“Listen to the whispers before they become screams.” That was the title of an article published in 2023 on Black maternal mortality in the United States. While the article is well done and chock-full of essential information, the title rings false. The whispers are screams. And they have been for centuries, growing louder with each passing decade of inaction. History and current trends prove this point and are part of a larger issue. This Black Maternal Health Week, it is time to listen to and amplify these voices and take collective action.
The origins of medical racism, specifically in the field of obstetrics and gynecology (OB-GYN), can be traced back to its inception in the US in the mid-1800s. Modern gynecology’s founder, Dr. James Marion Sims, used Black women to try out new procedures without giving them pain medication since he believed they had a higher pain tolerance than White women. He shared this belief widely throughout his life and established the medical practice of treating White and Black women differently—practices that still plague the medical field today.
A study published in 2016—nearly 200 years after Dr. Sims started practicing—showed that many White medical trainees still had the misperception that “Black patients feel less pain.” Research shows that implicit bias of health care providers results in 1) lower rates of pain medication for acute and chronic pain for Black patients, 2) lower rates of local anesthesia for joint replacement for Black and underinsured patients, and 3) fewer treatment and intervention options offered to Black patients.
These practices and beliefs have horrific impacts on both the population at large and on individuals. The US has one of the highest maternal mortality ratios (MMR) of all other wealthy countries, with an MMR three times that of our peers (32.9 deaths per 100,000 live births compared to 10.9). To further highlight the disparity within the US, the MMR for Black women was 55.3 in 2021, which is more than five times the ratio of other wealthy nations. This trend transcends socioeconomic status, even reaching famous sports stars. You may have heard of Serena William’s near-death experience with the birth of her first daughter. Despite being high profile and having a medical history of pulmonary embolism (blood clots in the lungs), health providers still didn’t take her seriously. Many other famous Black women have spoken out about the Black childbirth experience, like Beyoncé, Allyson Felix, Kamala Harris, Tatyana Ali, Michelle Obama, and the late Tori Bowie who died of complications from childbirth. Across the board, Black women are not taken as seriously, especially when it comes to health. The evidence is in the numbers.
These disparities are all symptoms of a larger issue. The social determinants of health show a broader problem of working and living conditions being set up in a way that creates and perpetuates health inequities. In a 2020 article, Dr. Jamila Taylor—a Black maternal health expert and IWPR’s president and CEO—discussed how these factors come together to contribute to racial inequity in maternal health. Since nearly every area of life has an impact on health, and by extension maternal health, including wage gaps, educational attainment, student debt, reproductive justice, and more, it is not a simple fix to save pregnant people and babies. That is why the Black Maternal Health Momnibus Act is an essential piece of legislation, as it includes 13 individual bills that aim to improve various aspects of health, like child care, housing, and other nonmedical factors. It is only the first step toward addressing the Black maternal health crisis, but it is a move in the right direction. It is far past time for Congress to learn from history by listening to the screams and join the 200+ endorsing organizations by passing the “Momnibus” Act.
