U.S. Maternal Mortality is Much Higher for African-Americans

Summary

In 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

00:00

🤰 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.

05:00

💪 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.

Keywords

💡Maternal Mortality

Maternal mortality refers to the death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management. In the video, it's highlighted that over 700 mothers die each year in the United States from complications related to pregnancy and delivery, underscoring a critical public health issue.

💡Racial Disparities

Racial disparities refer to the unequal treatment or access to resources between different racial groups. The script points out that black women are more than three times as likely as white women to die around the time of childbirth, illustrating a significant racial disparity in maternal health outcomes.

💡Maternal Mortality Rate

The maternal mortality rate is the number of maternal deaths per 100,000 live births. The video provides specific rates for black and white women, emphasizing the stark differences in maternal health outcomes between these racial groups.

💡Structural Racism

Structural racism is the system in which public policies, institutional practices, cultural representations, and other norms work in various ways to reinforce racial discrimination. The video discusses how structural racism is implicated in the racial disparities in maternal mortality rates, even when controlling for factors like education and income.

💡Prenatal Care

Prenatal care refers to the medical care a pregnant woman receives to ensure the health of the mother and the baby. The script mentions that black women are more likely to initiate prenatal care late, which may be linked to systemic barriers such as geography and health insurance.

💡Healthcare Triage

Healthcare triage is a process of determining the priority of patients' treatments based on the severity of their condition. In the context of the video, it refers to the analysis and discussion of healthcare issues, such as maternal mortality, to determine how to best address them.

💡Pregnancy Complications

Pregnancy complications are health issues that arise during pregnancy which could potentially be harmful to the mother or the baby. The video cites a study that shows black women are 2 to 3 times as likely to die from common pregnancy-related complications as white women.

💡Care Bundle

A care bundle is a set of practices or interventions that are combined to improve the quality of care. The video discusses a care bundle developed to reduce racial and ethnic disparities in perinatal health, providing actionable steps for clinicians and health systems.

💡Racism

Racism is discrimination against someone based on their race. The video explains that racism, particularly structural racism, is a significant factor contributing to the racial disparities in maternal mortality rates.

💡Perinatal Health

Perinatal health refers to the health of the mother and baby during pregnancy, childbirth, and the period shortly after birth. The video discusses efforts to improve perinatal health, especially for black women who face higher risks.

💡Interdisciplinary Research

Interdisciplinary research involves the collaboration of experts from different fields to solve complex problems. The video mentions that the script was written in conjunction with interdisciplinary research leaders, indicating a comprehensive approach to addressing maternal mortality.

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

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