By Dr. Mary T. Bassett
A woman arrives at Harlem Hospital in labor having received no prenatal care. The doctors delivering her baby didn’t realize she had heart disease until she went into cardiac arrest in the labor room.
The baby survived. The mother, who was Black, did not.
Her death was the first that I witnessed while I was completing my medical training. Unfortunately, the number of women dying in pregnancy and childbirth in the U.S. has gotten much worse since I was in medical school in the 1970s – and is now a crisis. That’s the main message of an alarming new report on maternal mortality released by the Centers for Disease Control and Prevention.
Every year in the United States, we lose 700 mothers who suffer complications of pregnancy. The loss ripples beyond the women themselves, affecting families and whole communities. Picture an entire high school or small town without any moms.
The statistics should embarrass us. The United States is one of the only developed nations in the world – and the only wealthy one – to have an increasing rate of maternal mortality. In fact, an American woman today is 50% more likely to die in childbirth than her mother was.
Black mothers are at the highest risk. In 2015, when I was health commissioner of New York City, we released a report which found Black women 12 were times more likely to die from pregnancy-related causes than white women.
But more than feeling embarrassed by these statistics, we should vow to take action. The new CDC report makes clear that the majority of maternal deaths are preventable. We just choose not to prevent them.
To be sure, maternal mortality is a complex issue – there is no magic bullet. Contrary to common misconception, racial disparities in health are not due to some innate difference between Black and white women. Instead, the burden shouldered by Black women is primarily the result of decades of inequitable resource distribution, and the toll racism takes on our bodies. Lack of affordable and dignified health care is also a major barrier.
At the same time, relatively simple and inexpensive solutions exist to save mothers’ lives, and they are solutions we can all agree on.
Consider this: when a person comes to the emergency department with chest pain, the doctors and nurses are quick to enact a well-established set of steps to diagnose and treat the pain. We need to implement a similar set of standardized protocols for pregnant women who present with high blood pressure or blood loss. Or for pregnant women reporting excessive pain, since research shows doctors often fail to take these warnings seriously.
Better data are key. No city, state or nation should ever be in the dark about the risks pregnant women face and who is falling through the cracks.
New York City has already started. In 2017, the health department established a committee, with representation from the medical community, community members and activists, to review every maternal death in the nation’s largest city.
An expanded surveillance system in New York City now tracks maternal morbidity as well as mortality. Maternal morbidity refers to the “near misses” during pregnancy or childbirth that still have health consequences for the mother and are about 100 times more common than maternal deaths. As for maternal deaths, black women are at the highest risk – which from 2008-2012 was three times higher than for white women.
As we develop a clearer picture of maternal health risks, we also need to address the medical community’s biased attitudes toward mothers, especially mothers of color.
Implicit bias training for doctors and nurses has been proven to improve relationships with patients. New York City included this training as part of a four-point plan launched last July. By combining provider training with maternal care coordinators who advocate for new mothers, we can elevate the voices of high-risk pregnant women and ensure they receive the right care.
New York City’s experience could have valuable lessons for the rest of the country. With better data about the causes of maternal deaths, new evidence-based strategies to prevent them, and an understanding of the structural barriers that prevent women of color from receiving the care they need, I believe it is possible to turn the tide on the maternal mortality epidemic. It starts with all of us speaking out, and urging those in positions of power to use their influence on behalf of mothers.
We know how to end maternal deaths. Together, let’s vow to never have to imagine a world without Mom.
Dr. Mary T. Bassett is the director of the Harvard François-Xavier Bagnoud (FXB) Center for Health and Human Rights and FXB Professor of the Practice of Health and Human Rights in the department of Social and Behavioral Science at the Harvard T.H. Chan School of Public Health. She served as New York City’s health commissioner from 2014 to 2018.