by Valerie Morales
Maternal death is an American horror story and a public health crisis that affects black women disproportionately. But why black women die after giving birth or die right before giving birth, is a complicated helix of causations. Obesity and hypertension, pre-existing conditions, and social trauma are risk factors that demagnetize white women and lure pregnant black women into graves.
Lifestyle and health challenges account for an estimated 40% of black women’s deaths. However, an estimated 60% of pregnant mortality is linked to racism causes as black women’s complaints, concerns, and fears are often ignored, dismissed, and erased.
According to the CDC’s Pregnancy Mortality Surveillance System, during a 9 year period (2007–2016) black mothers died at 3.2 times the rate of white women. (The CDC defines a pregnancy-related death as a death that occurs within a year of pregnancy).
Decades before data was being gathered Thomas A. Dorsey, the famous gospel singer, and writer, was about to be a father. He was married to Nettie Harper, who worked for blues singer Ma Rainey. Nettie was pregnant and the year was 1932.
When Nettie went into labor, Dorsey was on the road. She died during childbirth, news that devastated her husband. Two days later, the baby died too. Dorsey was traveling for a performance and immediately fell onto his knees and wept. He was inconsolable and began to pray. Standing nearest him a friend said to Dorsey “don’t say Lord while on your knees. Don’t say, Lord. Instead say, Precious Lord. Precious Lord”. And so it began. Dorsey’s most famous song. Precious Lord, Take my Hand. Lead Me On, Let me Stand.
Dorsey’s classic is a lamentation, a song of suffering and despair, a melancholic cry that is sung at funerals and Sunday services, and in the bathtub. But the emotionality of Precious Lord, its holy anguish and despair, is centered on a young woman who died while giving birth. Though tragic, until data presented the facts of black maternal death, it was not important to catalog the dead black women and babies, despite the graves, grief, and catastrophic pain.
When Malcolm X said the black woman was the most disrespected person on earth he oxygenated an American reality that has continued to expand and grow within multiple systems of inequality and oppression. His words became a shield against equality rather than a call for it. He named a truth which led others to obey its meaning and adopt its core message. And so here we are, black women are dying in childbirth and very few care that another racial narrative is being embraced by omission.
Although the U.S. has the highest rate of maternal mortality among developed nations, messy prenatal situations are a private matter for family, the pastor, and the undertaker. Or, a lightning rod of blame. Black women are obese. They eat fatty foods. They don’t follow prenatal rules like not drinking and not smoking. They miss appointments. They’re too high strung. Left out the conversation is how medical institutions infantilize black women, objectifying their pain, mocking their intellect, while routinely dismissing fears and concerns.
When I was young I carried a baby who died when I was 8 months pregnant. The technical term was fetal demise. I don’t think I did anything wrong. I didn’t drink and I ate healthily. I was devastated that I failed at what I thought was such a basic female thing. After showing me the ultrasound of what was a fetus but now looked like a floating lump of mashed potatoes, my doctor sent me to an abortion clinic to remove the dead thing that had shrunk inside of me. That I was walking around with a dead baby in my stomach was the epicenter of my despair. I was a human grave.
At the abortion clinic, I was given a late-term abortion and when I was recuperating I had the worst abdominal pains this particular night. I began expressing large blood clots and nearly collapsed on the bathroom floor. My husband worried and called my doctor who said “It would pass.” It did but I wonder now if my doctor’s white patients were so callously received as if their suffering didn’t matter. Were they sent to an abortion clinic, or were they ushered to a hospital? Was my doctor as indifferent towards white tears as he was towards mine?
However, it’s not as simplistic as a white doctor, black patient. Many years later, I was in the hospital for a hysterectomy and coded on the operating table. The seven surgeons who were trying to fix me were helpless after twelve blood transfusions failed. I eventually resuscitated, and everyone agreed it was an act of divine mercy.
On my first post-op visit, my gynecologists wept. He relived watching me die and was overcome with emotion. He was a white man who cared about his black patient who had a terrible surgical experience. Years before he was my gynecologist, I had a very well known black woman as a doctor. She made me feel as if I was interrupting her lunch dates and shopping trips at Saks.
Regardless of the color of the clinician, how black women are perceived shapes the kind of care black women receive. I’ve had great care in hospitals and I’ve also had clinicians dismiss my concerns. Black women are often blamed for their poor outcomes. Yes, we have to take accountability for responding to the stress and trauma in our lives by over medicating with food, alcohol, sex, and drugs. But systems and institutions need a tutorial in empathy. Many are desensitized to our racial suffering or consider us hysterical. As a population, black women are reviled or stereotyped or dismissed.
When I was in the hospital for uterine problems, the morning of my surgery the oncologist visited me. He wanted to prepare me for the worst-case scenario: ovarian cancer. He walked me through what would happen if they found cancer. Then he offered a passive-aggressive joke, the kind men love to toss out at women. He asked me “why do you women hold on to your uterus for so long?” I quipped back “the same reason you men hold on to your testicles.” But later when I thought about it, what he revealed was depressing. I was a redundant cliché taking up space. I was the woman who waited too long, something he decided was annoying or just stupid. After being wheeled into a holding bay before surgery, the anesthesiologist butchered my arm as he tried to find a vein. Perhaps he was a brute with everyone he came into contact with and who lay on the table waiting for surgery. Maybe expecting compassion was romantic; these men were scientists. Or perhaps it wasn’t me being sick that struck a nerve but me being black and sick.
There is something very, very wrong. The institution of medicine isn’t paying attention to 700 dead women per year, nor is it listening to women who are patients. Serena Williams almost died after childbirth. Allyson Felix was diagnosed with pre-eclampsia. Both struggled with their pregnancies as I struggled with mine.
Preventing Maternal Deaths Act which became law in 2018 allocates resources to collect, study, and analyze data on maternal mortality in every state. The law supports existing maternal mortality review committees (MMRC’s) that are federally funded.
Senator Kamala Harris introduced The Maternal Care Access and Reducing Emergencies (CARE) Act in 2018 and reintroduced it in 2019. The Maternal Care Access and Reducing Emergencies (CARE) Act would earmark $125 million for health providers in order to identify high-risk pregnancies very early. $25 million would go towards addressing and redressing racial bias in medicine through training, particularly in the areas of implicit bias, while simultaneously embracing integrated health care models that honor culture. Harris wrote, “Every day pregnant women walk into their doctor’s office for checkups, advice, and treatment; but that experience is very different for black women.”
In Louisiana, the racial divide has bypassed alarming and has reached catastrophic numbers. The rate of black maternal deaths per 100,000 live births is 72.6 while the rate of white maternal deaths is 27.3. Georgia, New Jersey, and Indiana also have higher than normal maternal deaths while California. Massachusetts and Nevada have the lowest rates of maternal mortality. California’s rate of maternal mortality is 4.6 per 100,000 live births.
Dr. Mary-Ann Etiebet explains that “women are entering pregnancy with other medical conditions that put them at greater risk for emergencies and not all hospitals are prepared to identify and respond to some of these emergencies during childbirth.”
But that doesn’t explain why when Serena Williams told her clinicians she was struggling after delivering her daughter they disregarded her fears. Williams had a previous scare with blood clots and was aware of what a clot in her lung felt like. Yet her fears and her symptoms tethered her to the stereotype of the black woman doing extra and being hysterical. Serena Williams is a woman of influence and artistry and wealth but in that bed, sicker than sick, she was as black as I was in my hospital bed, sicker than sick.
These are dark times for women of color. Covid-19 has sent many to early deaths as hospitals dismiss symptoms and tell us to go home. We return very ill. Or, we wait to go to the hospital until it is too late for treatment. Can you blame us for not trusting physicians and hospitals when we are treated like ghosts? With a sneer, many doctors look at black women as children to their great white father archetype.
“The way that the multiple layers of oppression show up in our world is not the same way that privileged communities get to experience these issues. This is why black women came up with the term ‘reproductive justice’ which is looking at the connection between the very real social justice issues that come into our lives every single day” Monica Simpson said. She’s the executive director of the Sister Song Women of Color Reproductive Justice Collective based in Atlanta.
I had a friend whose mother died of breast cancer at a particularly young age, she was 44. She didn’t go to her annual exam because she had been previously treated with disdain and disrespect and couldn’t bear to be diminished publicly. Not again. It was a shameful experience. Although cancer killed her, racism was the accelerant.
After my fetal demise, I changed doctors and hospitals. I sought out the best care I could afford without health insurance. Every week I was given a non-stress test to monitor the fetal heart. When I went into labor I was assigned a nurse who wasn’t allowed to leave my room. I began to become very ill; I ran a fever and was experiencing signs of sickness. They decided on a C-section and until I recovered I wasn’t allowed to hold my newborn. I was in the hospital for five days because they labeled me high risk. The clinicians treating me were determined not to have my death on their watch. My life was personal to them and yet not one of my clinicians was a person of color. They treated me as a human person who deserved the best that they could offer. But I was paying cash; they were further incentivized.
If I could ask one thing of Senator Kamala Harris it would be to make maternal health a consistent priority. Study what California is doing right and make the necessary applications. Establish systems in which black women are welcomed and not just tolerated. Remind health providers that pain isn’t linear, trauma isn’t ordinary, grief is expected in an oppressed population.
The babies in our bellies need extra care because racism cuts off oxygen and healing. Judging us doesn’t encourage positive outcomes. It doesn’t.
Which brings us to the election of 2020. For black women, so much is at stake, not the least of which is our buried history, specifically the daughters and sons in graves because doctors didn’t listen, or waited too long, or made up their mind about us because of our names or our twists or our skin art.
We know the story doctors ignore. Maltreated and invisible, our beautiful sisters are vulnerable. They traffic in death, in killing fields while being victimized because no one is paying attention. But it needs to be mentioned in multiple spaces. Black women's desires are the same as those whose skin color we do not share. We just want to be mothers. We just want to stay alive.