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Day 08
InEquity in Black Maternal Health Care
 
North Carolina is currently facing a critical maternal and infant health crisis, as highlighted by the March of Dimes. Disturbingly, various indicators of the well-being of pregnant women, new mothers, and infants in the state are heading in the wrong direction.
 
 
As is often the case with historical challenges, the impact of this crisis is disproportionately borne by women.  The maternal death rate in 2019 was 22 per 100,000 births. The next year, the rate per 100,000 births increased to 29 then spiked to 44 in 2021. “It's a huge jump, especially in such a short period of time,” said Keisha Bentley-Edwards, a Duke University researcher who studies health equity.
 
 
This disparity in maternal health is intricately linked with infant mortality rates. Black infants in North Carolina face a mortality rate more than twice that of white infants. In 2020, the infant mortality rate for Black babies in the state was 1.66%, significantly higher than the rate for white babies at 0.58%. In 2019, the Black infant mortality rate was 1.22%.
 
 
Surviving pregnancy for many Black mothers in North Carolina, like tennis phenom Serena Williams, becomes a harrowing experience. Countless others terminate their journey to motherhood traumatized by experiences of neglect, dismissal, and blame within the medical systems designed to support them.
 
These disparities for Black mothers and children are deeply rooted in oppressive and unjust systems, persisting even when accounting for factors such as education, body mass index, and socio-economic status. Dr. Elizabeth Howell, a professor and director of the Women's Health Research Institute at the Icahn School of Medicine, emphasizes the role racism plays in shaping health outcomes, challenging the notion that access to care and insurance alone can explain the disparities.
 
Looking back, from the 1600s to the mid-1900s, Black women in North Carolina received maternity care and birth support from Black midwives, a practice distinct from the clinical settings. The first Black midwife in America, dating back to 1619, played a vital role during enslavement, acting not just as a birth attendant but also as a spiritual healer, family counselor, breastfeeding consultant, nutritionist, postpartum doula, family planning counselor, and advocate for the community. Unfortunately, racism has led to the forgetting of many aspects of Black women's contributions to midwifery.
 
In the 1900s, approximately half of all U.S. births, including those in North Carolina, were attended by midwives, who were primary health care providers for Black women and often assisted white women in the South during childbirth. The Sheppard-Towner Act of 1921 systematically eliminated Black midwives from the profession, contributing to a legacy of birth injustices. The push from the American Medical Association in 1948 to standardize medicine further accelerated the decline of midwives, leading many, including Black women, to switch to physician care. By 1972, only 1% of all births in the United States were attended by midwives.
 
In the present day, North Carolina's Black families are increasingly turning to midwives and doulas—trained birth coaches providing physical, emotional, and educational support—contributing to improved health outcomes for both Black mothers and their babies.
 

READ
  • Black Women’s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities. (10 minutes)
  • The 2023 March of Dimes Report Card highlights key indicators to describe the current state of maternal and infant health. We continue to provide updated rates and grades for preterm birth and data on infant mortality and maternal health. New this year is the inclusion of maternal mortality, leading causes of infant death, and data describing selected risk factors for preterm birth. Indicators by maternal race/ethnicity are included to call attention to the need for addressing racism in our systems and communities to eliminate health disparities. Detailed analyses of these measures inform the development of policies and programs that move us towards improving health for birthing people and the millions of babies born each year in the U.S., D.C., and Puerto Rico. The Report Card presents policies like Medicaid extension and programs like Maternal Mortality Review Committees, which can help to achieve equity in maternal and infant health outcomes.
 

WATCH
  • ABC News report: Black maternal mortality in the U.S and its slave origins. (9 minutes)
  • Aftershock, a powerful new documentary airing on Hulu, follows two families after the preventable deaths of their loved ones due to childbirth complications and reckons with one of the most pressing American crises of our time – the U.S. maternal health crisis. (1 hour, 30 minutes)
 

ACT
 

REFLECT
  1. What is staying with you from today’s materials?
  2. Why should people care about the Black maternal health experience even if they’re not parents or don’t desire to have children?
  3. Reflect on your own birth experience, if applicable. What made you feel supported? What do you wish you had more of in your birth experience? 
  4. What makes a positive birth experience? 
  5. What actions can you take in support of Black women and children?  
 

MISSED A DAY?
 

The 21-Day Equity Challenge was founded by Dr. Eddie Moore, Dr. Marguerite Penick-Parks and Debby Irving, now embraced by a coalition of local leaders, and is being adapted for the United Way of Forsyth County.

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