NC congresswoman tackles maternal health disparities
By Melba Newsome
During a press conference on April 16, 12th district Congresswoman Alma Adams held up a picture of Kira Johnson, a woman she’d never met but whose tragic death compelled her to act.
Johnson, 39, was in exceptional health and had the best prenatal care. In 2016, she had a planned Cesarean section for her second child at Cedars Sinai hospital in Los Angeles. When Johnson left the operating room, her husband noticed blood running through her catheter, a sign of excessive bleeding or postpartum hemorrhage. Despite repeatedly alerting the medical team to the problem, doctors waited nearly 24 hours before returning Johnson to surgery to stop the bleeding.
By then, she had been hemorrhaging internally for almost 10 hours. Her heart stopped immediately and she died in surgery.
“This story hits close to home because it is so common in our community; so common, in fact, that I almost lost my daughter after she gave birth because her doctors wouldn’t listen,” Adams said at the D.C. press conference. She introduced the Kira Johnson Act as part of the Black Maternal Momnibus of 2020 bill written to make vital investments in reducing maternal mortality and morbidity rates overall, especially for black women.
Listen to black women
Last year, Rep. Adams, along with Rep. Lauren Underwood (D-IL) and Sen. Kamala Harris (D-CA), launched the Black Maternal Health Caucus, a congressional committee with over 70 members working to raise awareness and steer policy that can reduce maternal complications and deaths among black women. The group is one of many Congressional health care caucuses.
When the Caucus dubbed April 11-17 Black Maternal Health Week, Adams used the opportunity to reaffirm the need to take black women seriously when they speak about their health concerns, and to eliminate disparities and implicit bias from our health care system.
Maternal mortality rates have fallen 44 percent around the world from 1990-2015. The United States implemented the Pregnancy Mortality Surveillance System in 1987. Since that time, the number of reported pregnancy-related deaths steadily increased. The most recent data from the Centers for Disease Control (CDC) released by America’s Health Rankings is 29.6 deaths per 100,000 births in the U.S. According to the American Medical Association, the United States, Afghanistan and Sudan are the only three countries in the world with rising maternal death rates.
North Carolina’s overall rate is a touch lower than the national average, at 27.6 per 100,000 births. The situation is even more dire for black women who are three to four times more likely to die from pregnancy-related complications, according to the CDC data. For black women in North Carolina, the maternal mortality rate is 56.8 deaths per 100,000 births.
Black women are also twice as likely to lose an infant to premature death. Infant mortality for black babies, defined as when a child dies before reaching her first birthday, is about two-and-a-half to three times the rate for white women. For every woman who dies, the National Institutes of Health say 70 more experience “near misses” that lead to significant short- or long-term consequences to a woman’s health.
Legislative spotlight on disparities
Adams wanted to highlight these complex issues and address the racial inequities in American health care, especially among black mothers.
“There’s no question that our mothers and infants are suffering preventable tragedies that rarely occur in other developed nations,” Adams said at a House Education and Labor Committee hearing in January. “The only question is whether we will come together and fulfill our responsibility to find solutions and to take action.”
The Momnibus, (S. 3424: Black Maternal Health Momnibus Act of 2020), the first piece of legislation written by the Black Maternal Health Caucus, has been endorsed by more than 100 organizations, including Black Women’s Health Imperative, the National Perinatal Task Force, the NAACP, the American College of Obstetricians and Gynecologists (ACOG), and the Center for Reproductive Rights.
Composed of nine individual bills, the Momnibus is wide-ranging in its efforts to confront the social determinants that influence maternal health outcomes, such as housing, transportation and nutrition. The legislation also provides funding to support community-based organizations, collect more and better data, grow and diversify the perinatal workforce, invest in maternal mental health care and substance use disorder treatments, and extend health insurance coverage from pregnancy up to one year postpartum.
The picture in North Carolina
It makes sense that Adams would take up this cause, given that North Carolina ranks 30th in the country in terms of maternal mortality rates.
North Carolina earned a D+ on the March of Dimes’ 2019 report card assessing infant and maternal health for progress eliminating racial/ethnic disparities in preterm birth, a leading contributor to infant mortality. The preterm birth rate among black women in the state was 48 percent higher than the rate among all other women.
Dr. Augustus Parker, medical director at Novant Health’s women’s urgent care services, is an expert on infant mortality. He says many of his colleagues are shocked to learn about the maternal and infant mortality crisis that’s been around for decades and is getting worse. While social determinants and comorbidities such as obesity, diabetes, high blood pressure and heart disease are part of the problem, they are too often used as an excuse.
“Our society structures opportunity and assigns value based on race. We’ve got to get away from this notion of victim blaming,” said Parker.
Parker says the disparities may not be race, but possibly racism. Black women of all economic levels are affected, as evidenced by the pregnancy complications experienced by Serena Williams and Beyoncé, both superstars.
Even a black woman with a college degree is more likely to die from giving birth than a white woman without a high school diploma. The maternal death rate is 37 per 100,000 of which 54 percent are considered preventable. In white women, it’s 14 per 100,000, of which 9 percent are preventable.
Adams can attest to this. She said her daughter had adequate health care and was in a good socioeconomic place.
“But there were still issues that came up just as she was getting ready to give birth,” she said. “The literature on the topic says that it doesn’t matter what your socioeconomic background is. These kinds of complications happen, and black women experience them more than other women.”
Parker sees maternal mortality and infant mortality as a reflection of the overall health of our community.
“If we can’t take care of the most vulnerable of our population, what does it say about how we would care for the rest of our adult population?” he asked rhetorically. “This reflects our collective capacity to promote and protect the health and well-being of our very youngest, and most vulnerable.”
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