Systemic Racism in Women's Health is a Heavy Reality.

Systemic Racism in Women's Health is an unfortunate reality we can't ignore. In the United States, it persists in shocking ways, particularly impacting maternal health. Let's delve into the unsettling details, with data for this post from 2022.  I sadly believe it will get worse, before it gets better, which is why I am dating this post.  Please prove me wrong...

Key Takeaway: In 2022, in the United States, Women of Color have a 3-6x Higher Mortality Rates for Pregnancy and Postpartum than White Women

It's true, you can look it up. Black women of color (WOC), and all People of Color (POC), face a three to six fold higher risk of mortality during pregnancy, delivery, and the 12-month postpartum period than white counterparts. This stark statistic is independent of socioeconomic status, and demands our attention and action.

Lowlights of Systemic Racism in Women’s Health

Not highlights.  Lowlights.  Because this is atrocious for a ‘first world’ country to have such dismal maternal health statistics.

1. Location Matters:

• Black women are 2-6% more likely to die from pregnancy-related conditions based on their geographical location.
• Visit the CDCs, maternal mortality rates per state. Check how your state fares and advocate for change...or seriously consider relocating to a more favorable state for your third and fourth trimesters. Seriously.

CDC Maternal Mortality Rate Tracker 2018-2021

2. Recent Data:

• As recently as January 2021, a study by Crandall K. confirms the persistent racial disparities in pregnancy-related deaths among non-Hispanic Black women, which shows that the historical trend is not improving with time.

The Crandall Study

• Furthermore, Crandall found that for every maternal death that occurs in the United States, there are greater than 100 cases of severe maternal morbidity, and Black women experience these morbid outcomes at a rate that is twice that of their white counterparts
   

3. Additional Information:

• For a broader understanding, refer to Flanders-Stepans' summary of Disparities in Maternal Mortality, which sheds light on various problem areas related to maternal mortality, as well as some concrete suggestions for next action steps.

The Flanders Summary

Unraveling the Why of Systemic Racism in Women’s Health: Implicit Bias in Healthcare

Understanding the root causes is essential. Studies indicate that many healthcare providers hold misconceptions about biological differences between races, contributing to biased healthcare practices.

1. Pain Bias

Hoffman, et al, found that medical providers wrongly believe that people of color have "thicker skin" and required less pain medicine than white people.

Hoffman's research reveals racial bias in pain assessment and treatment recommendations, highlighting false beliefs about biological differences between blacks and whites...in 2016.

It's (terrible), but true. You can read about it here: The Hoffman Study

This study showed, amongst other things, that medical providers erronesouly believed that black people had thicker skin, blood that coagulated faster, nerves that were less sensitive (therefore needing less pain medicine), more efficient hearing and smell systems, and faster reflexes than whites. 

This. is. Not. good.  This means that these physicians believed that blacks and whites were biologically different AND that it lead to diagnosis problems, and utlimately negatively affected the care that this person received.  Just because they were black.

Gross. So the takeaway, is that if you, or someone you love, has beautiful black or brown skin, you need to be VERY protective of your health care, and make SURE that you are being listened to.

2. Implicit Bias

 Hall et al's 2015 study concludes that most healthcare providers harbor implicit bias, with positive attitudes toward Whites and negative attitudes toward people of color.

It's (also) terrible, but true.  Here's Hall's Study.

Double Gross.  So this study takes Hoffman’s one further, and instead of “some doctors have this implicit bias….most have implicit bias.” 

Taking Action: Suggestions for Change to Address Systemic Racism in Women’s Health

Elizabeth Howell's insights provide valuable suggestions for addressing these disparities in maternal health. Let's explore some starter ideas.

• Raise Awareness: Start by reading and becoming more aware of the issue. Knowledge is the first step toward change.
• Communicate with Doctors: Inform your healthcare providers about the issue. Many may not even be aware of their biases. Advocate for unbiased care.
• Dr. Kelly's Bonus Advice: If you, or someone you love, is a person of color, ensure that at least ONE person on their medical team is of color AND be extra vigilant with blood pressure checks throughout third and fourth trimesters.
• Spread the Word: Share information on social media and with friends. By raising awareness, you contribute to the collective effort to address systemic racism in women's health.

Here's Elizabeth Howell's Original 2018 article

Looking Ahead: The Future of Women’s Health

This post delves into the research surrounding the history and present status of systemic racism in health care, specifically how it affects maternal health. It is my hope that this post sets the stage for future discussions. Stay tuned for concrete examples of challenges faced by black women during pregnancy and postpartum, along with actionable steps for advocates.

Join the Conversation

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Thanks for being part of this important conversation!

xoxo, Dr. Kelly

It's true. You can look it up. (References)

CDC 2018-2021 Maternal Mortality Rate Tracker HERE

Crandall K. Pregnancy-related death disparities in non-Hispanic Black women. Women’s Health. January 2021. doi:10.1177/17455065211019888 HERE

Elizabeth Howell's article has some meaty morsels and suggestions for what to do about this. HERE.

Flanders-Stepans MB. Alarming racial differences in maternal mortality. J Perinat Educ. 2000 Spring;9(2):50-1. doi: 10.1624/105812400X87653. PMID: 17273206; PMCID: PMC1595019. Link here

Hall WJ, Chapman MV, Lee KM, et al. Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. Am J Public Health. 2015;105(12):e60-e76. doi:10.2105/AJPH.2015.302903 link here

Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016;113(16):4296-4301. doi:10.1073/pnas.1516047113 link here

Howell EA. Reducing Disparities in Severe Maternal Morbidity and Mortality. Clin Obstet Gynecol. 2018 Jun;61(2):387-399. doi: 10.1097/GRF.0000000000000349. PMID: 29346121; PMCID: PMC5915910. Link here