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MATERNAL
MORTALITY

Black Herstory and the Maternal Mortality

Crisis among African American Women

By S. Michelle Ogunwole, MD

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am young, I am a physician, and I am highly educated. I all maternal mortality rate; the notion that African-American women
I have financial advantages that are above average. I have ac- face profound disparities in maternal morbidity and mortality is so
glaringly apparent in the data that it has remained the most unwavering
cess to healthcare, healthy foods, clean water, and a safe
environment. fact in the crisis of rising U.S. maternal mortality rates.
And yet… So why are black women dying? Why are they facing complica-
If I have a child, none of these things will save me from having tions and adverse outcomes, and why are all of things happening at
a substantially increased risk of an adverse outcome, or even death. such a profound rate, and with such a sharp disparity?
Why? Because in addition to all of the things I described; I am an The reports by the Texas Maternal Morbidity and Mortality Task-
African-American woman. And, more than any of the things that force show that a rise of chronic disease: pre-pregnancy obesity, di-
define me, this is the label that most profoundly informs my chances abetes, and hypertension may partly be to blame, yet the rates are
at a healthy life before, during, and after pregnancy. rising for everyone.

Here are the facts: So, why are black women dying?
Within the field of obstetrics and gynecology, disparities in When the task force evaluated causes of death by race and eth-
pregnancy-related mortality among African-American women nicity, they found that pre-eclampsia and cardiovascular disease were
have led to a mortality rate greater than three times that of their among the leading causes of death for all women, but again black
white counterparts. 1 women were disproportionately affected.
While racial and ethnic disparities in maternal mortality dispro-
portionally affect African-American women nationwide, nowhere So, why are black women dying?
is this disparity more prominent than in the state of Texas where Is it simply a matter of physiological predisposition? The same
African-American women make up only 11.4 percent of the popu- way that African-American people are more likely to have sickle cell
lation of women who give birth, yet account for 28.8 percent of anemia, or Ashkenazi Jews to have Tay-Sachs disease (a rare neuro-
maternal deaths. 2 logic disorder). Should we just accept that black women have higher
Even amidst claims of calculation errors leading to an inflated over- rates of chronic disease and fare worse than others as a matter of

22 San Antonio Medicine • July 2018