The global healthcare system is riddled with racial-ethnic disparities with minority women bearing a disproportionate share of the burden of hypertension, strokes, breast cancer, heart disease and more recently, Covid-19. The reasons are expansive and range from a lack of resources, racism and colonialism to implicit bias, income inequality and a lack of ethnic representation in medical research, a battlefield in which Black women continue to fight for their lives.
According to the Center for Disease Control, in the United States, Black women are three times more likely to experience pregnancy-related complications compared to their white counterparts (CDC, 2021). Consequently, scholars and policymakers have called for renewed attention to this issue, but is this public health crisis getting the intervention it deserves?
Studies suggest that there are a number of ways of understanding the major inequities within the healthcare system. “Race and ethnicity are sociocultural constructs that reflect common geographic origins, cultures, and social histories of groups that are defined by societies in time-dependent contexts” (p.1). Chinn, Martin & Redmond (2021) further assert that one cannot initiate discussions around inequality amongst Black women until the intersectionality of these constructs is understood.
Considering the needs of Black women within a social, cultural and biomedical framework that acknowledges the impact on health and well-being in the areas where health, society, and culture intersect remains crucial as herein lies the driving forces behind the increased maternal mortality rate. “That seems to be the case irrespective of education or income or other factors we think of as making people vulnerable. While the economic disadvantage is also a contributor to maternal mortality, even being Serena Williams doesn’t entirely protect you.” says Neel Shah, MD, MPP, Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School, in an interview with the Institute for Healthcare Improvement (IHI).
Serena Williams, who in her athletic prime at the age of 36, having won 23 grand slam titles and despite being a multimillionaire, experienced her very own ordeal during childbirth. Following what she described as a “fairly easy” pregnancy, what ensued was an unexpected life-or-death experience during the birth of her daughter, Olympia. Williams delivered her daughter by way of an emergency C-section after Olympia’s heartbeat rapidly dropped during labor. Williams described her surgery as uncomplicated, however things changed “and then everything went [south]”.
A day after her delivery, Williams felt a sudden onset of breathlessness – a common symptom of her soon-to-be discovered diagnosis. Williams recounted in a 2018 interview with CNN, “Because of my medical history with [blood clots], I live in fear of this situation.” Williams recognized the warning signs and informed the nurses that she needed a CT scan and a heparin (blood thinner) drip. The nurse suggested she may be confused from her pain medication, however, Williams insisted on undergoing tests. Her medical team initially performed an ultrasound of her legs which was inconclusive, necessitating further investigation – a CT scan. Her diagnosis, just as Serena had anticipated and confirmed by her medical team: pulmonary embolism – a serious medical condition associated with a high prevalence and maternal mortality rate among Black women, in which blood clots travel from the legs to the lungs (CDC, 2021). Following her terrifying ordeal, Williams confessed “I almost died…yet I consider myself fortunate.”
Similarly, in the 2018 September issue of Vogue, Beyoncé detailed her life-changing pregnancy and birth experience, revealing she was 218 pounds the day she delivered her twins, Rumi and Sir. “I was swollen from toxemia (preeclampsia) and had been on bed rest for over a month. My health and my babies’ health were in danger, so I had an emergency C-section.” Preeclampsia is a life-threatening condition associated with high blood pressure during pregnancy and immediately after birth (Tsigas, 2020). The condition affects 4.6 percent of all pregnancies worldwide, however, as reported by Fingar, et al. (2017), the rate of preeclampsia in Black women was 60 percent higher than in white women.