Black Babies Are Dying, And So Are Their Moms … What Can We Do About It?

The recent edition of The New York Times Magazine, the article “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis” written by Linda Villarosa called out a disturbing and unnecessary truth: the discrepancy in death rates for black babies and mothers is not genetic or biological, instead it “has everything to do with the lived experience of being a black woman in America”.

There is perhaps no better day to draw more attention to this issue than Mother’s Day, a day created to celebrate mothers and their babies.

Here are the sobering facts written by Villarosa:

—Between 1915 and the 1990s, “amid vast improvements in hygiene, nutrition, living conditions and health care, the number of babies of all races who died in the first year of life dropped by over 90 percent — a decrease unparalleled by reductions in other causes of death. But that national decline in infant mortality has since slowed. In 1960, the United States was ranked 12th among developed countries in infant mortality. Since then, the rate is largely driven by the deaths of black babies.”

—The United States now ranks 32nd out of the 35 wealthiest nations in infant mortalities (most are black babies).

—Black infants in America are now more than twice as likely to die as white infants.

— 11.3 per 1,000 black babies, compared with 4.9 per 1,000 white babies, according to the most recent government data — a racial disparity that is actually wider than in 1850.

— Black women are up to four times more likely to die from pregnancy-related causes as their white counterparts.

It’s not just access to quality healthcare, it’s the ability/willingness of the healthcare professionals to treat every woman, whether black, white, Hispanic or otherwise the best possible way, in other words, to optimize care and to offer standardized care for all patients irrespective of race, ethnicity, or insurance status.

“Recently there has been growing acceptance of what has largely been, for the medical establishment, a shocking idea: For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions — including hypertension and pre-eclampsia — that leads directly to higher rates of infant and maternal death. “ And that societal racism is further expressed in a pervasive, longstanding racial bias in health care — including the dismissal of legitimate concerns and symptoms — that can help explain poor birth outcomes even in the case of black women with the most advantages.

Dr. Arline Geronimus, a professor in the department of health behavior and health education at the University of Michigan School of Public Health, “first linked stress and black infant mortality with her theory of ‘weathering.’ She believed that a kind of toxic stress triggered the premature deterioration of the bodies of African-American women as a consequence of repeated exposure to a climate of discrimination and insults. The weathering of the mother’s body, she theorized, could lead to poor pregnancy outcomes, including the death of her infant.”

So if “the black-white disparity in the deaths of babies is related not to the genetics of race but to the lived experience of race in this country,” the looming question is why? Why are black women having greatly poorer outcomes when genetics are not to blame?

First off, findings show “higher levels of preterm birth among women who reported the greatest experiences of racism.” Villarosa writes, “The bone-deep accumulation of traumatizing life experiences and persistent insults that the study pinpointed is not the sort of “lean in” stress relieved by meditation and “me time.”

“When a person is faced with a threat, the brain responds to the stress by releasing a flood of hormones, which allow the body to adapt and respond to the challenge. When stress is sustained, long-term exposure to stress hormones can lead to wear and tear on the cardiovascular, metabolic and immune systems, making the body vulnerable to illness and even early death.”

This is not mere speculation. The American Journal of Public Health published a study that showed that “persistent racial differences in health may be influenced by the stress of living in a race-conscious society. These effects may be felt particularly by black women because of [the] double jeopardy of gender and racial discrimination. Even when controlling for income and education, African-American women had the highest allostatic load scores — an algorithmic measurement of stress-associated body chemicals and their cumulative effect on the body’s systems — higher than white women and black men.”

Lynn Freedman, director of the Averting Maternal Death and Disability Program at Columbia University’s Mailman School of Public Health says “Disrespect and abuse mean more than just somebody wasn’t nice to another individual person. There is something structural and much deeper going on in the health system that then expresses itself in poor outcomes and sometimes deaths.”

When black women are given access to support, education, and stress management as well as quality care, the death rates for both babies (most often linked to low birth weight) and mothers dramatically decline.

How can we be allowing this to happen in 2108 in the United States, among the richest nations on earth? And the even larger question is what can we do about this?

In my personal experience, black women are more likely to get inferior levels of care because they are more likely to be impoverished, have lower levels of or no health insurances at all, and therefore, have less access to optimal health care the way women with commercial health insurances have. In my personal opinion, we should have universal health care for all pregnant women with access to any physicians or hospitals they want to. That is how it works in all other advanced countries.  Choice of healthcare is taken away when you have inadequate insurance which is not accepted by the majority of physicians. If doctors have the choice to accept a patient with a much higher paying insurance as compared to someone with an insurance that pays much less, it is clear  whom doctors will prefer to accept. And whom they will reject.

Many clinics in hospitals accepting Medicaid patients or patients without insurance have the best of intentions, but it’s still inadequate compared to individualized care that pregnant women with commercial insurances obtain.

If there is one thing I wish for on Mother’s Day it would be that all women in the U.S .have the same insurance and can choose any doctor they want to see independent of their insurance status. And that doctors must accept all patients independent of their insurances.

When is a good time to travel in pregnancy? And where to?

Is travel in pregnancy a good idea? And when? I should add and where to?

CNN reported on a baby that was born 8 weeks early in Hong Kong.  The mother apparently cannot pay the hospital expenses and the hospital withheld the baby’s birth certificate. Her insurance won’t pay for the baby either, likely because the hospital is outside the United States, so she is responsible to pay expenses herself.

This brings up many questions, and many of my patients ask me whether they can travel and/or fly during pregnancy.

I usually give them the same answer, though it also depends on whether the pregnancy is a high risk pregnancy or not. Here are some answers for low-risk pregnancies:

1. Travel in and by itself is unlikely to increase pregnancy complications.

2. Flying does not increase pregnancy complications, it does not make you go earlier into labor. Follow certain safety guidelines when you fly in pregnancy.

3.When? I strongly recommend to not travel too far after 20 weeks.

4. Where to? I also strongly recommend to not travel abroad and to places that have sub-standard medical care. You are seeing a doctor you like and have chosen a great hospital. Why risk it by being away?

A pregnancy more often than not ends up without any complications. However, complications can happen anywwhere anytime, no matter that you were traveling or not. It can happen at home or while you travel. Complications are more likely to happen if you are at risk. So maybe it’s a bad idea to be too far away from your favorite doctor or hospital if you have an increased risk. So why risk being away and get sub-standard care?

12 Steps to Fly Safely in Pregnancy