U.S. Maternal Mortality is Much Higher for African-Americans
Summary
TLDRIn the United States, maternal mortality rates have doubled since the 1980s, with over 700 deaths annually. Black women face a maternal mortality rate three times higher than white women, highlighting racial disparities not explained by education or income. Structural racism, including power inequalities and unequal access to opportunities, is identified as a key factor. Efforts to dismantle structural racism in healthcare are crucial, starting with understanding racial history and recognizing racism's operation. A care bundle of practices has been developed to reduce racial disparities in perinatal health, emphasizing the need for systemic change to ensure safe births for all.
Takeaways
- 🚨 The United States has a significant maternal mortality rate, with over 700 mothers dying annually from pregnancy and childbirth complications.
- 📈 Maternal mortality rates have doubled between the 1980s and 2010 in the U.S.
- 👩👧👦 Black women are at a higher risk, with a mortality rate three times higher than that of white women.
- 📊 According to CDC data, the maternal mortality rate for black women is 43.5 per 100,000 live births, compared to 12.7 for white women.
- 🏢 Racial disparities in maternal mortality are not solely explained by differences in education or income.
- 🤰 The causes of maternal mortality are complex and can occur before, during, or after childbirth.
- 📚 Research shows that black women face higher risks from pregnancy-related complications, even with the same diagnosis.
- 🌐 Structural racism, defined as systematic discrimination based on race, plays a significant role in these disparities.
- 🔍 Indicators of structural racism include unequal access to opportunities and differing policy outcomes by race.
- 🛠 Dismantling structural racism in healthcare involves understanding historical context and recognizing race as a social construct.
- 📈 A national work group has developed a 'care bundle' with practices to reduce racial disparities in perinatal health.
Q & A
美国目前的孕产妇死亡率是多少?
-根据2021年的数据,美国的孕产妇死亡率为32.9每10万活产[^7^]。
为什么美国的孕产妇死亡率在增加?
-美国的孕产妇死亡率增加可能与多种因素有关,包括心血管疾病、产科出血、自我伤害或意外伤害等。此外,结构性种族主义和医疗保健服务的不平等获取也可能是导致孕产妇死亡率增加的原因[^8^]。
黑人女性在美国的孕产妇死亡率是多少?
-2021年,黑人女性的孕产妇死亡率为69.9每10万活产,是白人女性的2.6倍[^7^]。
孕产妇死亡的主要原因有哪些?
-孕产妇死亡的主要原因包括严重出血(主要是产后出血)、感染(通常在产后)、妊娠期高血压(子痫前期和子痫)、分娩并发症以及不安全堕胎[^10^]。
如何减少孕产妇死亡?
-为了减少孕产妇死亡,关键在于预防非意愿妊娠,所有女性,包括青少年,需要获得避孕、合法范围内的安全堕胎服务以及优质的堕胎后护理。此外,所有女性都需要在妊娠期间以及分娩前后获得高质量的护理[^10^]。
孕产妇死亡率在不同种族间是否存在差异?
-是的,孕产妇死亡率在不同种族间存在显著差异。例如,黑人女性相比白人女性有更高的孕产妇死亡率,这种差异不能仅通过教育或收入差异来解释[^2^]。
什么是结构性种族主义,它如何影响孕产妇死亡率?
-结构性种族主义是指基于种族的资源和机会的系统性分配,它指的是制度和系统共同运作产生基于种族差异的结果,即使没有种族主义意图。结构性种族主义的指标包括权力不平等、机会获取不平等以及不同种族间政策结果的差异。研究表明,结构性种族主义与黑人婴儿死亡率的增加有关[^2^]。
美国采取了哪些措施来应对孕产妇死亡率的增加?
-美国采取了包括实施安全捆绑协议、团队培训、为高风险患者提供综合多学科护理、风险分层的孕产妇护理水平、改善提供者与患者之间关于早期警告信号的沟通,以及解决结构性种族主义和社会决定因素等策略来改善孕产妇安全、质量和公平[^2^]。
孕产妇死亡率的全球趋势如何?
-从2000年到2020年,全球孕产妇死亡率下降了约34%,但几乎所有孕产妇死亡都发生在低收入和中低收入国家,这些死亡大多数是可以预防的[^10^]。
哪些组织在努力减少孕产妇死亡?
-世界卫生组织(WHO)是努力减少孕产妇死亡的主要组织之一,通过增加研究证据、提供循证临床和项目指导、设定全球标准以及向成员国提供技术支助来帮助制定和实施有效的政策和项目[^10^]。
Outlines
🤰 Maternal Mortality and Racial Disparities
The paragraph discusses the alarming rate of maternal mortality in the United States, highlighting that over 700 mothers die annually from pregnancy and childbirth complications. It emphasizes the racial disparities, with black women being more than three times as likely to die as white women during childbirth. The data from the CDC is cited, showing stark differences in maternal mortality rates between white and black women. The paragraph delves into the complex causes of maternal mortality, including pre-pregnancy health, access to and quality of care during pregnancy, and post-childbirth support. It also addresses the role of structural racism, which is defined as systematic discrimination based on race, affecting resource allocation and policy outcomes. The paragraph suggests that tackling inequality in areas such as education, employment, and social economic status can help address structural racism. It concludes with the idea that while racism is man-made, it can be dismantled, and that understanding history and recognizing race as a social construct are essential steps towards change.
💪 Tackling Maternal Health Disparities
This paragraph focuses on the efforts to reduce maternal mortality and racial disparities in childbirth. It mentions the 'Alliance for Innovation on Maternal Health' and their development of a 'care bundle', a set of practices aimed at improving perinatal health outcomes. The paragraph stresses the importance of understanding and addressing racial inequities in maternity care. It also underscores the need to go beyond healthcare delivery systems to tackle payment reform, workforce diversity, and to listen to the voices of all mothers. The paragraph concludes by emphasizing the significance of birth as a human experience that connects us all and the necessity of ensuring safe births and strong families for all mothers. It also acknowledges the contributions of Katy Cosmo, Rachel Hartman, and other research leaders in the field, and encourages viewers to support the show through likes, subscriptions, and donations.
Mindmap
Keywords
💡Maternal Mortality
💡Racial Disparities
💡Maternal Mortality Rate
💡Structural Racism
💡Prenatal Care
💡Healthcare Triage
💡Pregnancy Complications
💡Care Bundle
💡Racism
💡Perinatal Health
💡Interdisciplinary Research
Highlights
In the United States, over 700 mothers die each year from pregnancy and childbirth complications.
Maternal mortality rate doubled in the U.S. between the 1980s and 2010.
Black women are more than three times as likely as white women to die around the time of childbirth.
Between 2011 and 2013, the maternal mortality rate for black women was 43.5 per 100,000 live births, compared to 12.7 for white women.
Racial inequities in maternal mortality are not explained by differences in education or income.
Black women are 2 to 3 times as likely to die from common pregnancy-related complications as white women.
Black women are more than twice as likely as white women to initiate prenatal care late in pregnancy.
Structural racism is a systematic allocation of resources and opportunity based on race.
Structural racism can be tackled by addressing inequality in education, employment, imprisonment, and social economic status.
High levels of structural racism and unemployment are associated with increased infant mortality among blacks versus whites.
Dismantling structural racism in healthcare involves understanding history and recognizing race as a social construct.
A care bundle of practices has been developed to reduce maternal racial and ethnic disparities in perinatal health.
The care bundle provides concrete action steps for clinicians and health systems to address racial inequities.
Addressing the effects of racism on birth outcomes requires expanding efforts beyond healthcare delivery systems.
Listening to all mothers is crucial for ensuring safe births and strong families.
Birth is a core human experience that binds us together and requires targeted efforts to support the most vulnerable.
The episode was written in conjunction with Katy Cosmo, model, and Rachel Hartman, 2016 Robert Wood Johnson Foundation interdisciplinary research leaders fellows.
Transcripts
in the United States too many moms are
dying around the time of childbirth
every year more than 700 mothers die
from complications related to pregnancy
and delivery leaving behind grieving
families as well as urgent policy
questions about how we as a country can
do better
between the 1980s and 2010 the maternal
mortality rate doubled in the United
States clearly births should be safer
for moms in the United States all moms
but it's not some moms are a greater
risk that's the topic of this week's
healthcare triage black women are more
than three times as likely as white
women to die around the time of
childbirth data from the CDC showed that
between 2011 and 2013
white women had a maternal mortality
rate of 12 point 7 deaths per 100,000
live births while black women had a rate
of 43.5 deaths per 100,000 live births
these racial inequities are not
explained by differences in education or
income for example a 2016 study of data
from New York City showed that
college-educated black women had a
higher risk of severe maternal morbidity
than a white woman without a high school
diploma the causes of maternal mortality
and racial disparities in maternal
mortality are myriad and complex they
can be grouped based on timing and
include one maternal health before
pregnancy to access to care and quality
of care during pregnancy and childbirth
and three recovery support and access to
care after childbirth many research
studies document that the risks from
maternal mortality are greater for black
women for example a 2007 study in the
American Journal of Public Health looked
at five of the most common and
potentially fatal pregnancy related
complications and found that black women
were 2 to 3 times as likely to die as
white women with the same diagnosis
black women are also more than twice as
likely as white women to initiate
prenatal care late in pregnancy which
may derive from access barriers that
relate to geography and health insurance
while public dialogue often blames black
mothers for these disparities many
experts were much more worse than this
than me believed that the true cause is
racism commonly defined as prejudice
plus power
racism is discrimination against someone
based on his or her race racism can be
manifested through beliefs attitudes
actions and policies structural racism
is the systematic allocation of
resources and opportunity based on race
it refers to the ways that institutions
and systems operate together to produce
outcomes the differ based on race even
in the absence of racist intent
indicators of structural racism include
power inequalities unequal access to
opportunities and differing policy
outcomes by race because these effects
are reinforced across multiple
institutions the root causes of
structural racism are hard to isolate
but a good entry point to address
structural racism is to tackle
inequality and education employment
imprisonment and social economic status
this link has been shown empirically the
2017 study of all US states found that
high levels of structural racism and
unemployment were associated with a 5%
increase in infant mortality among
blacks versus whites but low levels of
structural racism and education were
associated with the 10% reduction in the
black infant mortality rate compared
with whites here's the thing though
racism is man-made the good news is that
if it has been built it can be
dismantled dismantling structural racism
in health care can seem like a Herculean
task but it starts with two things first
we must understand our nation's history
and recognize that race is a social
construct and racism as an ideology was
invented to differentiate white people
from those with different skin colors
creating a racial hierarchy that
continues to this day
second we must become comfortable with
asking the question how is racism
operating here this simple question when
asked honestly and openly with curiosity
and positive intent can open the
floodgates to change in any clinic
classroom hospital or home and maternity
care a road map exists from 2015 to 2017
the Alliance for innovation of maternal
health convened a national work group
the group reviewed reams of scientific
evidence and develop what's known as a
care bundle or set of practices to
reduce maternal racial and ethnic
disparities in perinatal health that
bundle was recently published and
provides concrete action steps that
clinicians and health systems can take
during pregnancy to a
if I measure understand and begin to
make change in racial inequities that
occurred during pregnancy and child
birth care the bundle may signal
progress but it's not a panacea it will
take more than the bundle to undo the
effects of racism on birth outcomes
including expanding the work beyond
health care delivery systems to address
payment reform workforce diversity and
most importantly listening to all
mothers everyone deserves to feel safe
respected care for and empowered during
pregnancy and childbirth birth is at the
core of the human experience it is the
deepest form of human connection and the
ultimate antidote to dehumanizing policy
or rhetoric birth binds us together and
ensuring safe births and strong families
for all mothers starts with targeted
efforts to lift up those who are most
vulnerable to many black mothers die in
childbirth
we can fix that this episode was written
in conjunction with Katy Cosmo model and
Rachel Hartman who are 2016 Robert Wood
Johnson Foundation interdisciplinary
research leaders fellows
interdisciplinary research leaders it's
a national program of the Robert Wood
Johnson Foundation led by the University
of Minnesota hey B elect a show always
helps if you like or subscribe right
down there and another good way to
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healthcare triage through a donation as
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you like anything helps we'd especially
like to thank our Research Associates
joseph' it's Johnathan done and crafty
geek and of course our Surgeon Admiral
Sam if you'd like to help subscribe to
the show through patreon comm go to
patreon.com/scishow trash
also remember healthcare triage merch is
available at h CT merch calm and of
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on sale in stores
you
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