Running head: Racial Gaps in Maternal Mortality 1

Culminating Experience Final Paper

A Reflective Observance of Racial Gaps and Maternal Mortality

Milan Wyatt

Graduate Public Health Culminating Experience

Section: 010

Los Angeles Pacific University

Dr. Carter
Racial Gaps in Maternal Mortality 2

Abstract (Overview)

The racial gaps within maternal mortality rates are evident as African-American women are 3.3

times more likely to die during or after pregnancy, in comparison to their white women counterparts.

Unfortunately, in October of 2016, this could also have been my reality, as I faced medical discrimination

as a result of my age and race while in labor. Reading data and hearing stories of such beautiful moments

turning deadly instead within a blink of an eye remains heart shattering for me personally. Though there is

an evident racial disparity in pregnancy-related mortality, there is equally less accountability taken by

doctors and hospitals, along with compliance of lower standards moreover. One of the most well-known

cases as it pertains to maternal mortality within the black community is Ms. Kira Johnson- the daughter-

in-law of Judge Hatchett who was in overall good health, gave birth to a healthy baby boy, but shortly

thereafter was neglected by medical staff at the renowned Cedars-Sinai Medical Center in Los Angeles.

Coincidingly, her husband noticed her bleeding via her catheter, and brought it to the attention of staff

that could have performed an emergency CT scan. Instead, seven hours Ms. Johnson prematurely died

due to a hemorrhage. Unfortunately, Kira, along with many other black women died in 2016 while

pregnant or soon after deliver. These corresponding deaths have been deemed preventable.

In this evidence-based review I will explore some of the 400,000 articles related to black maternal

mortality rates in the United States, with the intent to understand and arrive at a conclusion derived of two

main questions. These questions are, “Why is medical neglect/discrimination common within the black

community, specifically pregnant women?” and, “How are medical facilities or medical professionals

being held accountable for apparent preventable deaths (as classified by the CDC)?” With assistance of

Leadership Competency #5 to provide alternative strategies that can help medical professionals be more

culturally intelligent and humanly compassionate, as well as utilizing Cultural Competency #5- I will

provide examples of policies and statistics that support my perspective of an equitable workforce within

the healthcare system, as well as continuous education and advocacy education for cultural representation
Racial Gaps in Maternal Mortality 3

to enhance aid toward awareness of racial gaps within maternal mortality. Additionally, I will provide

perspectives from women of color in maternal health: Dr. Amanda Williams, OBGYN of Kaiser

Permanente in Oakland, CA,, Gari McIntyre (Baltimore, MD), and/or Donna Hughes (Oakland, CA) who

are doulas in their communities. A doula is another term recognized for mid-wife and those who support

women with child delivery.

Introduction/Background

Complications during and after pregnancy is the leading cause in death and disability for

women of reproductive age across the world. As defined by the World Health Organization,

“Maternal death is the death of a woman while pregnant or within 42 days of termination of

pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or

aggravated by the pregnancy, or its management, but not from accidental or incidental causes”.

Since slavery, there have consistently and undeniably been acknowledged racial gaps

within maternal mortality, but the difference between now and then is recorded data, and women

of color sharing their narratives without fear of punishment as well. Satcher and colleagues

(2005) assert: “ In the past forty years, African Americans have witnessed some progress

in civil rights, housing, education, employment, and health care. In 1960, segregation was

evident in hospitals and doctors’ offices throughout the South. In 1960, there was no

Medicare or Medicaid, and the infant mortality rate was 44.3 per 1,000 for African American

babies; 29.2% for whites.”

Examples of systems change in health care would include universal health insurance

coverage, a primary care medical home for each American, proportionate representation of

African Americans in the health professions, and the elimination of bias in the delivery of
Racial Gaps in Maternal Mortality 4

diagnostic and therapeutic interventions. Systems changes related to the health of communities

would have to be much more expansive than they currently are, from nonviolent and

exercise-friendly neighborhoods, to more nutritious food outlets, educational equality, career

opportunities, parity in income and wealth, home ownership, and ultimately increased

hope.

Once a baby is born, they appear to become the center of medical attention, subsequently

leaving the mother to be monitored less. Unfortunately, hereafter, mothers’ concerns, if any, are

dismissed or they themselves are not provided with enough knowledge on what to expect after

birth, or in the case of an emergency. Specifically, for African-American women, risks

disproportionately increase throughout their stages of labor.

Methodology

The African-American population has been at a disadvantage since the beginning of time,

stemming from economics, but without fail of mention, education, health, and unfortunately, this

reality remains current today. Noonan (2016) points out:

In 1928, Louis Israel Dublin wrote “An improvement in Negro health, to the point where

it would compare favorably with that of the white race, would at one stroke wipe out

many disabilities from which the race suffers, improve its economic status and stimulate

its native abilities as would no other single improvement. These are the social

implications of the facts of Negro Health” [1]. This compelling assertion remains . The

fact that the African American population is the least healthy ethnic group in the USA is not

due to chance. The first African Americans were brought to the USA in chains as slaves. The
Racial Gaps in Maternal Mortality 5

transport itself from Africa to the New World, remains one of the most prominent examples of

this terrible origin and its impact.

As of recent, public health surveillance by health organizations have been used to further

investigate the racial gaps in maternal mortality. Stroup and associates (2017) informs us,

“Public health surveillance—the continuous, systematic collection, analysis, and interpretation of

health-related data needed to plan, implement, and evaluate public health practice—is another

fundamental public health activity. Publishing the results of surveillance activities is an essential

part of public health action;” In research of this population Rabin (2019) notes:

The C.D.C. examined pregnancy-related deaths in the United States from 2011 to 2015,

and also reviewed more detailed data from 2013 to 2017 provided by maternal mortality

review committees in 13 states.

The agency found that black women were 3.3 times more likely than white women to

suffer a pregnancy-related death; Native American and Alaska Native women were 2.5

times more likely to die than white women.

Data such as this exemplifies the need for policy reevaluation and the need to address the

negligence of prenatal and postpartum healthcare conducted by medical professionals.

Association of Maternal & Child Health Programs (2016) asserts:

Prenatal care, which is a national priority addressed in the Healthy People 2020 and

other major health policy initiatives, is predicated on access to coverage for women of

reproductive age. Healthy People 2020 objectives related to pregnancy include increasing

the proportion of pregnant women who receive prenatal care beginning in their first
Racial Gaps in Maternal Mortality 6

trimester and increasing the proportion of pregnant women who receive early and

adequate prenatal care.3 According to Healthy People 2020 baseline data, about 70

percent of women received early and adequate prenatal care starting in their first

trimester.4 This indicates that there remain barriers to accessing timely prenatal care.

Prenatal care is critical to reducing the risk of pregnancy-related complications for

mother and infant. Access to health care coverage and subsequent utilization of prenatal

care allows health care practitioners to monitor the health of mothers and infants and

detect and treat certain medical conditions, such as gestational diabetes and preeclampsia,

in a timely manner. Women who do not receive prenatal care are also three to four times

more likely to die from pregnancy-related complications than those who do receive care.

In order for effective to change to occur healthcare professionals must first take accountability

for their actions or the lack thereof; however, this may only happen if patients continue to speak

out and bring it to the attention of the facilities and legislation. Rice (2013) recommends:

We hold people's feet to the fire in all of those different industries. If they mess up, they

are held accountable for it. But there needs to be more accountability in healthcare as

well, but with sensitivity to the fact that they aren't necessarily an interchangeable

employee… There needs to be work put into place into the way our teams are coached,

teams are measured, and the teams are hired quite frankly, as well. […]Physicians,

nurses, medical technicians and other clinicians can become unaware that their level of

compassion is waning when they're under pressure, but it's up to the organization to

renew their awareness and hold them accountable.

Accountability is essential for the growth of an organization and individuals who are associated

with the organization as well.

Conclusions and Statement

The legacy of racial gaps in maternal mortality accompanies with other social

determinants specifically within the African-American community has compromised the trust of

African-American women and the healthcare system. Though there have been several

advancements in healthcare since slavery there has been minimal progress as it pertains to

discrimination. Prather (2018) expresses the potential immediate and long-term of impact on the

target population in stating:

The sexual and reproductive health of African American women has been compromised

due to multiple experiences of racism, including discriminatory healthcare practices from

slavery through the post-Civil Rights era. However, studies rarely consider how the

historical underpinnings of racism negatively influence the present-day health outcomes

of African American women. Although some improvements to ensure equitable

healthcare have been made, these historical influences provide an unexplored context for

illuminating present-day epidemiology of sexual and reproductive health disparities

among African American women.

Therefore the implications of the professional experience on public health practice are often

misconstrued due to a tainted experience that African-American often encounter, more so, than

not, yet the perspectives can be changed when public health agencies regain their trust through

advocacy, reminding them of their patient rights, and providing them with incentives (i.e. breast
Racial Gaps in Maternal Mortality 8

pumps, baby food, etc.) which in return provides public health agencies with the participation

they need to continue to operate, in addition to the data their stakeholders request.

Overall, this Culminating Experience has provided me with a greater appreciation for

Azusa Pacific University’s MPH program as it is notably diverse and really embodies the idea of,

“Make a difference and help people better their lives with an MPH degree, which will prepare

you to plan prevention and other wellness programs, as well as analyze and develop health

policy.” I can honestly say through every course taken throughout my time at APU I have been

challenged not only as a student, but as a future healthcare professional, which has only made me

a better individual eager to make a change while staying true to my personal values and the

professional ethics and standards.

References

Association of Maternal & Child Health Programs. (2016, September). Opportunities to

Optimize Access to Prenatal Care through Health Transformation. Retrieved December

4, 2019, from http://www.amchp.org/Policy-Advocacy/health-

reform/resources/Documents/Pregnancy Issue Brief_Final 2016.pdf.

Azusa Pacific University. (n.d.). Master of Public Health: Improve Public Health with an MPH

Degree. Retrieved December 4, 2019, from https://www.apu.edu/nursing/programs/mph-degree/.

Helm, A. (2018, October 19). Kira Johnson Spoke 5 Languages, Raced Cars, and Was Daughter in Law

of Judge Glenda Hatchett. She Still Died in Childbirth. Retrieved October 22, 2019, from

https://www.theroot.com/kira-johnson-spoke-5-languages-raced-cars-was-daughte-

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Neighmond, P. (2019, May 10). Why Racial Gaps In Maternal Mortality Persist. Retrieved October

22, 2019, from https://www.npr.org/sections/health-shots/2019/05/10/722143121/why-racial-

gaps-in-maternal-mortality-persist.

Noonan, A. S., Velasco-Mondragon, H. E., & Wagner, F. A. (2016, October 3). Improving the health of

African Americans in the USA: an overdue opportunity for social justice. Retrieved December 4,

2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810013/.

Prather, C., Fuller, T. R., Jeffries, W. L., Marshall, K. J., Howell, A. V., Belyue-Umole, A., & King, W.

(2018, September 24). Racism, African American Women, and Their Sexual and Reproductive

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Rabin, R. C. (2019, May 7). Huge Racial Disparities Found in Deaths Linked to Pregnancy. Retrieved

December 4, 2019, from https://www.nytimes.com/2019/05/07/health/pregnancy-deaths-.html.

Rice, C. (2013, March 4). Make Hospital Staff Accountable for Patient Experience. Retrieved December

4, 2019, from https://www.healthleadersmedia.com/strategy/make-hospital-staff-accountable-

patient-experience.

Roeder, A. (2018, December 21). America is Failing its Black Mothers. Retrieved December 2, 2019,

from https://www.hsph.harvard.edu/magazine/magazine_article/america-is-failing-its-black-

mothers/.

Stroup, D. F., Smith, C. K., & Truman, B. I. (2017, December). Reporting the methods used in public

health research and practice. Retrieved December 4, 2019, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798489/.

World Health Organization. (2014, March 11). Maternal mortality ratio (per 100 000 live births).

Retrieved December 2, 2019, from

https://www.who.int/healthinfo/statistics/indmaternalmortality/en/.