The statistics around Black maternal health in the United States remain unsettling. In the U.S., Black women are three to four times more likely to die from pregnancy-related causes than white women. Black women are also two times more likely to experience severe maternal morbidity and 1.5 times more likely to have a preterm delivery, compared to their white counterparts. There are various factors that contribute to these disparities, such as systemic racism, implicit bias, lack of access to quality care, social and environmental factors, underlying chronic conditions and more.
Due to these factors, many Black women tend to experience symptoms during their pregnancy that result in delayed treatment or have dismissed concerns that should have been paid attention to. With most maternal deaths being preventable, it’s crucial that Black women feel safe, respected and heard during their pregnancy.
Addressing the Root Cause of Black Maternal Health Disparities
Fixing the health care system is just one element in the piece to improve Black women’s maternal health outcomes. Mary E. Fleming, MD, MPH, Director of Leadership Development to Advance Equity in Health Care at Harvard T.H. Chan School of Public Health Executive and Continuing Professional Education, said it’s a multi-prong approach that is mainly rooted in society.
“It’s a systemic issue that is not just based on the health care system. It’s based in society. When we think about community-oriented solutions, or any solutions, there has to be people that want to think about the downstream solutions,” Fleming said. “There needs to be training for people who offer direct services—the physicians, nurses, [and] clinicians; when they get training to be culturally competent, sensitive or empathetic, there needs to be a piece about systemic factors.”
Fleming explained that since Black women know they are not seen, listened to or valued in the health care setting, many of them choose to opt out from seeing a provider, or engage with them in a way that could be beneficial.
“The social economic factors that usually protect women across the board—such as a higher income, more education, [and] living in an affluent neighborhood—usually [means they] get better care. That doesn’t translate for Black women in maternal health. It doesn’t matter what they have, their outcomes are still horrendous compared to other women.”
Fixing a Flawed Payment Model in Health Care
The social determinants of health play a large role in the quality and quantity of one’s life. Fleming shared that there are various factors at play when thinking about maternal health and how it’s approached in the U.S.. Systemic solutions don’t only require looking at policies and practices, but taking a deeper look into a fragmented value-based care model in the context of equitable solutions. Matching reimbursement to quality care is a first step, but those types of solutions can only be implemented if federal and state funding were to cover it.
“What are the policies that are in place that affect reimbursement that are going to affect health care outcomes?” Fleming said. “How do we influence policies that are going to affect educational policies? Transportation policies? Housing policies? Access to food policies?”
The medical field is a profession that can be rewarding, but one that often comes at a high cost. Individuals who go through medical school and the training to be a physician typically incur debt of $200,000 or more, and the numbers often look worse for underrepresented populations that want to serve in their communities.
Systemic solutions don’t only require looking at policies and practices, but taking a deeper look into a fragmented value-based care model in the context of equitable solutions.
“If you’re starting your career with that much in debt, and then add in the reimbursement structure of the health care system that is extremely inequitable, you’re already at a disadvantage,” said Fleming.
“In the context of maternal health, for the most part it’s funded by Medicaid and Medicaid, which pays poorly. So when people are starting their career and figuring out what kind of practice they want to enter and how to pay their loans back, if they have to decide between health care reimbursement or their family, they will likely choose their family. And they aren’t necessarily wrong for that. We need to fix the reimbursement process.”
Best Practices Moving Forward
To move the needle and improve the health outcomes for pregnant Black women, there are a few takeaways to consider:
- Diversifying the workforce. Having a workforce that reflects the patient population can go a long way. When a workforce is diverse, everyone can learn from each other, and it will inherently make them better in the practice.
- Training staff to be culturally competent and empathetic. There is often the notion that populations that face disparate health outcomes—oftentimes, people of color—that there is something inherently wrong with them. Training physicians and staff to understand that these outcomes are based on systemic factors and influences, rather than inherent or genetic influences, will help to eliminate biases and racist beliefs.
- Holding accountability among clinicians and leadership. Health care organizations need to ensure that accountability and transparency are key principles when serving its patients. High quality should be the standard of care, and staff should be held accountable when mistrust or bad outcomes arise that could have been prevented.
Harvard T.H. Chan School of Public Health offers Leadership Development to Advance Equity in Health Care, a healthcare leadership program that is designed to pioneer innovation in policies, practices, and programs that advance health equity.