By Dr. Wiyatta Fahnbulleh, Clinical Psychologist
I was devastated and heartbroken when my OB/GYN died suddenly. For the first time in my adult life, I had found a doctor who took the time to address my concerns and answer all my questions during my appointments. I had met him in 2014 when my fibroids returned, and I needed to have them removed. Before my surgery, he ensured that I was well informed of the treatment options and my follow-up plan. During my years with him, he took the time to educate me about fertility and fertility treatment options.
Unfortunately, not everyone has the opportunity to have a doctor like mine when it comes to reproductive health—a doctor who addresses their concerns based on their specific needs and not an implicit bias based on race.
According to an article in Women’s Health, an international journal that focuses on women’s healthcare, research indicates that regardless of income, education, and socioeconomic status, Black women are more likely than any other race to have their pain complaints dismissed and overlooked by medical staff. In my work in the fertility field, I have encountered many women of color, some friends and some clients, who have shared their frustrations when addressing their concerns in medical settings with their health professionals. Some examples include, “My doctors are not listening to me even when I explain something is not feeling right” and “My doctors make me feel like I am crazy and stupid when I explain my symptoms and they dismiss me.”
The stories are all too familiar, yet most people are unaware of the systemic bias women of color face compared to White women in medical settings. Most people are also completely unaware of the maternal health crisis in America for the Black community. The dismissive behavior of the medical staff is not only negligent but dangerous, as there have been countless instances of near-death misses or death related to negligence, as in the case of Kira Johnson. Kira Johnson was a successful businesswoman who died hours after giving birth to her second child in 2016. As noted in the same Women’s Health article, “Hours after her childbirth, massive bleeding led Kira and her husband to plead for physicians to take a closer look. After being overlooked for eight hours, Kira was rushed into an emergency surgery which she did not survive.”
It is a fact that the United States has the highest mortality rate for Black women during and after childbirth among developed nations. According to a report by the Commonwealth Fund, the United States has the highest mortality rate of preventable pregnancy-related deaths compared to 10 other developed nations. Receiving appropriate treatment is critical to maternal health, yet Black maternal health remains a critical issue as studies continue to confirm that, more than any other race, Black women are disproportionately affected by maternal mortality and morbidity in the United States. Studies suggest that Black women also face significant disparities in maternal mental health outcomes, including higher rates of postpartum depression and other perinatal mood and anxiety disorders, than White women. If left untreated, these mental health disorders can lead to detrimental outcomes for the mother and her child or children.
In 2020, the Centers for Disease Control and Prevention (CDC) released data showing the number of preventable pregnancy-related deaths for non-Hispanic Black women in the US was 2.9 times the rate of non-Hispanic White women. As noted by the CDC, the trend increased with age, as the death rate of women aged 40 and over was 7.8 times higher than that of women under 25.
Why is there such a drastic difference in outcomes, and why are maternal mortality and morbidity so common? To say that race is not a factor is impossible, as the data show the prevalence is not as high for other races, especially their White counterparts. Nevertheless, as prevalent as this statistic is, the average person remains unaware of it. The common question about this topic is, “Why do you think this happens?” The answer is complex and partly attributed to structural bias and racism. In maternal health, structural bias and racism refer to how systemic and institutional factors contribute to poorer health outcomes for specific racial and ethnic groups during pregnancy and childbirth.
Structural bias and racism can impact maternal health outcomes in multiple ways. For example, it can lead to healthcare providers holding biases and stereotypes that affect how they care for patients of different racial and ethnic groups. As noted in the journal Health & Place, these biases and stereotypes can lead to inadequate or inappropriate care, delayed diagnosis or treatment, and lower quality of care overall. A survey done in 2020 examined treatment options and practices among women from different racial and ethnic backgrounds and found that even when the pregnancy was deemed low risk, doctors performed cesarean sections on Black women at a higher rate than White women.
In addition, other systemic factors such as poverty, poor access to healthcare, and inadequate support for maternity care and maternal health can all contribute to worse outcomes for certain racial groups. As confirmed by healthcare professionals in the field, addressing structural bias and racism in maternal health requires a multifaceted approach that should include improving healthcare provider education and training, increasing access to healthcare and resources for maternal health, implementing systems to improve the overall standard of care, and addressing systemic racism and discrimination in society as a whole.
Being informed of your rights as a patient is also crucial and may be the difference between walking out alive or dying in the hospital’s care. Until there is a decrease in the inequalities of treatment between White women and Black women, you can take steps to advocate for your needs and ensure that you receive the best treatment for your symptoms and the best health equity and support you deserve.
Educate yourself about your rights and options
As a Black woman, you have the right to receive equitable and respectful health services like any other pregnant woman. Make time to learn about your rights and options, including your right to informed consent and refusal, your right to have a support person present during labor and delivery, and your right to request a different healthcare provider if you are unsatisfied with the care you are receiving.
Choose the right individuals to be a part of your support team
Surround yourself with people who will advocate for you and support you throughout your pregnancy and delivery. Your team may include a doula, a midwife, a trusted healthcare provider, family members, and other mamas and friends.
Always communicate your needs and any concerns to your healthcare team
Communicating your needs and concerns with your healthcare provider is essential. If you believe that your concerns are dismissed or are not being addressed, you can contact the hospital’s “ombudsman” to help with navigating appropriate care while you are in the hospital. Consider bringing a trusted support person with you to your appointments or finding a new healthcare provider who will listen to you and care about your well-being.
Do not be afraid to assert yourself and communicate your needs to healthcare providers. Be clear about your symptoms and physical and mental healthcare concerns, and ask questions about treatment options and medications. Remember that you are the expert on your own body and experiences.
Find a culturally competent provider
It is essential to find a healthcare provider who understands the unique challenges and racial disparities the Black community faces in the healthcare system. Look for providers with experience working with Black women who have good birth outcomes and know the cultural and historical factors that can impact Black maternal mental health conditions.
Make self-care a priority
Taking care of yourself physically and emotionally is crucial before and during pregnancy and in the postpartum period. Prioritize self-care activities that make you feel good, which may include going for a walk, taking breaks when needed, spending time with loved ones, getting enough rest, eating a healthy diet, exercising, or practicing mindfulness exercises.
Advocate for systemic change
Remember, your voice matters, and advocating for yourself is essential to ensure that you receive equitable and respectful prenatal care throughout your pregnancy. Your race, ethnicity, socioeconomic status, and level of education should not prevent you from receiving proper and adequate care. Finding a provider who understands your needs, documenting your experiences, seeking community support and being collaborative, advocating for systemic change, and considering legal action can help ensure that Black women do not face health disparities before, during, and after their pregnancy.