Research Paper

By Christiana Johnson

Why is it that the mortality rate of black women is two or three times higher than that of white women?

Usually, when pregnancy comes into a marriage it is good news and known as the joy of the family. But issues are arising where black mothers can’t even trust the hospitals for a safe birth. In hospitals in the United States today, there is an issue with maternal mortality when it comes to black mothers. Black women are 2 or 3 more times likely to die during childbirth than white women. It is said that doctors pay less attention to black women during their pregnancy because they assume that they don’t know what they talk about when they complain about certain symptoms. Swapna Venugopal Ramaswamy, in her article “Without an ‘ounce of empathy’: Their stories show the dangers of being Black and pregnant”, uses the story of several black mothers and families to effectively portray the negligence of white doctors towards black women during and after pregnancy, institutional racism, and implicit bias as contributing factors as to why the maternal mortality in black women is higher than that of white women.  

Ramaswamy makes the argument that doctors dismiss concerns or overlook severe conditions of black mothers during and after pregnancy. She starts with the story of a 35-year-old pregnant woman whose nutritionist gave her advice to eat fried chicken despite her family history of diabetes and stillbirth. She continues to give another story of a woman who was denied pain medication even though she asked several times during her delivery. In trying to bring awareness to this issue she targets the public as her audience. She uses a news article format to write this source, as well as publishing on a website that focuses on news. News is usually for the public to read or watch. And so, to post it on a news website that is accessible by all without having to pay and write it in the format of a news article shows that she is dedicating this article to the public so that they can read it. In one of the headings, she says, “Be Your Own Advocate” It shows that she is speaking to the public especially black women. She uses “your” which shows that she is directing her message straight to her audience.  

As she continues to speak on the stories of these families, she takes on an urgent, serious, and critical tone. When she was what the possible cause of this disparity in maternal mortality rate. She explains that that people thought it was racing but the truth is that racism is the cause. She goes on to say that “Creating that understanding is critical. It’s a life and death matter.” When life and death are brought into the conversation it shows how urgent and serious the situation is. So her emphasizing that it is critical and that it is something that plays a determinist in the matter of life and death, shows that her tone is hinting that the issue at hand is urgent and critical. After all, she said, 700 black women die during pregnancy and 60% were avoidable. And so, she uses a serious and critical tone to voice out how serious the issue of maternal mortality is and its underlying cause. As a black woman speaking on this issue, it is no surprise that she has this urgency in her tone.  But the question lies with why doctors brush off the complaints of black women.

The answer lies within the implicit bias that black people feel less pain than white people.  According to “Some medical students still think black patients feel less pain than whites” by Ike Swetliz, there was a study that took place in 2016 because it was believed that medical students believed that black people do not feel pain. In this study, a survey was conducted. “In [this] survey of 222 white medical students and residents, about half endorsed false beliefs about biological differences between blacks and whites. And those who did also perceived blacks as feeling less pain than whites and were more likely to suggest inappropriate medical treatment for black patients.” (Swetliz).  They believe that black people have less sensitive nerve endings, thicker skin, and stronger bones. This goes back to the Statistic that Ramaswamy gave when she said 60% of the 700 deaths in black women due to pregnancy was avoidable. And so, when, a black woman complains of a symptom, it is no surprise that these white doctors brush past it as they brush past the concerns of Sha-Asia Washington from Ramaswamy’s article who died during a c-section that failed to diagnose her properly. Just like how they ignored the others who asked for pain medication during delivery, doctors and nurses continue to ignore the symptoms and requestion for help and medication when they need it. They are less likely to be given pain medication to black women than white women. With treatment like these, one can see why maternal mortality rates for black women are so much higher than that of white women

 “Black Maternal Mortality-The Elephant in the Room” by Rolanda L Lister, Wonder Drake, Scott Baldwin H, and Cornelia Graves has given speaks on statistics that support the list of stories Ramaswamy put in her article. As well as context to why black women such as Amber Isaac and Sha-Asia Washington are dying are falling victims of this disparity.  “Black Maternal Mortality-The Elephant in the Room” by Rolanda L Lister, Wonder Drake, Scott Baldwin H, and Cornelia Graves states that the millennium project has aspired to have a 75% decrease in maternal mortality but compared to first world countries, the U.S increases with 26.4/100,000 compared with Italy, Denmark, and Finland who are about 3.2-4.2/100,000 maternal mortality. This is the case because of all the deaths mentioned in Ramaswamy surrounding the story of black women who were overlooked.  Doctors fail to see what is wrong with these patients and they fail to run tests to either clear up or confirm any suspicions. With all these flaws doctors are showing is no surprise that the maternal mortality rate of black women has tripled that of white women.

Another article, “How Implicit Bias Contributes to Racial Disparities in Maternal Morbidity and Mortality in the United States” by Bani Saluja and Zenobia Bryant, also gives some insight into the institutional racism that Ramaswamy mentions in her article. In a comprehensive report, it was said that one in five black and Hispanic mothers experience mistreatment from hospital staff because of their race and ethnicity. (Saluja and Bryant). The maternal mortalities are stemming from the treatment doctors are giving the patients. This supports what Ramaswamy says when she mentions that the underlying reason for this issue is racisms. Doctors are letting their racist way of thinking shows in how they mistreat their patients. Ramaswamy talks about Amber Isaac who died during a c-section because the doctor failed to spot a rare condition that caused her blood platelet to drop dangerously low. They overlooked her condition and she bled out as soon as she was cut open. So, one can conclude that as Ramaswamy mentions there is a lot of racism surrounding the rise in maternal mortality seen in black women.

Maternal mortality is indirectly affected by the hiring process of the hospitals. In order to bring an end to this, you would have to tackle it from the root, racism. Ramaswamy emphasizes that “Addressing racism in hiring practices can have a direct impact on patient experience.” She targets black women and medical institutions. The patients are black women who are going through or are going through the neglect of doctors during or after their pregnancy. Since it she mentions racism, it makes clear that the patients are people of color or black people, and her article talks about maternal mortality which shows that she is talking about women. Ramaswamy uses the experiences of these to target upcoming black mothers who seek help from hospitals during their pregnancy.

When it comes to hiring people, institutions are the ones responsible. They decide who they hire into their hospitals. Who they hire plays a huge role in how black women are treated in hospitals. “Twenty-nine black women who underwent focus questionnaires…describe a lower quality of prenatal care based on racism from providers.” (Lister, Drake, Baldwin, and Graves).  The kind of doctors they chose to hire is why black women like the ones who took the questionnaire experience racism. This supports what Ramaswamy emphasizes when she says that institutional racism plays a role in maternal mortality. When institutions hire doctors blindly, patients such as black women must deal with discrimination from these medical providers. Ramaswamy gave an example of a black mother who emphasis the difference in treatment from when she was attended to by a white doctor during her first pregnancy versus a black doctor during her second pregnancy. A black doctor was able to give her safer during her second pregnancy compared to the white doctor. This shows that it isn’t just the hospital, but who the medical providers are. Even so, the amount of discrimination black women are receiving from white doctors points out that structural violence is involved with the discrimination that black women are receiving.

On suffering and structural violence: A view from below.” by Paul Farmer and “Black Maternal and Infant Health: Historical Legacies of Slavery by Deirdre Cooper Owens Ph.D., and Sharla M. Fett Ph.D. give an explanation as to how the experience of several black women and their families during their pregnancy that Ramaswamy has emphasized in her article, is a result of structural violence created from racism because of slavery. Paul Farmer mentions in his writing, that to look at the political violence pertaining to the AIDs crisis in Haiti, “a corollary of this belief is that extreme suffering, especially when on a grand scale, as in genocide, is seldom divorced from the actions of the powerful. The analysis must also be historically…enough to remember that modern-day Haitians are the descendants of a people kidnapped from Africa in order to…enrich a few in the mercantilist economy.” (Farmer, 274). According to Farmer, to understand the reason for the violence against Haitians, one would have to look back on slavery. When the same logic is used with the high rates in maternal rate in black women compared to white women, it would be evident that this stems from the history of which their ancestors were brought as slaves. Deirdre Cooper Owens Ph.D. and Sharla M. Fett Ph.D. explain that Black women were used as experiments during the enslaved era to deal with infertility after the slave source, Africa, was cut off by the US and Britain. (Owens, and Fett). Whenever enslaved mothers were pregnant, they would call on white doctors. Since “White physicians had little to offer. Consequently, they often blamed enslaved mothers and midwives, using harsh gendered and racist language, for infant deaths that were more likely a result of mothers’ hard labor and poor nutrition…US physicians also began to use their access to Black and enslaved bodies to expand their scientific knowledge and build their professional reputations.” (Owens, and Fett).   Black women during the slave era were just seen as experiments. Something to use to gain experience as creating a name for themselves.

Systematic racism was birthed from slavery and so these ideologies that black women can handle pain more than white women grew. And because this country has been built with this history, it is safe to say that racism is rooted in the system. The same behavior in which white doctors used black mothers as experimental tools is still rooted in the structure the United States has built. It might not be as obvious and plain as taking women and using their experiment, but it is portraying the same message. Which is that there is no value in the lives of the Black mothers. Due to the fact the system is a bath in this thinking, upcoming doctors are entering the field with racist implicit bias, that when it comes to playing it affects black women negatively at hospitals.  Farmer also exclusively mentions that racial classification has deprived certain groups of basic rights. Once a black woman comes into the hospital for a symptom especially during or after her pregnancy, she has already been classified by the color of her skin. Once she begins to make her condition known they begin to look down on her.  Therefore, they are denied the basic right to receive testing and proper treatment. These sources support Ramaswamy’s argument because these ideologies and ways of thinking have been passed down for generations and so black women today are falling victim to structural violence as doctors today, just like the ones during the time of slavery, overlook the human rights of black women.

A young mother came to TikTok to talk about her experience during the time she was delivering her twins. She said that she and her twins almost died because the doctor refuses to believe that she had pre-eclampsia, the white doctor was making jokes with her while ignoring her symptoms, but 4 days later a doctor of color heard a report about her case from the nurse and rushed her to emergency surgery which saved her and her children’s lives. One can’t say that the patient didn’t know what she was talking about, or that the patient was making up storied because as soon as the doctor of color came in, he attended to her immediately after hearing her reports. This shows strong evidence of racism and structural violence. The doctor has the power to take care of the patient and take control of her situation but refuses to use it due to his own implicit bias. It took a doctor of color to step in and help.  

Paul Farmer also gave statistics to show how structural violence, through racism,  is showing itself in the US. “In the United States, in 1988, life expectancy at birth was 75.5 years for whites and 69.5 years for blacks.”  (Farmer, 276). There are fewer Blacks than Whites in the U.S and yet the life expectancy after birth for Blacks is much lower.  This supports Ramaswamy mentions because explains that “Despite the fact that Black women make up about 13% of the population of American women, they die in numbers not far behind white women, who make up 60%. From 2006 to 2017, the most recent years analyzed by the Centers for Disease Control and Prevention, 2,432 Black women died compared to 2,756 whites.”  These numbers depict the disproportionate rate at which Black women die compared to White women. Yet the United States has failed to record the number of deaths in the country by socioeconomic status. This all goes back to structural violence because of slavery. The history of the United States has created a structure in which the lives of black individuals were and would continue to be irrelevant. And what better way to target this than by hitting them at their source, black women. After all, black women are the ones who bring black lives into the world. By causing more complications for black women during delivery, by ignoring black women and their complaints, and by causing avoidable deaths. As they risk the lives of Black mothers during delivery, they risk the lives of black babies, and they risk an opportunity to add to the Black lives in the United States despite the amount that is being taken away by racism.  

To bring an end to all that is happening. Medical Schools need to start educating their future medical students about the implicit bias when it comes to different races in medicine. Racism is bigger than the medical field but educating doctors and debunking all implicit bias can be the first steps to ending maternal mortality as well as the refusal to treat black people according to their symptoms.  “Dr. Satin said he was disturbed by how many medical students and residents agreed with some of the false beliefs, such as the belief that blacks age more slowly than whites, with which 28 percent of surveyed second-year medical students agreed.” (Swetlitz).  Despite the medical knowledge that medical students attain through their years of education, they still believe in false beliefs that have not been proven scientifically.

         Apart from Educating medical students on implicit biases, the medical field needs to address the racism that occurs between the medical community and their patients. Doctors claim that black women are not treated differently from white women. They claim that patients aren’t treated differently based on socioeconomic status. But it is evident that there is discrimination in the treatment of black and white women, as doctors tend to dismiss concerns of Black women than White women. Doctors need to come to terms with the existence of this and consciously understand that discrimination and racism exist in the medical field. And so, to begin a change doctors need to begin, actively, listening to patients and their concerns. They should demonstrate quality patient-provider communication, provide continuity of care, treat the women with respect, and deliver compassionate care.” ((Lister, Drake, Baldwin, and Graves). Achieving these qualities of communication would not just help black women regain trust in their providers but also will help reduce mortality.  

         All in all, maternal mortality in black women compared to white women is an issue that hasn’t fully been brought to light by the media. But there is great evidence of the discrimination that is taking place in the medical field. This discrimination comes in form of dismissing black women, complaining about their symptoms, putting more black women in c-sections, ignoring the conditions of black women, and telling them that they are either confused by their medication or have no idea what they are talking about. Ramaswamy uses her article to bring to light the different experience of various black women has had with their medical providers during and after pregnancy showing the underlying causes for the higher rates of maternal mortality in black women. Medical institutions play a big role in the cause for this, but so does the system put in place by the United States and its history. The history of slavery has created systematic racism that has been placed set in place to take down black lives. And with this structural violence against the black race was born. So, women are facing structural violence as the system has installed various outlets of doctors has their minds filled with implicit bias in the medical. This doesn’t only occur to black mothers but all people of color. The only way to do this is to educate doctors to step out of their implicit bias as well as tackle the system starting with the medical institutions.

Work Cited