Black mothers die of issues related to pregnancy or birth at more than three and a half times the rate of white women in New Jersey. The reasons go beyond the usual barriers to healthcare, insurance, or economic support, and also involve the physical stress of experiencing racism on a daily basis.
That was the message highlighted by a coalition of advocacy organizations, led by the national Black Mamas Matter Alliance, which joined forces to celebrate the first-ever Black Maternal Health Week, which ended last week. The event was designed to coincide with National Minority Health Month, recognized each year in April.
And while the racial gap in maternal care has become a growing priority for healthcare leaders in the Garden State, New Jersey needs to do more to protect women and children and reduce the “staggering disparities” that still exist, according to state officials who joined local advocates to mark what they hope will become an annual event.
Jackie Cornell, a deputy commissioner with the state Department of Health, said the administration of Gov. Phil Murphy, a Democrat who took office in January, has already taken a number of steps to address this gap. Murphy has expanded funding for women’s healthcare, supported food and nutrition programs for pregnant women and infants, and focused on efforts that help at-risk women have safe pregnancies and healthy babies.
“In addition to the current work going on, we recognize that we need to re-examine our approaches because progress on reducing disparities has stalled in New Jersey,” Cornell said at a Black Maternal Health Week community discussion in East Orange, also attended by first lady Tammy Murphy. Cornell called the current racial disparities in maternal and infant “unacceptable.”
Nationwide, 42.8 black women die for every 100,000 successful births, compared with a rate of 12.5 for white woman and 17.3 for women of all other races, according to federal data. In New Jersey, the figures are slightly higher: 46.5 for black women and 12.8 for white women. (The disparity is also passed on to babies: The infant mortality rate is 9.7 deaths per 1,000 live births for black babies and 3.0 for white newborns, state data from 2015 shows.)
New Jersey has made progress in reducing infant morality, which has declined since 2000 and remains below the national average, but maternal deaths may be on the rise. And as healthcare experts examined this trend, the racial disparity became more apparent. The issue was the focus of a summit at Rutgers University last June, a legislative hearing led by Senate health committee chairman Joseph Vitale in February, and an emergency meeting U.S. Rep. Bonnie Watson Coleman hosted later that month.
Murphy’s cabinet has also highlighted concerns about the racial disparity. Dr. Shereef Elnahal, the DOH commissioner, and Carole Johnson, commissioner of the Department of Human Services, have pledged to improve data collection and modernize government systems to provide more efficient, better quality of care that results in fewer racial disparities in general. They also promised to better coordinate government services to help address housing, transportation, nutrition, and other social factors that have a tremendous impact on the health of vulnerable residents.
The Black Maternal Health Week — which involved live events, social media, webinars, and other advocacy — was designed to ratchet up awareness among the general public and create wider engagement, explained Monifa Bandele, vice president of maternal justice programs at MomsRising, a national advocacy organization that supported the Black Mamas and other black-led organizations on the campaign.
“We wanted to uplift these disparities,” Bandele said, “and underline racism as a key factor as to why these black women are dying at such higher rates.” By “consolidating and amplifying” the voices of black women, the alliance hoped to “really put this issue on the national radar,” she said.
Bandale said a growing number of studies — many based on the pioneering work of Arline Geronimus, a public health researcher at the University of Michigan who has dedicated her life to the issue — have shown that the cumulative impact of racism experienced by black women results in a build-up of toxic stress that contributes to higher maternal and infant death rates.
“The weathering of black women’s bodies happens because of the impact of racism even before you get pregnant,” Bandale explained.
Research has shown that the disparity is not related to economics or healthcare access — issues that often impact black communities more negatively than white neighborhoods, Bandale pointed out. Even wealthy, well-educated black women with quality healthcare experience poorer outcomes than white women, regardless of their economic or social status.
Serena Williams is the perfect example, Bandale noted. Despite her wealth, health, and celebrity, the tennis star nearly died of complications after giving birth earlier this year, in part because healthcare providers seemed slow to respond to her concerns about breathing difficulty.
“That story went viral because it resonates with so many black women, the invisibility we feel in the office of so many health providers,” she said. “And not everyone is able to advocate like that.”
Improving the status quo requires greater awareness, the advocates note, but also changes in healthcare policy. Bandale said this starts with better data; too often, maternal mortality is classified as an unrelated death (technically the term covers any death related to pregnancy or childbirth, up until 42 days after delivery). For example, if a woman’s death is categorized as heart attack or stroke — without noting that the victim was pregnant — it might not be flagged as maternal mortality. The potential undercounting makes it hard for policymakers to effectively address the problem.
This issue has also been a priority for Vitale and his colleagues who sponsored legislation — now awaiting the governor’s signature — to improve operations within New Jersey’s medical examiner system, including standardizing how deaths are classified and recorded. Murphy has also committed millions of dollars to upgrade data collection efforts in several departments.
Standard protocols are critical
Standard hospital protocols for dealing with maternal health crises are also critical, Bandale said. The American College of Obstetricians and Gynecologists launched a best-practices program in 2013 that has been used by hospitals nationwide to reduce the number of fatalities; in New Jersey, the DOH rolled out the “Improving Pregnancy Outcomes Initiative” the same year, enabling the state to work with local providers — now in all 21 counties — who can connect women with high-risk pregnancies to appropriate care.
Much of this critical work is happening at the community level, led by groups like the Essex County Birth & Breastfeeding Coalition, which partnered with the East Orange Family Success Center to host the community discussion last week. The event honored the work of doulas, trained birth coaches who can help improve pregnancy outcomes, deployed through a program run by the SPAN Parent Advocacy Network, which works to strengthen families statewide.
Addressing the larger issue of systemic racism is clearly another challenge, Bandale said, and black women must lead this change or the disparity will likely remain. But, while far from simple, any improvements will benefit women and babies of all races, she said.
After all, any weakness in the healthcare system is likely to impact others as well. “After all, black women are like the canary in the coalmine,” Bandale commented.