improvements in Black maternal health rely on an investment to collect high-quality, reliable and timely data on maternal health care generally, for that data to be available and accessible to patients and other providers, and for the data to be deidentified and disaggregated for community members and stakeholders. This last point has long been a struggle in our state.
Q: What will it take to get where we need to be? What are things that policymakers, government agencies, and health care providers must do to address racial disparities in maternal health?
Hope Lane: It will take concerted effort and investment on the local, state and national levels to truly address racial disparities in maternal health. While we are pleased to see increased attention to the issue of maternal health over the past several years, to move the needle substantially, Black women and their babies must be centered in any strategies and must be at the table when the policies are created. As mentioned previously, to do this decisionmakers must acknowledge that the root of the racial disparities in maternal health is racism in the health care and bureaucratic systems. To dismantle racism requires recognition that it exists. Community Solutions continues to propose and advocate for changes that must be made to not only address racial disparities in maternal health but to improve the maternal health of all of Ohio’s women. These include integrating National Standards for Culturally and Linguistically Appropriate Services (CLAS) standards into all public medical school education and continuing education requirements to guarantee that current and future providers don’t uphold myths about differences between white and Black bodies that have previously been used to justify slavery.
Tara Britton is the Director of Public Policy and Advocacy at the Center for Community Solutions. Hope Lane is the Public Policy & External Affairs Associate at the Center for Community Solutions. Learn more about The Center for Community Solutions at www.communitysolutions.com.