Racial Disparities in Healthcare Have Led to High Maternal Mortality Rates — What One Doctor Is Doing About It
"Pregnancy has moved from being a joyful event to something that many Black women now fear," says Dr. Mary-Ann Etiebet
The likelihood that a woman can die during childbirth is still alarmingly high in the United States.
The maternity mortality rate in the U.S. is the highest among developed countries, and Black women are 2.5 times more likely to die from complications of pregnancy or childbirth than white women, according to the Centers for Disease Control and Prevention (CDC). Despite research that's found that 60 percent of all maternal deaths are preventable, a total of 658 women died of maternal causes in 2018.
Merck for Mothers — a global initiative that uses a holistic approach to help promote birth equity and to reduce disparities in maternal health — has supported the CDC to make sure every death is not just counted, but also investigated. In doing so, the organization has discovered that solving maternal mortality is within our grasp because now we have a full understanding of the racial disparities that exist in maternal health.
"One of the themes that came up during the second cohort of our Safer Childbirth Cities initiative was the fear that exists amongst Black women and their families," Lead and Executive Director of Merck for Mothers Mary-Ann Etiebet tells PEOPLE.
"Pregnancy has moved from being a joyful event to something that many Black women now fear," she continues. "Their experiences with our health system during and after pregnancy is many times not just devaluing for them as human beings, but it can be traumatic and result in death."
More women are sharing their stories of loss and trauma, which is something Dr. Etiebet is all too familiar with, as well. One of her husband's family members died after giving birth, leaving behind a daughter. Her husband, to this day, continues to ask what more his family could have done — and why things aren't changing.
Below, Dr. Etiebet shares how addressing maternal health equity through a holistic lens, coupled with hard data, can explain why the maternity mortality rate is still rising, particularly for Black, American Indian and Alaska Native women in the U.S., and how Merck for Mothers is helping the country get to a place where a mother no longer has to die while bringing forward life.
PEOPLE: How is Merck for Mothers creating opportunities for new conversations to take place during pregnancy and childbirth?
DR. ETIEBET: A lot of what we focus on is creating a dynamic where women will have more information to feel empowered throughout their pregnancy journeys. We're trying to shift the conversation so the responsibility is placed not on the woman, but on her care team.
We've had women in focus groups from New York City and Atlanta tell us that providers are not listening to them. They're not listening to their symptoms or respecting their experience, especially complaints around pain. Giving birth can be a very fast-moving situation and when a woman is expressing pain and they're not being listened to, that window to intervene can be lost and result in death. That's unfortunately one of the ways we are hearing systemic racism influence the inequities that we see in maternal health.
PEOPLE: Do you think enough is being done, even at the medical school level, to discuss how systemic racism often plays a role in our healthcare system?
DR. ETIEBET: The responses and solutions to systemic racism have to be comprehensive and will have to happen over periods of time. They cannot be instituted at just the health care visit. They have to be incorporated early, into med school, residency training and beyond. We also need to look at how racism affects institutional aspects of giving birth.
When you don't have communities or women of color reflected in the committees that are reviewing maternal deaths, you are not able to surface their unique experiences or recognize preventable interventions to avert the next death because there's no understanding of that experience or what is happening in that community. A simple institutional response that allows more inclusion of Black women and women of color can help with dismantling the effects of systemic racism.
PEOPLE: With there being more data being shared and discussions being had about maternal equity and childbirth safety, why are we seeing the mortality rate in cities like New York continue to rise? What is getting in the way of progress?
DR. ETIEBET: There are a number of reasons why things are getting worse, one being that there are higher levels of pre-existing chronic conditions that disproportionately impact communities of color. We also see barriers of access to high-quality care and the variability we see in quality of care. Often under-resourced hospitals are the only hospitals available to many of these communities. The perfect storm of these conditions have a mutual multiplier effect on each other, so to really address maternal mortality and the inequities we see, we need a comprehensive, concerted effort to tackle all of these dimensions. If we only deal with one dimension, it's not going to be enough.
PEOPLE: How have hospitals responded to the issue of maternal mortality?
DR. ETIEBET: With Merck for Mothers, we're privileged that we can step in and help fill the void for hospitals in need. We've learned in the first 10 years of the initiative that it often takes a kind of catalytic partner to bring people together to create the conditions where you can build trust and build a plan to support a shared vision.
One of the things we've done early on to support is what we call safety bundles, which are quality of care standards for labor and deliveries in hospitals. As part of that process, we brought together doctors and nurses and had to build trust between those two groups because they needed to work together as a cohesive team to improve the quality of care in childbirth emergencies.
Through our Safer Childbirth Cities initiative, we're helping to create a connection between care and support in the community and care and support in the traditional hospital system because many deaths can occur outside of the hospital. Signs and symptoms may first be noticed at home or in the community. It all takes time because you have to build trust.
We need to get to a place where it's not about assigning blame because if that is the focus, we're not going to get anywhere. We need to build trust so folks can feel comfortable sharing their experiences, including their negative ones. We want the response to be, 'How can we, as a team, make sure this doesn't happen again?'
PEOPLE: If you were to help guide a first-time mom with her birth plan, what type of advice would you give, especially for women of color and Black women in the U.S.?
DR. ETIEBET: Find your community and your support network. Don't be shy or afraid to ask all of the questions you have to get the help that you need. There are many resources you can use, including:
It's about both empowering yourself with information and having that community of support.
PEOPLE: What are some actionable things women can do if they find themselves not being taken seriously or if they feel like their needs are not being met during doctor's visits?
DR. ETIEBET: The Hear Her campaign resource site is a great resource because there are step-by-step guides around how to talk to your providers, what questions to ask, what to do if you're not being heard, which organizations you can reach out to support you. In addition to other advocacy groups out there who can help, through our Safer Childbirth Cities initiatives, you can have a doula or other peer support companion with you.
PEOPLE: How can people get involved with Merck for Mothers?
DR. ETIEBET: You can go to our website and sign up for our newsletter. Then, you can connect with our collaborators and grantees because they're the ones who are doing the work on the ground, in these communities.