The United States is considered the most dangerous developed nation to be pregnant in – particularly if you are Black. 

This is according to Stacey Stewart, the President/CEO of the March of Dimes, an organization which advocates for better health outcomes for mothers and babies, in a recent CNN piece.  

Furthermore, according to a report published last month in the American Journal of Public Health, it’s only getting worse. 

Black women are found to be three to four times more likely to experience a pregnancy-related death than White women.  They are also more likely to experience complications during their pregnancy.  This includes preeclampsia, which involves high blood pressure and can lead to complications including, among other things, low birth weight and preterm birth, if not treated properly. 

The high mortality rate is not only due to socioeconomic reasons or the lack of prenatal care.  Black women with college degrees, for example, had a mortality rate five times greater than White women with a similar education.  

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“Studies have shown that underrepresented women feel that the care they receive is different when it comes from someone who looks like them and understands their culture.  They are more likely to follow through with the recommendations of these providers and the actual outcomes tend to be better,” said Dr. Karen Murray, an OB/gyn and Medical Director of Women’s Health at Open Door Family Medical Center.  “There can be unintentional biases that come from a medical professional’s own influences, which does not allow them to see these subtle changes.  It’s not a malicious thing, but a case of not recognizing the subtle signs.  These signs can sometimes get lost in the interpersonal interactions.”

The findings in the latest report are not surprising when you look at the percentage of Black physicians in the U.S. While Blacks comprise 13 percent of the population, only 5 percent of physicians in the U.S. are Black.  As the associate dean of admissions at New York Medical College, Dr. Murray has been trying to change that.  During her time in this position, the admission rate for Black students at the Valhalla-based school has jumped from 8 percent to 20 percent.

“My goal is to have the medical school reflect the population of the county,” she said.    

In the report from the American Journal of Public Health, embolism and preeclampsia/eclampsia tied for the leading overall causes of maternal death for Black women, followed by postpartum cardiomyopathy, hemorrhage, and complications from obstetric surgeries such as Cesarean surgeries.  Postpartum cardiomyopathy, which can occur as much as a year after birth, was six times more likely to occur among Black women than White women. 

Even extremely successful celebrities like Serena Williams and Beyoncé were victims of serious health scares during recent births. Tennis star Serena Williams suffered a pulmonary embolism a day after giving birth to her daughter via Cesarean section.   Medical staff initially dismissed her concerns at the time, wasting critical time between her diagnosis and treatment.  Pop singer and actress Beyoncé suffered from preeclampsia, which left her entire body swollen and forced her to undergo bed rest a month before giving birth to twins by C-section.

According to the report “Unequal Treatment:  Confronting Racial and Ethnic Disparities in Health Care,” published by a division of the National Academy of Sciences, researchers found that bias and stereotyping regarding people of color can impact the level of health care they receive.  This can be through direct care or from communication gaps in which crucial details about a patient’s medical story never get passed along. 

“It often comes down to the ability of the medical personnel to recognize the early signs because people may present a little bit differently,” said Dr. Murray, who moved to the United States from Jamaica as a 17-year-old.  “I always think of my mom and grandmother and how would they present?  What do they eat?  And how much exercise do they get daily?  You can’t, for example, look at the BMI of an Asian and Black woman the same way.  They have different body types and carry their weight differently.  For example, the Joslin Diabetic Center and Clinic in Boston proposed an Asian BMI where the cut off for healthy, overweight and obesity ranges are slightly lower for Asian Americans than for others.

“You also have to pay attention to the culture, become familiar with the diet in order to counsel them on nutrition. For example, you can’t just tell a person who is diabetic to stop eating white bread because they may have other staples in their diet that have the same effect as white bread,” she said.  “You have to recognize the nuances.” 

Education is key to knowledge. These are subtleties, she said, that medical providers can learn, as demonstrated by her team at Open Door, where all the midwives are White. “The support patients have here is wonderful and our birth outcomes are excellent. Knowing the nuances may not always be intuitive, but it can be taught. Either way, it’s often about the clinician’s ability to recognize the early signs.”

“Studies have shown that underrepresented women feel that the care they receive is different when it comes from someone who looks like them and understands their culture.  They are more likely to follow through with the recommendations of these providers and the actual outcomes tend to be better,” s

Dr. Karen Murray, an OB/gyn and Medical Director of Women’s Health at Open Door Family Medical Center (Westchester, NY)

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