Davis (2019) comments, “The repertoires of racism exist in the crevices and creases of a conversation, in the space between a comment and a pause. ET While the global maternity mortality rate has dropped by 44 percent worldwide between 1990 and 2015, and by 48 percent in developed countries, the US is one of only 13 nations who has seen its maternal death rate rise. MMRC data suggest the majority of deaths – 60% or more – could have been prevented by addressing these factors at multiple levels. As described in my previous blog posts (Experiences of Safety Enhance Prenatal Maternal-Child Health, July 24, 2018; Trauma Informed Care Needed to Address Obstetric Violence, March 31, 2019) posttraumatic stress symptoms develop in response to overwhelming experiences. (20) Berger, M. & Sarnyai, Z. Even in states with the lowest PRMRs and among women with higher levels of education, significant differences persist. Protecting the health of mothers and infants is a critical measure of a country’s development. Obstetrics and Gynecology, 124(6), 1111-1119. (1) Taylor, J, Novoa, C., Hamm, K, Shilpa, P. , 2019, “Eliminating Racial Disparities in Maternal and Infant Mortality”, Center for American Progress, p.2. More than half of maternal deaths occur in fragile and humanitarian settings. Maternal and Child Health Journal, 13(1), 29-39. The chance of death is 1 in 2,500 for black women according to the UK Confidential Enquiry into Maternal Deaths. Acknowledging the experiences of African American women and their developing babies in the medical system is the first step towards identifying and implementing urgently needed policy and practice changes that can reduce disparities in maternal and infant mortality rates. The death set off protests outside the hospital calling attention to racial disparities in maternal mortality rates. The psychophysiology of posttraumatic stress disorder (PTSD) associated with experiences of racism suffered by African American women and girls may be one mechanism that contributes to their increased risk of preterm birth and the disparities in maternal and infant mortality between African American and Non-Hispanic white women. (19) (Okhomina, V. I., Glover, L., Taylor, H., & Sims, M. (2018). “Infant mortality differences between whites and African Americans: The effect of maternal education”. (12) Bloom, S., & Farragher, B., (2013). (23) Davis, D. (2018). Dimensions of responses to perceived discrimination and subclinical disease among African-Americans in the Jackson Heart Study. Vicarious traumatization ensues not only by means of collective memory, storytelling and oral traditions, but also becomes ‘embodied’ in the offspring of subsequent generations by epigenetic and genetic mechanisms” (4). "Postsecondary education reduced the risk of death among infants born to white mothers by 20 percent but had zero impact on those born to African American mothers" (7). “African American women across the income spectrum and from all walks of life are dying from preventable pregnancy-related complications at three to four times the rate of non-Hispanic white women, while the death rate for black infants is twice that of infants born to non-Hispanic white mothers” (1). “Racial discrimination and preterm birth among African American women: The important role of posttraumatic stress disorder. The risk remains high and extends to a much older age. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESexternal icon. The New York City Department of Health and Mental Hygiene conducted a study that found that black non-Latina women with at least one college degree have higher severe maternal morbidity rates than all other women who never graduated high school (8). Risky Maternal Behaviors Do Not Account for Racial Disparities in Infant Mortality Rates. 2,3 During 2014–2017, the pregnancy-related mortality ratios were: 41.7 deaths per 100,000 live births for non-Hispanic Black women. In M. J. Friedman, T. M. Keane & P. A. Resick (Eds. All-cause mortality rates were estimated by age group (<1, 1-4, 5-9, 10-14, 15-19, and 20-24 years) for the United States, Canada, and England/Wales from 1999 to 2015. Studies show that women who report experiences of racism may have as much as a threefold increase in the incidence of adverse birth outcomes, including: low birth weight and very low birth weight babies and preterm birth (9)(10). According to the CDC, per 100,000 live births, there were 14.1 deaths among Asian women, 30.4 deaths among Indigenous women, and 42.4 deaths among black women, in comparison to 13.0 deaths among white women. Dreams have been described as dress rehearsals for real life, opportunities to gratify wishes, and a form of nocturnal therapy. Experiences of racism in health care settings in the present, resonate with past imprints of trauma resulting from reproductive violence experienced by generations of African American women and girls over 246 years of slavery. New York: W.W. Norton). The United States has the highest maternal and infant mortality rates among developed nations. (17) Kramer, M. R., Hogue, C. J., Dunlop, A. L., & Menon, R. (2011). (2015). National  Vital Statistics Reports, 62(8), 1-26. The maternal mortality ratio in developing countries in 2015 is 239 per 10… The maternal mortality rate in the United States is three times higher than that in neighboring Canada and six times higher than in Scandinavia. Overall PRMRs increased from 15.0 to 17.0 pregnancy-related deaths per 100,000 births. Racial discrimination over the life course encompasses the transmission of the intergenerational mass trauma of slavery and Jim Crow policies. As described by Davis, (2018), obstetric racism “includes but is not limited to, critical lapses in diagnosis; being neglectful, dismissive, or disrespectful; causing pain; and engaging in medical abuse through coercion to perform procedures without consent.” Davis elaborates, “obstetric racism is not new, but rather, it is entangled with histories that shadow contemporary expressions of medical racism deployed on Black women’s bodies. (3) Mathews, T. J., & MacDorman, M. F. (2013). Why Do So Many Mothers Still Die in Childbirth? Medical and Obstetric Racism Past and Present. Smith et al., (2018) also found that infant mortality rates for African American women are minimally impacted or not at all, by the protective factors that significantly reduce infant mortality rates in the general population (6). Z., Bentley-Edwards, K. L.. El-Amin, S., & Darity, W. (2018). (10) Dominguez, T. P., Dunkel-Schetter, C., Glynn, L. M., & Sandman, C. A. DOI: 10.1080/01459740.2018.1549389. There is a striking disparity in maternal and infant mortality rates between African American women and non-Hispanic white women in the United States. Data Brief From 14 U.S. Maternal Mortality Review Committees, 2008-2017 Preventing Pregnancy-Related Deaths plus icon Infographic: Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016 Posttraumatic stress disorder and risk of spontaneous preterm birth. New York: Guilford Press. Through the process of neuroception our nervous system rapidly evaluates our internal and external environment for safety, danger or life threat beneath our conscious awareness (11). The way that Black women have been demonized, stereotyped, violated and policed in the past, is consistent with contemporary medical interactions and operate as reminders of the past” (23). State Pregnancy-Related Mortality Ratios (PRMR) were placed equally into three groups (high, medium, low) and the PRMR was further calculated by race/ethnicity for each group. Racial Disparities in Rates of Posttraumatic Stress. 28.3 deaths per 100,000 live births for non-Hispanic American Indian or Alaska Native women. More than skin deep: Stress neurobiology and mental health consequences of racial discrimination. Epigenetics research demonstrates how the activity of genes is altered by interactions between the genes and the environment. The failure to find an explanation for the disparity in maternal and infant mortality rates associated with traditional prenatal risk factors has led researchers to consider the impact of exposures to other factors that occur over the life course. As noted in the report by the Center for American Progress (2019), eliminating disparities in maternal and infant mortality can only be accomplished if African American women and infants are prioritized and inequality and racism within America’s structures and institutions are addressed (1). These findings suggest that the disparity observed in pregnancy-related death for black and AI/AN women is a complex national problem. p. 203, Acknowledging the Role of Racism in Disparities in Maternal and Infant Mortality Rates. (11) Porges, S. W. (2011). Implement standardized protocols in quality improvement initiatives, especially among facilities that serve disproportionately affected communities. If doctors and nurses give dismissive looks or make a woman feel unworthy, that also constitutes a repertoire of racism. Journal of Health Disparities Research and Practice, (11)4, p. 100). Risk factors commonly associated with preterm birth include age, education, alcohol and drug use, smoking cigarettes and stress. Medical Anthropology, p. 11. A recent report with data from 13 state MMRCs determined that each pregnancy-related death was associated with several contributing factors, including access to appropriate and high-quality care, missed or delayed diagnoses, and lack of knowledge among patients and providers around warning signs. Thirteen state maternal mortality review committees reported 60% of pregnancy-related deaths were preventable, and there were no significant differences in preventability by race/ethnicity (1). Relationships among neighborhood environment, racial discrimination, psychological distress, and preterm birth in African American women. By most accounts, however, the United States holds the worst records for maternal and infant mortality in the developed world. Racial discrimination results in high levels of chronic stress exposure across the life course and influences physical health outcomes (19). Why Romance Movies May Be a Social Problem, 6 Simple Steps to a Happy, Thriving Relationship, How a Celebrity Crush Can Impact Your (Real) Relationship. Enslaved Women in America: An Encyclopedia. (2006). A new theory aims to make sense of it all. The rate of reported pregnancy-related maternal deaths has been rising in … Despite California’s success at cutting the state’s overall maternal mortality rate in half between 2005 (from 13.1 per 100,000 to 7.0 in 2013), racial disparities persist. The May report outlines maternal mortality disparities, using data from 2011 to 2015 and select data from 2013 to 2017. In recent years, maternal mortality in the United States, has been rising, with significant variation by race … CDC is headquartered in Atlanta and has experts located throughout the United States and the world. This report shows the critical need to accelerate efforts and to identify the initiatives that will be most effective,” said Wanda Barfield, M.D., M.P.H., F.A.A.P., director of the CDC’s Division of Reproductive Health. The specific mechanisms that connect racial discrimination and preterm birth are being explored. The Link Between Narcissistic Mothers and CPTSD, A New Neurosurgical Procedure May Help Treat PTSD, Psychology Today © 2021 Sussex Publishers, LLC, How Baby Boomers Maintain Their Sex Lives, Working Like a Machine? Racial and ethnic disparities in pregnancy-related deaths have persisted over time. (9) Nuru-Jeter, A., Dominguez, T. P., Hammond, W. P., Leu, J., Skaff, M., Egerter, S., …Braverman, P. (2009). Pregnancy-related deaths per 100,000 live births (the pregnancy-related mortality ratio or PRMR) for black and AI/AN women older than 30 was four to five times as high as it was for white women. For more information about CDC’s work on maternal mortality, please visit www.cdc.gov/reproductivehealth. It may involve stereotyping a patient which can lead to a misdiagnosis, or setting aside a woman’s concerns about the fears she has for her health, her newborn’s health or the treatment of her partner.” (24). More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia. Maternal mortality is a sentinel event that is a crucial indicator of a nation’s health. Whether disease start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. Transgenerational consequences of racial discrimination for African American Health. Reducing disparities will require the participation of multiple systems to address the factors affecting these disparities. According to the CDC, white women accounted for 12.7 deaths per 100,000 live births from 2011 to 2013. “These disparities are devastating for families and communities and we must work to eliminate them,” said Emily Petersen, M.D., medical officer at CDC’s Division of Reproductive Health and lead author of the report. Maternal deaths:What states aren't doing to save new mothers' lives Researchers analyzed 1.8 million hospital birth records in Florida from 1992 to 2015 and identified the race … This investment will provide over $9 million a year to 24 recipients representing 25 states. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41(6), e51-e61. To read the MMWR report, visit www.cdc.gov/mmwr. 99(4), 651-656. When an individual perceives they have experienced a social stressor such as racial and/or gender discrimination, it may trigger metabolic, cardiovascular and immune systems changes and PTSD symptoms (20). These defense system responses may be triggered by moral, social, psychological and physical assaults and injuries suffered over the life course (12), including those experiences that are transmitted intergenerationally and epigenetically (13). CDC twenty four seven. Overall pregnancy related mortality in the United States occurs at an average rate of 17.2 deaths per 100,000 live births. Identify and address implicit bias in healthcare that would likely improve patient-provider interactions, health communication, and health outcomes. (22) Shaw, J. G., Asch, S. M., Kimerling, R., Frayne, S. M., Shaw, K. A., & Phibbs, C. S. (2014). Racial differences in birth outcomes: The role of general, pregnancy and racism stress. (8) New York City Department of Health and Mental Hygiene, Bureau of Maternal, Infant and Reproductive Health, (2016). (5) CDC and National Center for Health Statistics 2017, “User guide to the 2015 Period Linked Birth/Infant Death Public Use File.” Hyattsville, MD: National Center for Health Statistics, 2017. Prenatal Development and Parents’ Lived Experiences: How Early Events Shape Our Psychophysiology and Relationships. (1998). Hemorrhage and hypertensive disorders of pregnancy contributed more to pregnancy-related deaths among AI/AN women than white women. In addition, at every maternal educational level, infants born to African American mothers had a higher risk of dying than those born to white mothers. Disaggregating the data reveals a grim picture of the appalling racial disparities of the maternal mortality rate. But those 18 deaths become 40 … Almost all maternal deaths (99%) occur in developing countries. The Impact of Education Levels on Maternal Morbidity and Mortality Rates Differ By Race. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Washington gave birth to … Gavin et al., explain that “Socioeconomic class and educational attainment do not protect African American mothers from having higher rates of PTB [preterm birth] than do their white peers; a middle-class, college educated African American woman is more likely than a Non-Hispanic white woman with a high school degree to give birth prematurely” (4). Stress, 18(1), 1-10), (21) Goosby, B. J., & Heidbrink, C. (2013). To receive email updates about this page, enter your email address: Centers for Disease Control and Prevention. (14) Roberts, A. L., Gilman, S. E., Breslau, J., Breslau, N., & Koenen, K. C. (2011). Concerns over all aspects of their children's safety before, during and after pregnancy and birth may also contribute to adverse pregnancy outcomes. In the United States specifically, maternal mortality is still a prevalent issue in health care. Risky Maternal Behaviors Do Not Account for Racial Disparities in Infant Mortality Rates. Maybe That’s Why You Ate That KitKat, What Goes on Beneath the Surface When Narcissists Get Angry, The Post Traumatic Stress Response Helps People Avoid Danger, COVID-19: Trauma-Informed Perinatal Care and Maternal Health, “Deaths of Despair” Meets “Black Lives Matter”. “Severe Maternal Morbidity in New York City, 2008-2012” available at https://www1.nyc.gov/assets/doh/downloads/pdf/data/maternal-morbidity-report-08-12.pdf. Smith et al., (2018) also found that infant mortality rates for … A., & Jain, S. (2013). (13) Weinstein, A. D. (2016). “There is an urgent need to identify and evaluate the complex factors contributing to these disparities and to design interventions that will reduce preventable pregnancy-related deaths.”. (6) Smith, I. )., Handbook of PTSD: Science and Practice. Disparities persist in infant mortality rates by race/ethnicity. 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