The Role of Systemic Racism and Injustices in Black Maternal Health

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Prematurity Prevention InitiativePrematurity Prevention Initiative Collaborative effort that focuses on reducing the number of babies born too soon in New Jersey Published Feb 25, 2022 + Follow

The Role of Systemic Racism and Injustices in Black Maternal Health Christine Ivery, MPH, CHES Project Director Prematurity Prevention Initiative Family Health Initiatives For centuries, Black birthing people in the United States and their families have endured immeasurable discrimination, racism, and mistreatment. Consequently, such injustices reflect on modern-day birth outcomes. The Maternal Experience Survey (MES) is New Jersey’s first data-gathering tool designed to improve the way birthing people receive care and address biases among care providers. The survey, developed by the NAACP Atlantic City Black Infant and Maternal Mortality (BIMM) Task Force and Family Health Initiative’s Prematurity Prevention Initiative, amplifies birthing people’s voices, which have been unheard or silenced. The survey also empowers sustainable change. In observance of Black History Month, this paper reviews injustices and disparities faced by Black birthing people and their families. It also highlights strategies that advance maternal health and prevent prematurity through awareness. Black Maternal Child Health The United States is one of the wealthiest developed nations in the world. Yet, it has the highest rates of maternal mortality in comparison to other developed countries. According to the Center for Disease Control, about 700 women in the U.S. die from pregnancy-related complications every year. Sixty percent of those deaths are preventable. Black birthing people are disproportionately affected by maternal health issues. Black birthing people in the United States are two to three times more likely to die from pregnancy-related complications compared to their white counterparts (Source: CDC 2019). Racial disparities relating to pregnancy-related deaths in the U.S. have remained unchanged for more than six decades. Behind these statistics are names of real people we have lost. Kira Johnson of California and Shalon Irving of Georgia are two women who died after giving birth. Tragically, they represent only a small percentage of Black birthing people whose devastating stories of racial injustice and neglect led to adverse birthing outcomes. Pregnancy-related deaths in New Jersey illustrate similar disparities when examined through the lens of Black birthing people. Black birthing people in New Jersey are seven times more likely to die from pregnancy-related complications compared to their white counterparts. This heightened risk of pregnancy-related death among Black birthing people spans income, economic status, and education levels (Source: National Partnership). Infant mortality in the United States was responsible for 21,000 infant deaths in 2018 (Source: CDC 2021). In New Jersey, infants who are born preterm are at greater risk of death. Babies born early in the state are seven times more likely to die within their first year of life. Black babies are twice as likely to be born prematurely compared to their white counterparts. Leading causes of infant mortality include:

1. Low birthweight/preterm birth

2. Congenital abnormalities

3. Sudden Infant Death Syndrome (SIDS)

4. Maternal pregnancy complications

5. Placenta complications

6. Respiratory distress

7. Bacterial sepsis

Maternal and infant morbidity and mortality are attributed to various health and environmental conditions and comorbidities. In an effort to have a comprehensive and accurate understanding of these factors and mechanisms to address these issues, the impact of systemic racism must be addressed. Far too often, Black birthing people are silenced, unheard and disrespected in health care settings which, in turn, leads to preventablecomplications and deaths. Racial Disparities in Black Maternal Child Health Dr. Carmara Phyllis Jones, professor, anti-racism activist, and former executive director of the American Public Health Association, defines racism as: “…a system [that assigns] value based on how one looks, [and] unfairly disadvantages some individuals and communities... and saps the strength of the whole society.” Systemic racism has a pervasive impact on Black birthing people and families. Throughout history, Black people have and continue to face inequalities in healthcare. In 1830, Dr. Francois Marie Prevost inhumanely performed 30 experimental cesarean sections on enslaved women. Coined the “Father of Modern Gynecology,” James Marion Sims performed experimental surgeries on numerous enslaved women in the 19th century without pain medication (Source: Holland 2016). Stigmas and myths perpetuated during periods of enslavement not only persist in the 21st century, but are commonplace in modern-day healthcare practices. In a 2016 study, 50 percent of white medical trainees believed one or more of the following:

1. Black people have thicker skin

2. Black people are less sensitive

3. Black people’s blood clots faster compared to white counterparts (Source: Sabin 2020).

There are numerous, adverse implications when a birthing individual’s voice is disregarded in healthcare. Black women who face racism and related disadvantages over the course of their lives are at increased risk of “weathering” (Source: National Partnership). The term “weathering” refers to the impact of chronic stress leading to premature birth and comorbidities like hypertension, heart disease, diabetes, and many cancers. Fact: health and racial disparities adversely impact Black families through systems of oppression, discrimination and exclusion (Source: Healthy People). To achieve equity in pregnancy and birth spaces, there must be an acknowledgment of barriers to care and health disparities facing Black birthing individuals, considering social health determinants like where people live, work, pray and play. There also needs to be a concerted effort to remove obstacles to care and create opportunities to meet birthing people where there are. How to Address Challenges Whether you are a parent, community member, birth worker, or healthcare provider, everyone has a role in advancing Black Maternal Child Health. Guidance for Birthing People:

• Seek Out a Doula or/and Support Person: A doula or support person will help you throughout your pregnancy and the birth of your baby. Find a support person/ team that will ensure your wishes are respected.

• Share Your Voice: Parents have the right to be heard during pregnancy, birth, and beyond. Ask your provider questions and outline important aspects of birth preferences in a birth plan. For more information on an empowered birth, visit NJpreterm.org.

• Boost Your Health: It is important to build a healthy lifestyle for you and your family. Boost your health by:

Limit Stress: Reduce stress with activities like meditation and yoga; seek help from a healthcare provider and/or mental health specialist if needed. Include Nutritious Foods in Your Family’s Diet: According to MyPlate.gov, a balanced diet of fruits, vegetables, grains, proteins, and dairy helps boost overall health. Dark, leafy greens like kale and spinach are rich with vitamins A and C and folic acid (Folic Acid helps prevent certain birth defects during pregnancy). Stay Active: Regular exercise can help reduce chronic diseases like high blood pressure and diabetes. (Check with your healthcare provider before starting any new physical activity or exercise routine). · Know the Resources Where You Live: These are the trusted and respected maternal health consortia for birthing people across New Jersey: - Northern New Jersey: The Partnership for Maternal and Child Health of Northern NJ- PMCH.org - Central New Jersey: Central Jersey Family Health Consortium - CJFHC.org - Southern New Jersey: The Cooperative - SNJPC.org For additional resources in your area call NJ 2-1-1 or visit nj211.org.

• Early Prenatal Care: Receiving early and consistent prenatal care can help reduce the risk of preterm birth and other adverse outcomes.

Guidance for Providers:

• Check Biases: As providers and professionals in the field, it is incumbent upon us to identify and be accountable for attitudes, biases, and stereotypes that do not serve patients. Learn more and take the implicit bias test today https://implicit.havard.edu/implicit/takeatest.html.

• Collaborate: Work with organizations like Black Mamas Matter Alliance, Melanin and Motherhood, Perinatal Equity Foundation and Melinated Moms to address concerns among communities impacted by maternal and child health disparities.

• Provide Prevention and Intervention Treatment Options: Providing treatment options for patients can foster respectful birth collaboration and be vital to your patient's health. One intervention to share with birthing people at risk of preterm birth is 17 hydroxyprogesterone alpha. Studies have shown some decreased risk of preterm birth in women who have had a previous early birth when given 17P progesterone weekly injections starting at 16 weeks.

The Prematurity Prevention Initiative offers funding for birthing people in need of 17P and nurse assistance. To find out more visit: www.njpreterm.org/providers

• Educate parents and colleagues: Share maternal child health messaging through social media, toolkits, podcasts, videos, and related readings. The Prematurity Prevention Initiative offers two toolkits to advance these messages. To find out more visit: https://www.njpreterm.org/socialkits

• Advocate and evaluate policies: Ask yourself, “are we doing enough?” Introduce resources that involve maternal and child health (e.g: Doulas, mental health services, lactation resources).

Maternal Experience Survey Stories from New Jersey birthing people Danica and Naome The Maternal Experience Survey (MES) is New Jersey’s first community tool designed to improve care and reduce childbirth-related disparities for Black birthing people. With support from the NAACP Atlantic City Black Infant and Maternal Mortality Task Force and the Prematurity Prevention Initiative, this tool enables birthing people to share their unique experiences in a safe manner that offers assurances of acceptance and respect to participants. The Maternal Experience Survey is available in English and Spanish for all New Jersey parents. The survey features three unique breakouts: 1. Currently Pregnant 2. Recently Delivered 3. Full MES (birthing people share their entire pregnancy and birthing journey) To prevent future disparities in care and reduce the incidence of maternal and infant mortality, it is essential for parents to share their experiences and perspectives. The Maternal Experience Survey magnifies the voices of birthing people and implements strategies to improve crises around Black maternal and child health in the state. To access the Maternal Experience Survey visit https://www.njpreterm.org/mes. The Prematurity Prevention Initiative is a program of Family Health Initiatives (FHI) supported by funding from the NJ Department of Health. FHI is a subsidiary agency of the Southern New Jersey Perinatal Cooperative 2022.