New data from the Blue Cross Blue Shield Association’s (BCBSA) Health of America Report show Black and Hispanic women are more at risk than White women for severe childbirth complications regardless of age.
Disparities in maternal health are so severe that young Black women are at greater risk for childbirth complications than older White women considered high risk (after turning 35).
“The disparities we see in maternal health care are unconscionable and unacceptable, and they require a new system of health caring, not just health care,” Kim Keck, President and CEO, BCBSA said. “These outcomes are likely driven by a number of factors, including maternity care deserts, higher rates of underlying chronic conditions, limited access to health care, continued racial disparities and bias within the system, as well as other barriers which threaten women’s access to necessary and appropriate care before, during and after childbirth.”
The BCBS’ findings have revealed Black women experience childbirth complications, as measured by the CDC’s Severe Maternal Morbidity Measure (SMM), at rates up to three times higher than white women.
“We looked at Severe Maternal Morbidity, or ‘SMM,’ a measure the CDC uses to talk about an unexpected outcome from pregnancy or childbirth,” Keck said. “The CDC categorizes SMM by 21 different adverse events, known as ‘indicators,’ which include, but are not limited to, kidney failure, respiratory distress and eclampsia. In some cases, an SMM indicator can be associated with maternal death.”
Dr. Rachel Hardeman, Founding Director of the Center for Antiracism Research and Health Equity at the School of Public Health at the University of Minnesota says maternal morbidity has increased by 75% in the US and has increased disproportionately among racial and ethnic minority birthing people.
“Health care providers must acknowledge and address the impacts of discrimination on Black and Latinx maternal health outcomes. Previous studies have shown that a culturally centered care model and diverse provider staff fill an expressed desire for maternal care outside of traditional birth settings reported by 69% people of color,” Dr. Hardeman said.
The report is a part of BCBSA’s National Health Equity Strategy, which aims to reduce racial health disparities. With an initial focus on maternal health, BCBSA has committed to a goal of reducing maternal health disparities by 50% over the next five years.
“We’re setting bold goals and holding ourselves accountable,” Keck said. “Our efforts start by leveraging existing BCBS programs and partnerships. From using technology to identify and support high-risk pregnancies, to increasing support for doula coverage, incentivizing OB/GYN doctors to train in managing chronic conditions and implementing culturally appropriate interventions.
“As we aim to close the gaps in maternal health, we must also work to reduce racial disparities across the health care system,” she continued. “We’re committed to addressing social determinants of health, improving access to health coverage, driving equity through data analysis, expanding diversity among clinicians while also enhancing culturally appropriate care, and targeting chronic conditions that have plagued communities of color of far too long.”
With a maternal health disparities gap of this magnitude, it can’t help but raise questions regarding other aspects of society that may go under the radar when it pertains to the overall crisis of minorities and reproductive healthcare.
“The persistent inequities in reproductive health are not just a result of failings within the healthcare delivery system,” Dr. Hardeman said. “We must look beyond the walls of our hospitals and clinics to recognize that the social context in which live, work, play and age causes Black birthing people to enter pregnancy at a health disadvantage.”
Several complications could potentially go wrong during any pregnancy or child-birth, yet, many minority mothers’ concerns have gone overlooked by birthing healthcare professionals when experiencing the same complications in comparison to their white counterparts.
“Another frequently overlooked complication of both pregnancy and the postpartum period is pain; numerous studies have demonstrated that Black patients across the life course are less likely to be prescribed pain medicines than white patients experiencing similar pain levels,” Dr. Hardeman said. “Pain is an important quality of life problem in and of itself, but can also be a sign of a serious health concern, such as a blood clot.
“Cesarean birth increases the risk of severe maternal complications such as bleeding, blood clots and seizures,” she continued. “Black and Hispanic women need to be aware of their personal risk factors for Cesarean birth and, if possible, discuss their concerns and desires with their care team prior to going into labor. Having a continuous birthing support person like a doula can support a birthing person in self-advocacy and potentially reduce unnecessary interventions.”
Hardeman goes on to say that Black birth giver’s communication and concerns are taken less seriously because of implicit bias.
Hispanic mother’s SMM rates have jumped 19% in two short years. 63% of Hispanic mothers are also more likely than white mothers to undergo a hysterectomy following childbirth complications.
“There may be a number of causes for this increase, including higher prevalence rates of risk factors for SMM among women of color and barriers to getting the care they want, like prenatal visits,” Keck said. “In addition, the majority of pregnancies are among millennial women and we’ve seen an increase in chronic conditions in this population. Every mother deserves to have to have the best care at every stage of their pregnancy. We must confront health disparities across the board to change the trajectory.”