Addressing Inequities to Improve Maternal Health and Other Health Outcomes for Black Women
The World Health Organization defines health inequities as systemic differences in the health status or in the distribution of health resources across different populations. In the United States, health inequities put Black women at higher risk of poor health outcomes compared with White women.
A stark example is maternal health: According to the National Partnership for Women & Families, Black women are three to four times more likely than White women to die from (often preventable or treatable) pregnancy-related complications. Black women also have poorer outcomes after a breast cancer diagnosis; the American Cancer Society notes that although they are less likely to be diagnosed with breast cancer, they are 40% more likely to die from the disease than White women.
Black women experience increased environmental, social, and physical stress that can affect their physical and mental health. These are a few of the factors that contribute to disparate health outcomes for Black women that may also be connected to others, such as such as racial bias and discrimination from within the medical system, lower-paying jobs that may result in increased likelihood of being underinsured or uninsured, reduced access to preventive care and medical services, and poorer-quality care.
How Are Organizations Supporting Maternal Health?
Merck for Mothers recently launched a U.S.-based effort called Safer Childbirth Cities that administers grants to approximately 20 organizations around the nation to provide equal access to quality maternal healthcare and other related services for Black, American Indian, Hispanic/Latino, Pacific Islander, and immigrant women.
One grant recipient is Black Women’s Blueprint in Brooklyn, NY, which is addressing key issues expectant Black and other minority women experience. These include sexual assault, unaddressed trauma, distrust of healthcare professionals, and maternal mortality. The organization reaches more than 5,000 people each year with a mobile health unit that brings doulas, midwives, and birth workers into 50 locations throughout the community. The organization also educates as many as 800 clinicians each year on the link between trauma and the health of expectant women.
How New York City Is Addressing Maternal Health
Black Women’s Blueprint is representative of a broader New York City-based effort to address the problem of mothers and babies dying during or shortly after childbirth. Recently, NYC Mayor Eric Adams expanded citywide efforts to improve maternal healthcare for women at risk of poor outcomes. One component of the program is the Citywide Doula Initiative, which will provide free access to doulas for 500 expectant families who live in 33 neighborhoods with the greatest needs based on various social drivers of health.
Doulas are non-healthcare professionals who are trained to support a woman physically and emotionally through the labor process. Doula care has been found to reduce complications from childbirth and lead to better outcomes for mothers and babies. For instance, a study that appeared in eClinical Medicine found that doula care during pregnancy can reduce the likelihood of a cesarean delivery (c-section) by 53%. The study also found that doula care can reduce the risk of postpartum depression or anxiety by 57%.
New York City is also expanding the Maternity Hospital Quality Improvement Network (MHQIN) to better identify and address racial inequities that can lead to poorer quality care for women of color. This initiative supports hospitals in collecting and reviewing data on maternal mortality to identify contributing factors and develop recommendations to improve care delivery and outcomes. For instance, MHQIN encourages the training of healthcare professionals to recognize and reduce biases in the care they provide; promotes the importance of patient-centered care and positive patient-clinician communication; and helps hospitals integrate doulas onto the birthing team.
The city’s administration is also partnering with area organizations to capture data on women who use a clinical nurse midwife (a healthcare professional trained in the care of women during pregnancy and childbirth, as well as routine women’s healthcare), to better understand who has access and how they benefit from this relationship.
Taking a Strengths-Based Approach to Cancer Screening
Research on Black Women’s Health Across the Diaspora is another initiative dedicated to changing health outcomes for Black women. This program, which is run through The Ohio State University, is led by Karen Patricia Williams, PhD. Dr. Williams also serves as Director of the Martha S. Pitzer Center for Women, Children and Youth. Williams has dedicated her career to combatting health inequities facing Black women and empowering them to take better care of their health—both by trying new ways to engage this population and by furthering research to understand the challenges and to identify what works to address them.
Williams explained that her approach is to celebrate Black women’s strengths, such as the strong relationships they form with other women and the way they communicate with and support other women in their families. She uses these strengths to educate women and families about their healthcare risks so they can take better control of their own health.
One example of this approach is the Kin KeeperSM Cancer Prevention Intervention. Community health workers meet with Black women and their female relatives in their homes, to discuss the importance of routine health screenings like mammograms and Pap tests. The Kin KeeperSM approach teaches participants how to build on their strong familial relationships to support and encourage one another to take better care of themselves and make their health a priority.
A study looking at the effectiveness of this approach among more than 500 Black, Latina, and Arab women found that participating in the program increased their breast cancer literacy, improving their likelihood of following up and getting screened for breast and cervical cancers.
Williams stressed that this strength-based model can also be tailored for different needs. It is already being used across the country and around the world for different populations and different health risks.
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