You may or may not know that the overall maternal mortality ratio — the number of mothers who die from pregnancy-related causes per 100,000 live births — is pretty abysmal for both Georgia and the United States at large, especially compared to other developed countries.
For the U.S. the nationwide maternal mortality ratio in 2018 was 20.7 deaths per 100,000 live births. For Georgia the 2018 maternal mortality ratio was 46.2, well over double the national maternal death rate; in comparison, most other developed countries tend to have maternal mortality ratios in the single digits.
Even if you knew all that already, what you likely don’t know is how much worse the risk of death during or because of childbirth is for African-American women. (Hint: it’s a lot.)
Roughly a 20-point gap between black mothers and their white counterparts. The maternal mortality ratio for African-American women nationwide was 44.7, and for Georgia, 66.6.
People who prefer not to think about structural racism like to point to issues like the higher rates of diabetes in African-Americans and lower rates of insurance coverage — usually while ignoring the ways these issues may also be related to structural racism.
However, the poorer quality of healthcare for black Americans has been increasingly well-documented since the 2000’s.
A 2016 University of Virginia study found that its white participants, which included those with no and varying levels of medical training, often held false beliefs about biological differences between black and white people — for example, that the blood of black people coagulates (clots to stop bleeding) more quickly than the blood of white people.
Furthermore, in the second part of the study, following up with the white medical students and residents in their sample found that those who held false beliefs were more likely to incorrectly rate the pain levels of black patients lower than the pain rates of white patients.
Although this is only one study, it is part of a trend of scientific focus on racial inequality in medical care.
“Given the well-documented, pervasive racial disparities in pain management, understanding who might contribute to this racial bias and why is of paramount importance,” wrote the authors of the University of Virginia study.
Medical racism is a complex and multifaceted issue, but one of the ways it manifests is in lack of empathy towards black patients. Combined with a tendency to underestimate the pain of black patients, medical racism can be deadly for black mothers.
A recent, high-profile example is tennis star Serena Williams’ birth of her daughter in late 2017. Williams faced serious complications after delivering through C-section. A pulmonary embolism — a blood clot that reached her lungs — nearly killed her.
Williams credited her survival to the medical team that treated her. However, it’s worth noting that part of the reason her medical team was able to act so quickly was that Williams had experienced a pulmonary embolism before in 2011.
As a result, Williams was on the lookout for symptoms of blood clots, aware of what those symptoms felt like and was able to demand a computed tomography (CT) scan with dye after previous tests for blood clots came back negative.
Not everyone has that kind of awareness of their own medical history, much less of the complications that can result during childbirth even in those with no risky medical history. Furthermore, not everyone can advocate medically for themselves as competently as Williams did.
For white patients giving birth, a lack of comfort with demanding the attention of doctors who dismiss, downplay or delay treating their concerns can already be deadly. Black patients also have to contend with the possibility that doctors aren’t reacting promptly to their complaints not because their symptoms don’t indicate a risky complication, but because the doctor simply values their health less.
Georgia’s overall higher maternal mortality ratio is already outrageous. However, taking a long hard look at the failures — societal and medical — that cause such a large gap between white and black maternal mortality ratios is absolutely crucial. A problem is not solved if it’s only solved for white women.