Maternal Mortality Rate By Race and Ethnicity
What is the meaning of maternal health? How does that meaning change when factoring in race and ethnicity? Of course, the answer should be that it doesn’t. In a perfect world, all pregnant people would receive the most comprehensive and effective medical care available. Unfortunately, this is not our reality.
Currently, the quality of treatment and care someone experiences during their pregnancy differs depending on their race and ethnicity. Abhorrent disparities in the caliber of treatment provided to marginalized individuals, although shocking to most, are far too common in Indiana maternal health and throughout the United States.
As it stands, Alaskan Native, American Indian, and Black persons are two to three times more likely to die from pregnancy-related complications compared to white individuals.
But why is this the case? What can be done to remedy this dire issue and provide high-quality, standardized medical care to pregnant people? In this article, we will answer these questions and more to equip you with the insight you need to make positive changes in your community.
Why Is the U.S Maternal Mortality Rate So High, Especially for Minorities?
It’s a well-known fact that the U.S ranks amongst the countries with the highest maternal mortality rate. A study conducted by The Commonwealth Fund reviewed the U.S maternal mortality rate compared to other developed countries and found that in 2020, the U.S experienced 24 maternal deaths for every 100,000 live births. That is more than three times the rate of the 10 other high-income countries The Commonwealth Fund studied.
Source: The Commonwealth Fund, 2020
According to the most recent CDC maternal mortality report, 700 U.S people die each year due to pregnancy or delivery-related complications. On the state level, Indiana has a maternal mortality rate of 52 deaths per 100,000 births.
To grasp the full picture of why this is the case, we need to look into the childbirth mortality rate history of the United States. Although there was a significant decline in infant and maternal mortality during the 20th century across all U.S populations, the mortality rates of minority populations remain disproportionate. For example, the gap in maternal mortality between Black and white pregnant individuals has increased since the early 1900s even though the collective maternal mortality rate decreased. It is worth noting that the data used to monitor and review maternal mortality (especially in Indiana) is often outdated and flawed, making it even more difficult to effect positive change within the healthcare system.
There are a multitude of factors influencing high maternal mortality rates, including:
Maternity or Obstetric Care Deserts: Maternity care deserts are U.S counties where access to maternal health care services is deficient or completely absent. This applies to either a short supply of maternal health services or additional barriers that prevent people from accessing proper care, including poverty or lack of legislative support. The impact obstetric care deserts have on maternal mortality rates should not be understated. To illustrate, the maternal mortality rate in Indiana obstetric deserts currently stands at 76 deaths per 100,000 births. Additionally, marginalized groups are far more likely to live in maternity care deserts. This makes it much more difficult for them to access the treatment they need, increasing the risk of harm to themselves or their babies.
Lack of Prenatal Care: It is vital that all pregnant people have access to prenatal care during their first trimester. Having access to quality prenatal care early on can help prevent complications throughout the entire pregnancy and birthing processes. However, it is difficult for many people of color to access the prenatal care they deserve.
Racial Discrimination: In addition to having substandard access to quality reproductive health services, minorities also have to deal with the stress of being discriminated against by the healthcare system. Many people of color, especially Black persons, experience high rates of disrespect and mistreatment from healthcare professionals. This refers to the presence of implicit bias and other discriminatory practices that cause healthcare professionals to be less inclined to believe a person of color who raises concerns about their pregnancy. Additionally, many studies have revealed evidence suggesting that the stress and pain associated with racial discrimination substantially increases the likelihood of maternal and infant mortality amongst Black people and other minorities.
Which Ethnicity Has the Highest Maternal Mortality Rate in Indiana?
As we mentioned before, Black individuals in the United States are three times more likely to die from pregnancy-related complications than white people. Unfortunately, Black persons have the highest maternal mortality rate in Indiana as well. A report recently published by the Indiana Maternal Mortality Review Committee delivers an in-depth analysis of Indiana maternal mortality data from 2018. One of the most significant findings from this report stated that pregnant Black people accounted for 18% of deaths related to pregnancy complications. This is especially harrowing when you consider that Black people accounted for only 13% of births in Indiana.
This all relates to the issues we established in the previous section. Far too often, pregnant people's experiences and concerns, particularly people of color, are not taken seriously by the healthcare system.
Where Do We Go From Here? Addressing Racial and Ethnic Disparities in Maternal Morbidity and Mortality
Although much of this information is deeply unsettling, we all must resist the temptation to despair. Inspiring efforts have been initiated by the CDC and other entities to combat these devastating issues. Here are a few examples of how organizations are taking steps in the right direction:
The CDC’s CORE commitment to greater health equity
Ongoing research being conducted by the Indiana Maternal Mortality Review Committee
Women4Change monitoring and supporting legislation that benefits pregnant people, and reproductive rights in general.
High maternal mortality rates are a solvable problem. This begins by addressing the root causes of this issue. This includes assessing the failures of our healthcare system and current legislation surrounding the quality of care provided to all pregnant people in the U.S. If anything is to change, a serious effort must be made to fully understand the biological, socioeconomic, environmental, and psychological factors that contribute to maternal and infant mortality.
Here are just a few of the steps involved with eradicating racial disparities in maternal health:
Address bias in the U.S healthcare system. This means taking steps toward evaluating how we structure patient-provider interactions and health communication in minority communities. Furthermore, it is our health system’s responsibility to incorporate methodologies that deal with unconscious discrimination in the medical practice. This includes introducing ongoing implicit bias training and other diversity educational programs into the medical curriculum.
Standardize prenatal, delivery, and postpartum care. Standardizing the coordination of care is a critical component of improving the quality of prenatal, delivery, and postpartum practices. According to the National Library of Medicine, the implementation of safety bundles for life-threatening complications like hemorrhages, and venous thromboembolic diseases can dramatically reduce the risk of deadly delivery complications. Additionally, proactive prenatal protocols, maternal early warning criteria, simulation training, and more new procedures are now being recommended to promote a safer delivery environment.
Conduct thorough and frequent reviews of all maternal mortality cases. Collecting and analyzing data related to maternal mortality will lead to a better understanding of how to improve medical and legal processes moving forward. This involves researching and analyzing how factors such as poverty, literacy, race, ethnicity, language barriers, transportation access, sexual orientation, and obstetric care deserts all impact the overall maternal and infant mortality rate on a national and state scale.
Support legislation designed to help all pregnant people. On an individual level, we can all make a collective effort to engage with our local and national government bodies to affect change. Women4Change is dedicated to advocating for policies that support all aspects of reproductive health. For example, during the 2022 legislative session, we advocated for House Bill 1294 and House Bill 1140.
House Bill 1294 establishes that minimal restraints should be used on a pregnant inmate when the pregnant inmate is in the second or third trimester of pregnancy. This bill also states that no restraints shall be placed on an inmate who is in labor, in the immediate post-delivery period or during a medical emergency related to their pregnancy.
House Bill 1140 increases the Medicaid income eligibility requirements for pregnant people.
For more information on current Indiana legislative efforts we support and oppose, visit our legislative blog.
Your Voice Has Power. Continue the Conversation With Women4Change
At Women4Change, we are devoted to eliminating racial disparities in maternal and infant mortality, and decreasing the maternal mortality rate in Indiana. All pregnant people deserve the highest quality medical care possible—that’s a fact. Although progress is being made, there is a lot of work to do. Currently, over 30 Indiana counties have no hospital or no obstetric services. We believe that this is unacceptable. Join our initiative and become an agent of change by subscribing to our newsletter, donating to our cause, or applying to become an action advocate.