By Jennifer Fernandez
COLFAX — Everyone here knew the data: Black women are three times more likely to die in connection with childbirth than white women.
And they knew the cause: hard-to-solve social and structural problems in health care.
Their goal: Get to the source of the problem to help save the lives of Black mothers and their babies.
As the United States marked Black Maternal Health Week (April 11-17) this year, North Carolina advocates and health care professionals from across the state met in Colfax to discuss solutions.
More than 110 people registered for the two-day, inaugural Black Maternal and Infant Health Conference hosted by the Black Pearls Society at the Cameron Campus of Guilford Technical Community College.
Presentations tackled such topics as action-based research, where new ideas are put into practice then evaluated; legislation at the state and federal level; crafting new curriculum and looking at the issue through the lens of racial justice to find solutions based on changing the health care system.
“This forum is … about going to the source and doing something about it,” state Sen. Gladys Robinson (D-Greensboro) said Friday during the opening session of the conference.
“The problem is old, it’s not new,” she said. “We just haven’t done anything about it. We’ve been working on pieces of it for a very long time.”
Robinson knows that change can take time. She told the audience she introduced the first Medicaid expansion bill in the state 10 years ago. Gov. Roy Cooper just signed that policy into law last month.
“You have to keep on, keep on,” she said. “Hopefully, it won’t take you 10 years, but you know … you have to keep on at it to make sure that people hear you … understand the issue, and then they begin to address the issue.”
Death rate rising
The maternal death rate in the United States, already the highest among high-wealth nations, worsened during the COVID-19 pandemic. The overall rate increased from 20.1 to 32.9 per 100,000 live births from 2019 to 2021, according to data from the Centers for Disease Control and Prevention. Those numbers were driven, in part, by how dangerous COVID-19 is for people who are pregnant.
Black birthing people saw an even larger impact. For them, the rate jumped from 44 to 69.9.
The white maternal death rate also climbed, but at a slower pace, from 17.9 to 26.6.
During that same time period, overall maternal mortality rates in North Carolina increased from 22 to 44 deaths per 100,000 live births, according to CDC data compiled and analyzed by the investigative news organization MuckRock.
More than 80 percent of these deaths are preventable, according to data collected from Maternal Mortality Review Committees — multidisciplinary groups that gather on the state and national levels to examine deaths during or within a year of pregnancy.
Disparities persist even when controlling for underlying social and economic factors, such as education and income, which points to the “roles racism and discrimination play in driving disparities,” according to a November report by KFF, a nonpartisan nonprofit focused on health research and policy.
The most recent report from America’s Health Rankings broke down state-level CDC data by race and ethnicity from 2016 to 2020. North Carolina’s Black maternal mortality rate for that period was 52.8, more than three times the 17.3 rate for white mothers. It was nearly five times higher than the rate of 10.7 for Hispanic mothers.
“We all realize that the policies must be changed to bring about a real difference with the statistics,” said Goldie Wells, a Greensboro City Council member.
Changing the system
Speakers said system-level changes are needed to improve the outcomes for Black birthing people.
In one of the breakout sessions, participants were asked to share their birthing experiences as health professionals and as Black, Indigenous or Hispanic mothers.
They talked about not being heard or believed when raising concerns about what was happening to their own bodies. They said doctors don’t always spend enough time to ensure that patients understand instructions.
Some said they weren’t allowed to bring in their doulas — nonmedical, trained labor coaches who provide “physical, emotional and informational support” to pregnant people before, during and after birth, according to certifying agency Doulas of North America International.
Information gathered from conference participants and others will be used to create the BELIEVE curriculum, which will incorporate real scenarios to help health care professionals understand how to connect with patients and break through social and structural problems that have harmed pregnant people.
They’re planning to build the curriculum in time for a fall 2024 launch, said Kimberly D. Harper, a research associate at UNC Chapel Hill and adjunct faculty member in nursing at N.C. Central who is co-leading the work. The course initially would be available to professionals and later to students, she said.
Race in health care
A central theme running through the conference was a focus on the impacts of bias and racism, whether conscious or not, on health outcomes for Black mothers and infants.
“We know that race-based problems can’t be solved with race-neutral solutions,” said Deena Hayes-Greene, managing director of the Racial Equity Institute, a training and consulting business that works with organizations to provide understanding and analysis of structural racism and its cultural and historic roots.
Christina Yongue, an associate professor at UNC Greensboro with a master’s in public health, shared in one breakout session how previous work using anti-racism principles to shift the focus to changing the system is being used in a new study on maternal health.
Accountability for Care through Undoing Racism and Equity for Moms, or ACURE4Moms, seeks to reduce pregnancy complications, especially for Black people, by decreasing institutional racism and bias in health care and improving community-based social support during pregnancy.
Some of the concepts are modeled after a study Yongue worked on for breast and lung cancer. That study showed that changes to health system processes closed the gap between Black and white patients and led to improved health outcomes for all participants, she said.
All of the interventions in that study, such as data accountability and electronic warning systems, focused on changing the institution.
“They were not about changing the individual,” she said. “That’s a huge shift, and it was based on anti-racism principles.”
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Organizers want to make the weekend conference an annual event.
There was a good response, said Hayes-Greene, who is also a member of the Black Pearls Society and the conference’s planning committee.
Participants spoke of “being full” — not just of information, but emotion — after the conference, she said.
She also said there will likely be more work done between now and next year’s conference to address these issues.
That’s exactly what Harper said she wanted to see.
“I hope we’re able to continue the conversation,” she said, “and put some of the things that we’ve heard into action.”