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MATERNAL
MORTALITY

predetermined genetics? myriad considerations for addressing disparities in maternal mor-
While this reasoning may seem attractive, it oversimplifies a com- tality; the systematic oppression of black women and the impact
plex problem. Though genetic predisposition may play a small role, that this repetitive and unyielding trauma (both physically and emo-
mounting evidence suggests that the social determinants of health: tionally) has had on their bodies; is a story that is too often discred-
education, poverty, geographic location, etc. have a much greater ited as relevant to the problem.
impact on health, and preventable mortality. 4 But how does this help us move forward toward improving ma-
However, I opened this piece with a proclamation that even with ternal mortality disparities? I make no conscious claims to having
all the social advantages, African-American women still fare worse the solution for this problem. As with all wicked problems, the so-
in pregnancy. lution is multifaceted. However, I do have a proposition on where
to begin.
So, why are black women dying?
It seems that of all the social determinants of health, race and Here is what I know:
ethnicity most strongly predict the quality and intensity of care re- I am a primary care provider; I believe that lifestyle changes and
ceived. The 2002 Institute of Medicine Report Unequal Treatment medications can reduce chronic disease. I believe that in conjunction
found that racial and ethnic disparities contribute to worsened with good obstetric care and follow up, access to a primary care
healthcare outcomes independent of factors related to access to provider prior to and in the year following pregnancy can help black
care. Furthermore, the report implicated physician bias, stereotyp- women have healthier lives through conception and beyond.
ing, and prejudice as important contributors to this problem. 5 And yet…
Based on this, I submit that that there is perhaps an alternative I know that solving this complex problem is not just about health-
narrative, one that is darker, one that is more uncomfortable, one care. That it is also about recognizing the social and environmental
that asks you to consider the history that shaped the treatment of factors that influence a black woman’s health, and about empower-
black women in the healthcare system and what impact this has on ing her to choose behaviors that promote self-care.
the present state. Even with these things, however, acknowledgment remains the
first act of any lasting recovery. And so, we must acknowledge.
Here is the history: Acknowledge that the black woman may still be healing from his-
Modern gynecology was perfected through the unimaginable ex- torical wounds, that she is perhaps trying to build trust within a
ploitation of black women’s bodies. Dr. Marion Sims (hailed as the healthcare system that has cultivated generations of mistrust. That
father of modern gynecology) performed countless gynecological she is trying to teach herself and her community that her strength
procedures on his slaves without the use of pain medication or anes- is not measured by her capacity to endure pain and suffering, and
thetic. He asked other slaves to hold each “patient” down and muf- that prioritizing her own health is not a fatal flaw, that it is, in fact,
fle their screams as he went about his work, inviting other colleagues the opposite, a radical act of self-preservation.
to observe the horrific experimentation. He then went on to addict That for all we ever try to accomplish to solve this problem, our
these women to opioids; furthering the reach of his control over interventions will be inane unless they acknowledge, respect and in-
their bodies. corporate her story.
Across the country, Dr. Marion Sims has statues erected in his
References
honor, and while recognition of his contributions to the field of
1. Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-Related Mor-
obstetrics and gynecology are plentiful; the costs of those contri-
tality in the United States, 2011–2013. Obstet Gynecol. 2017.
butions are rarely mentioned. And worse yet, the reproductive ex- 2. Shirley A. Maternal Mortality and Morbidity Task Force and Department of
ploitation of black women did not stop with him. It continued on State Health Services Joint Biennial Report. 2016.
3. Baeva S, Saxton DL, Ruggiero K, et al. Identifying Maternal Deaths in Texas
in history in many ways. It occurred in the form of federally-funded
Using an Enhanced Method, 2012. Obstet Gynecol. 2018;131(5):762-769.
reproductive health procedures which amounted to coerced sterili- doi:10.1097/AOG.0000000000002565.
zation; and persisted in segregated healthcare practices that denied 4. McGinnis JM, Williams-Russo P, Knickman JR. The Case For More Active
Policy Attention To Health Promotion. Health Aff. 2002;21(2):78-93.
black women the standard of care. This is all part of the historical
doi:10.1377/hlthaff.21.2.78.
context that shaped society’s valuation of black women’s bodies. 5. Smedley BD, Stith AY, Nelson AR. Unequal Treatment. National Academies
And while understanding the historical context is only one of the Press (US); 2003. doi:10.17226/12875.

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