Last month Vogue published its September issue, with Beyoncé Knowles, one of the world’s most elusive stars, on the cover. She is Vogue’s first African-American September cover girl, making the new edition buzzworthy to say the least. It is Knowles’ frank discussion of pregnancy, however, that yet again thrust Black women, maternity, and mortality into national conversations concerning health, gender, and race.
In January, Serena Williams, in her own Vogue article, recounts the details of her own pregnancy with her now one-year-old daughter.
“And then everything went bad,” she recalls, after explaining her low heart rate and subsequent emergency C-section. She explains her shortness of breath the next day, her history of blood clots, and her desperate attempts to explain what she needed - a CT scan and a heparin drip. She also chronicles her dismissal by medical staff.
Williams did have multiple small blood clots on her lungs, and spent the next several days in and out of the OR, dealing with coughing spells, an opened C-section wound, and hemorrhaging. She spent six weeks afterwards at home, unable to leave her bed.
Williams’s is a story of success, in which she and her newborn have moved on to healthy, safe lives after delivery struggles and medical provider failures. However, not all such stories, especially for Black mothers, have such happy endings. Black women are 243 percent more likely than white women to die of childbirth and pregnancy-related causes, and 2-3 percent more likely to die of the five most common causes of maternal death.
The latter is in part what drew readers to Beyoncé’s Vogue article. In her description of her second pregnancy, she details her struggle with toxemia, or preeclampsia: one of the top five causes of maternal death. She, too, had an emergency C-section and spent several weeks afterwards recovering.
“I was in survival mode and did not grasp it all until months later,” Knowles recalls.
What is more disturbing is the fact that Black women’s maternal mortality rates are not improved by socioeconomic status or education - college educated Black mothers are at a higher risk of maternal mortality than white mothers without a high school education. Black mothers have mortality rates comparable to women in Mexico and Uzbekistan, both significantly less wealthy countries.
“There's something inherently wrong with the system that's not valuing the lives of Black women equally to white women," Raegan McDonald-Mosley, Planned Parenthood Federation of America’s chief medical director states.
Since Black maternal mortality is neither an accessibility nor an education issue, researchers have looked into Black women’s health care itself. 33 percent of Black women in a Harvard study said that they had been racially discriminated against in a medical setting.
Furthermore, Black patients overall are far less likely to have their pain taken seriously by medical professionals, and are often not perceived as victims in cases of suffering or pain.
Beyond healthcare, Black women’s health may struggle from social issues. The term “weathering” refers to “stress induced wear and tear on the body.” For Black women, weathering as a result of racial and gendered discrimination puts them at increased risk of chronic diseases, and ages them on a chromosomal level - Black women in their 30s have the same pregnancy risks as white women in their 40s.
Fortunately, the issue is gaining traction. Organizations like Black Maternal Health Week and the Black Mamas Matter Alliance have sprung up to address the discrimination that Black mothers-to-be face, even sharing issues at the U.N.
North Carolina has also implemented programs that have closed the maternal mortality rate gap between Black and white women. Doctors can receive compensation for screening newly pregnant women on Medicaid for factors that make their pregnancies high risk. Black mothers in North Carolina were at a 24.3 out of 100,000 mortality rate in 2013, compared to 60 ten years earlier.
Closing the national gap will require a cultural upheaval, including erasing racial biases in and out of medicine and investing in accessibility. Regardless, Black maternal care must evolve quickly - Black mothers’ lives quite literally depend on it.