WASHINGTON — Black mothers are dying in childbirth at alarming rates in the United States, and a North Carolina congresswoman wants the federal government to do more about it.
Rep. Alma Adams (D) is gathering allies and pushing legislation to respond to what she describes as a “crisis situation” of maternal death in the United States, which disproportionately impacts Black women.
“This is a public health crisis, with more moms likely to die in childbirth than in any other developed country,” Adams said in an interview with Policy Watch. “This is the United States of America, we are supposed to be further along.”
The United States ranks the worst among 39 industrialized nations for maternal mortality, according to the World Health Organization. The statistics are grim for Black women in the United States, who are three to four times more likely than white women to die from pregnancy or childbirth related complications.
Adams introduced legislation this month that seeks to reduce racial disparities in maternal health care, drawing on models from programs in North Carolina — which is notable as a state that has seen some improvements in Black maternal health and fewer deaths than the national average. It is part of her larger push to bring the issue to the forefront in Congress this year. She also recently launched the Black Maternal Health Caucus to raise visibility of the issue.
Nationwide, about 700 mothers die from pregnancy-related causes in the United States each year, and three out of five of those deaths were preventable, according to a recent report from the Centers for Disease Control. Additionally, more than 50,000 other women experience dangerous, life-threatening complications associated with pregnancy and childbirth.
“When it comes to maternal health, the United States today is the most dangerous place in the developed world for a woman to give birth to a child,” said Dr. Rahul Gupta, senior vice president and chief medical and health officer for the March of Dimes.
The maternal death rate has doubled in the last 25 years and is continuing to rise, making the United States the only industrialized nation with a rising maternal mortality rate, according to Gupta.
“What makes it even worse than the number and makes it about the character of our nation, is that despite these bad numbers, Black women are more likely to die during childbirth compared to other ethnicities,” Gupta said. “We believe there are chronic inequities and unequal access to health care that end up having negative impact to women’s health.”
Closing the gap in North Carolina
Health experts have been able to track the problem of Black maternal mortality, but the causes are more complicated. Nationwide, the pregnancy-related mortality rate is 12 deaths per 100,000 live births for white women and 40 deaths per 100,00 births for Black women.
When researchers break down those numbers for socioeconomic status or education, there is still a gap between white and Black women, and doctors have not found seen evidence that genetic predispositions are the issue.
This leads many experts to believe the causes are more complicated and include racial bias in the health system and access to appropriate care.
“The reality is that what we are really left with are the issues of social determination and racism,” said Kathryn Menard, a professor and director of the division of maternal fetal medicine at the University of North Carolina’s School of Medicine.
North Carolina is one of only a few states that has seen a decline in mortality rates for Black women, and a rare southern state with rates close to or below the national average.
In the early 2000s, upwards of 40-60 Black women died each year in North Carolina as a result of pregnancy-related complications, per 100,000 live births. Since 2010, the rate has been fewer than 30 deaths per year for every 100,000 births.
At the same time, the mortality rates for white women in North Carolina saw an uptick, from a low of 12 deaths per year to a high of 22 per 100,000 live births. Health experts say they are still trying to understand what might be behind those numbers, but that given the relatively small numbers of deaths, rates can fluctuate a fair amount from year to year.
“We do not have a good explanation, but there is an undeniable decrease in Black maternal mortality and a modest increase for white women. We want them both to go down,” said Menard.
The bill from Adams would establish a nationwide grant program for bias training in medical schools and support demonstration projects in 10 states based on a North Carolina program that many see as a success: the pregnancy medical home. The program, run through North Carolina’s Medicaid, connects high-risk, low-income women, regardless of race, with care managers that can help the mother get the support she may need from various medical specialties and social-services.
Adams introduced similar legislation last year that saw no movement.
Help from Beyoncé, Serena Williams
The issue of Black maternal mortality is gaining more traction with mounting data from national and international health groups, as well as more visibility in popular culture.
Notably, singer Beyoncé and professional tennis player Serena Williams have both spoken out in the past year after serious health scares associated with the births of their own children — a move that helped bring the issue to national attention, Adams said.
“Now we have the attention we need to move ahead,” said Adams, who is in her third term representing the 12th congressional district around Charlotte.
Her caucus has 60 members so far, including co-chair Lauren Underwood (D-Ill.). It also has backing from heavyweights like House Majority Leader Steny Hoyer (D-Md.), who stood in support at the opening press conference.
The House Ways and Means Committee held a hearing earlier this month on racial disparities in maternal mortality, and some of the Democratic presidential hopefuls have spoken out about the issue. Presidential hopeful Sen. Kamala Harris (D-Calif.) introduced companion legislation to Adams’s bill on the Senate side. Lawmakers also approved targeted legislation last year to aid state committees that review each instance of maternal death.
For Adams, the issue is also personal. The congresswoman, who turned 73 on Monday, has two children and four grandchildren. But her daughter almost died in childbirth, Adams says, despite good health insurance and medical care.
“It does not matter what your socio-economic background is, we find this is a problem,” Adams said.
Allison Winter is a reporter for the States Newsroom Network of which NC Policy Watch is a member.