Improving Maternal Health
By Rayna Tamko
Health disparities have been a talking point in the 2020 presidential campaign. Four of the Democratic candidates have put plans to address poor maternal health outcomes for black and Hispanic women. Senator Elizabeth Warren proposes offering financial incentives to hospitals that show improved maternal morbidity. Senator Kamala Harris introduced the Maternal CARE Act which would invest $30 million to train providers to recognize implicit racial bias and to establish a demonstration project to assist with implementing and sustaining pregnancy medical home programs.
The United States has the highest maternal mortality out of all the developed countries in the world. Non-Hispanic black women experience maternal deaths at three to four times that of non-Hispanic white women, according to data by the American College of Obstetricians and Gynecologists. This statistic transcends education or socioeconomic status. The Bronx has significantly poorer health outcomes compared to other parts of New York City. The Bronx has the highest teen pregnancy rate in NYC which may be indicative of poor sexual education in the borough schools.
The American Pregnancy Association advises that women should have their first prenatal visit eight weeks into their pregnancy. According to Montefiore Medical Center’s Bronx Community Health dashboard, 9.3 percent of expecting mothers in the Bronx do not get prenatal care until their third trimester, compared to 5.5 percent in the rest of New York City. This may be due to lack of education and lack of access to quality medical care. In New York City, pregnant women are eligible for Medicaid, but the quality of care is often subpar. Poor prenatal care can prove fatal for many women in the Bronx. The maternal mortality rate from pregnancy or delivery complications has increased by 12 percent in the Bronx, despite a 31 percent decrease in the rest of NYC.
Although these health statistics are staggering, some individuals and organizations are working to improve health outcomes for women of color in the Bronx. “We have birth equity initiative where we work directly with physicians and staff Montefiore Medical center to look at and think about the care that black women are receiving regarding pre and post-natal care,” said Kim Freeman, manager at Tremont Neighborhood Health Action Center. The health action center operates within the New York City Health Department’s Center for Health Equity and Community Wellness and provides resources that might not normally exist in their neighborhood.
There are many different social factors that impact the lives of black women that are often not linked to health but should be, says Ashlee Wisdom. Wisdom is co-founder of Health in Her HUE, a digital platform that connects Black women to healthcare providers and services. “The neighborhoods in which we live, the schools we have access to and our housing, all of that has impact on our health and access to healthcare,” said Wisdom. “In public health, we call these things the social determinants of health.”
Some suggest alternatives to traditional hospital birth settings could improve maternity health outcomes for Black women. “Doulas should be implemented in hospitals more and even supported by insurance,” said Cynthia Cameron, a doula and a mother of five. A doula is someone without formal medical training that coaches and provides support for women throughout their pregnancy and in childbirth. Doulas can develop a close relationship with patients because they work with them throughout their pregnancy, unlike an obstetrician that may meet their patient a few times if at all. “When you have somebody that can share their experiences with you, it takes away a lot of the fear,” says Cameron. “A lot of stress and anxiety is alleviated because a doula prepares you for what is to come.” Doulas, she says, don’t just show up in the delivery room, but instead to build a relationship, based on trust.
Pregnancy and childbirth should be a joyous time for all mothers but for some, it can be fatal. The poor health outcomes that women of color face in the Bronx is a health equity issue, so all aspects of life must be considered when attempting to rectify them.