Women of color, particularly black women, encounter challenges during pregnancy and childbirth. This leads to disproportionate adverse consequences, such as invasive treatments, infant mortality, serious complications and even death of these women. The role of racism and discrimination is highlighted even when taking into account some underlying social and economic factors. For example, education and income do not protect against poor outcomes, and health care inequities persist for black women.
Many Black women endure untold and unseen negative experiences, resulting in the loss of lives due to a disdain that discourages them from reaching out or believing their pain is normal when it is not. A pregnant black mombetter known as Serena Williams' own experience, illustrates this reality. His essay on the question last February provides direct insight into why medical staff initially dismissed her concerns about blood clots, wasting crucial time before proper diagnosis and treatment.
Even as a wealthy woman, William's wishes were still ignored. Diversity and equity in hospitals and health care settings are the first steps toward a safe and respectful space for all. No one should feel like they can't speak or express themselves. Black women face a higher risk of childbirth complications and invasive treatments than white women due to significant health care disparities. These disparities include frequent dismissal of pain, projection of stigma, and unequal treatment of Black women in health care. This story reviews three themes elucidated from several sources.
Theme 1: Racial bias and stereotypes against Black women contribute to disparities
A black woman seeks to have a child and adapts her life accordingly. In doing so, she does not recognize the risk she is taking for herself. From 2023, Black women are three times more likely that white women not only die, but also suffer serious pregnancy complications. Dismissal of pain, poor communication, and projection of bias from healthcare providers contribute to this statistic. Here are some key differences that women of color face compared to white women.
Theme 2: Inequitable health care further exacerbates the challenges faced by Black women
Fairness involves everyone receiving what they need, while equality occurs when everyone receives the same fair treatment. However, nothing is fair or equal when one individual improves or surpasses another. Regarding the quality of health care, white women are treated better than black women. “Even when controlling for clinical characteristicsBlack women are less likely than white women to have labor induced or have regular cervical exams during labor and more likely to have cesarean delivery under general anesthesia. Racist behavior, whether intentional or not, affects the overall treatment of this patient.
Inadequate health care is more prevalent among Black Americans with lower socioeconomic status. This is associated with access, insurance, and monetary income because as you earn more, it “results in superior access to the fastest and most expensive health care.” The lack of resources afforded to Black women occurs regardless of socioeconomic status. For example, it is more common for a black mother to have little or no prenatal health care if she is both poor and black. Many black women tend to live in maternity deserts where they are further marginalized due to lack of resources. “To be black anywhere in America is to experience higher rates of chronic diseases such as asthma, diabetes, high blood pressure, Alzheimer's disease and, more recently, COVID-19. Additionally, Black Americans have less access to adequate medical care and shorter life expectancies than white Americans. In addition to the lack of health care that many African Americans suffer from, much of the care they receive is inequitable.
Theme 3: Morbidity and mortality in the black pregnant population
Institutionalized, ingrained racism in medical curricula contributes to increased suffering among Black women, who also face increased risks due to inadequate, impersonal, and biased health care. Relative to their babies and themselves, Black people experience significantly higher rates of morbidity and mortality than their racial counterparts, especially White people. Striking evidence is highlighted by Donna Hoyert, PhD, “In 2021, the mortality rate for non-Hispanic black women was 69.9 deaths per 100,000 live births. This highlights the nearly three times higher mortality rate for African Americans than that of their Hispanic and white equivalents. Even taking into account socio-economic factors does not fully explain this glaring gap. The highlighting, racism, dismissal and inadequate treatment in the care of black patients further exacerbate the negative health consequences.
Solutions
Fortunately, there are several solutions that can be implemented to improve the negative experiences that Black women face during labor and delivery.
Match white and black women throughout their pregnancies. The couple's goal would be to ensure that women receive the same treatment. This could decrease stereotypes projected onto black women, as health care would be women-centered (and not race-centered).
Increase staffing levels to include more doctors of color. The simplicity of having things in common allows for comfort because the guard is down, allowing for trust, connection, and rapport between a patient and healthcare provider. “In addition to a shared culture and values, a Black physician can provide Black patients with a sense of safety, validation, and trust..”
Eliminate the links between race and certain diseases during medical training. This type of thinking process is a “unscientific racial stereotype.” If this ideal is ignored, more trust will ensue.
Create a safe place to talk freely and ask questions. Black women often feel invisible and refrain from asking questions due to a feeling of invisibility. Addressing patient concerns and reassuring them can help resolve this issue. Overall, achieving equity in healthcare is essential to eradicating the negative experiences faced by Black women.
Conclusion
Due to implicit bias, stereotypes, and inequitable health care, Black women face adverse outcomes during labor and delivery, putting them at high risk for negative outcomes. These risks arise from doctor-patient interactions influenced by biases ingrained in medical training, leading to inequitable treatment. Recognizing imperfections and biases is the first step toward improvement, while raising awareness and promoting trauma-informed care is essential to achieving a more equitable future for all.
Acknowledgement: University Scholars Program Harvard Student Agencies
Sophia Alexander is a high school student. Deepjot Singh is an obstetrician-gynecologist. Jessica L. Jones is a public health doctor.