The latest data on maternal mortality from the Centers for Disease Control and Prevention show that childbirth is getting more dangerous for mothers, especially Black mothers.
From 2020 to 2021, the maternal mortality rate jumped by more than one-third.[1] The Black maternal mortality rate was more than twice as high as that for white mothers.[2]
COVID-19 played a significant role in this spike. But another major contributor to racial disparities in maternal health is underdiscussed. And that's the disparate impact of chronic disease.
Before the pandemic, complications from chronic conditions accounted for half of all maternal deaths in the United States and were the fastest-rising cause of maternal mortality nationwide.[3]
According to research from JAMA Pediatrics, sickle cell disease -- a chronic red blood cell disorder that disproportionately affects Black people -- accounts for between 9% and 14% of the Black-white disparity in severe maternal morbidities, which include heart failure and sepsis.[4] [5] Black individuals with sickle cell disease face a risk of severe maternal morbidity that's nearly four times greater than that for the general population.[6]
Moreover, a large study from California found that women who suffer from the disease are substantially more likely to live in distressed neighborhoods, deliver at a younger age, and experience stillbirth.[7]
Black mothers also suffer from other common chronic illnesses -- including diabetes, cardiovascular disease, and hypertension -- at higher rates.[8]
Thankfully, it's possible to narrow racial disparities in maternal health. In a study from Maternal Mortality Review Committees, "Over 80% of pregnancy-related deaths were determined to be preventable."[9] To prevent them, we must better allocate resources.
Sickle cell disease expert Dr. Srila Gopal notes that women with chronic conditions, like sickle cell, often require early detection, specialized management, and coordinated care to ensure a safe birth for themselves and their babies.
Dr. Gopal's work at UC San Diego Health can serve as a model for other public hospitals serving marginalized communities. Under her direction, UCSD Health has made enormous progress in treating sickle cell disease by establishing protocols for pain management and telemedicine geared specifically towards patients.[10] The impact of chronic conditions on health equity is not limited to maternal health and better management and improved health care access could save California $475 billion over ten years.[11]
Later this month, PFCD is convening a conversation in California to discuss these important issues with leading voices including Assemblywoman Akilah Weber, M.D. (D-San Diego_, Dr. Cynthia Gyamfi-Bannerman, UCSD, and Dr. Suzanne Afflalo, IWC Primary Care.
Dr. Weber serves as a champion in bridging the gap between health disparities and its plague on communities in California. In September, Dr. Weber introduced AB 85 in the Senate, which required health plans and insurers to pay for the screening of social determinants of health (SDOH). The SDOH have a major impact on people’s health, well-being, and quality of life, particularly on individuals of color. The conditions and environments where people are born, live, work, and play contribute to wide health disparities and inequities raising their risk of obesity, heart disease, and diabetes. Many of these factors include food insecurity, inadequate housing, or lack of transportation. The bill would make SDOH screenings a covered benefit for Medi-Cal beneficiaries, connecting patients directly to community resources or government social services that address their SDOH needs.
PFCD advocates for collaborative action among healthcare professionals and policymakers to confront the disparate impact of the maternal mortality crisis and work for health equity. We urge local, state, and federal lawmakers to craft legislation that addresses the root causes of chronic disease among marginalized communities.
We also recognize that achieving health equity means eliminating the scourge of racial discrimination in every facet of American society -- including education, housing, and the labor market.[12]
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[1] https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm
[2] https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm
[3]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709216/#:~:text=Complications%20from%20pre%2Dexisting%2C%20chronic,half%20of%20all%20maternal%20deaths.
[4] https://sc.edu/study/colleges_schools/public_health/about/news/2023/scd_smm_boghossian.php
[5]https://www.nichd.nih.gov/health/topics/maternal-morbidity-mortality/conditioninfo/causes#:~:text=Some%20SMM%20examples%20include%20heart,%2Fblood%20infection%2C%20and%20hysterectomy.
[6] https://sc.edu/study/colleges_schools/public_health/about/news/2023/scd_smm_boghossian.php
[7]https://health.ucdavis.edu/news/headlines/study-finds-black-women-with-sickle-cell-disease-have-worse-maternal-health-outcomes/2023/06#:~:text=Black%20pregnant%20women%20with%20SCD,stillbirths%20and%20inpatient%20maternal%20mortality.
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9914526/
[9]https://www.cdc.gov/media/releases/2022/p0919-pregnancy-related-deaths.html#:~:text=More%20than%2080%25%20of%20pregnancy,identify%20recommendations%20to%20prevent%20future
[10] https://today.ucsd.edu/story/uc-san-diego-health-recognized-for-health-equity-in-care-of-sickle-cell-crisis Email from PFCD
[11] http://www.fightchronicdisease.org/sites/default/files/download/PFCD%20-%20Health%20Equity%20Fact%20Sheet%20%28CA%29.pdf
[12] https://www.fightchronicdisease.org/latest-news/pfcd-statement-health-disparities-and-race