From ... in Health — May 4, 2020

For Maternal Health and Covid-19, a Racial Divide

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Representative Lauren Underwood (D-IL), co-founder and co-chair of the Black Maternal Health Caucus, speaking at the Black Maternal Health Caucus Stakeholder Summit at the Capitol in Washington, DC on July 11, 2019. © 2020 Sipa USA via AP (Photo by Michael Brochstein) In the week and a half leading up to my daughter’s birth last July, I saw an obstetrician several times, then was hospitalized to monitor my high blood pressure. I was diagnosed with severe pre-eclampsia, a condition that can lead to serious, and sometimes fatal, complications during pregnancy, and was induced six weeks early. Persistent high blood pressure for several weeks following childbirth meant even more visits to the doctor. U.S. Representative Lauren Underwood (D-IL), co-founder and co-chair of the Black Maternal Health Caucus, speaking at the Black Maternal Health Caucus Stakeholder Summit at the Capitol in Washington, DC on July 11, 2019. Although serious, pre-eclampsia is one of the most common ways that women needlessly die giving birth. I knew from the outset that I was more likely to develop the condition and experience poorer health outcomes from it as a Black woman in the United States. It’s also more common among women who live in poverty and in the South. Going through my ordeal during the COVID-19 crisis would be all the more frightening. As the pandemic overwhelms our healthcare system and leads to shortages in medical providers and supplies, pregnant women will suffer, and the many Black women living in rural areas who already lack access to an obstetrician or hospital will have an even tougher time. Health disparities that existed long before the pandemic will contribute to the alarming rate at which Covid-19 is infecting, and killing, Black Americans. Routine appointments and access to obstetricians and a nearby hospital led to a healthy outcome for me and my baby but many women, especially those who are Black or live in poverty, don’t fare as well. In the United States, about 700 women die as a result of complications during pregnancy and delivery each year. Most of these deaths are preventable. Black women are more than three times as likely to die from pregnancy-related complications as white women. Healthy pregnancies and safe deliveries require routine prenatal visits and hospitals with obstetrics. Yet women in many states struggle to get these services. Rural hospitals in southern states like Alabama that refused to expand Medicaid continue to close — and with them, places to safely give birth. In 1980, there were 45 hospitals providing obstetric care in Alabama’s 54 rural counties. As of 2016, only 16 were still in operation — including only two hospitals in the entire Black Belt, a rural region of the state with a predominantly African American population, widespread poverty, and poor health outcomes. It’s not surprising that Alabama, like many other southern states, has high maternal mortality rates. When obstetricians have nowhere to deliver babies, they move away. So pregnant women have no choice but to travel — sometimes a long way — for care, including for prenatal care that is critical in reducing the risks of complications. Travel takes time and some women can’t get off work long enough for these visits. Others can’t find a way or can’t afford to get to these appointments. Black women in rural areas already face a heightened risk of dying during pregnancy because of the shortage of hospitals and doctors, disproportionate rates of poverty, glaring health disparities, and persistent structural racism in the medical field. As the pandemic escalates in the United States, it terrifyingly exacerbates this risk. Black women, who are more likely to suffer from pre-existing health conditions such as hypertension, are at a heightened risk for both pregnancy- and Covid-19-related complications. Access to prenatal and obstetric care is especially important right now. But when everyone in the United States is being encouraged — if not ordered — to practice social distancing, how will women in rural areas get to prenatal appointments or to hospitals for delivery that are increasingly far from home? Catching a bus, arranging a ride with someone outside their household, and other ways to travel long distances aren’t safe options anymore. Likewise, telemedicine appointments aren’t practical for women who don’t have reliable access to internet service, or who are in labor or have an obstetric emergency. It shouldn’t take a pandemic for states to start to worry about the decreasing rural hospital beds. States can expand Medicaid eligibility to increase coverage rates, which could help stem the high number of rural hospital closures and ensure that women can deliver their babies in safe and respectful circumstances. And investing in transportation and programs to connect rural women with quality and accessible health care — including telemedicine, virtual care, and mobile medical providers — can help pregnant women get the care they desperately need. As I faced pregnancy complications last July, I didn’t think twice about how easily I could access prenatal care on the short drive to see doctors who cared for me early enough to save my life. It’s heartbreaking that many Black women around the country can’t say the same — and this current crisis will only make it worse..

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