Part 3 of a three-part series.
As Texas looks to reduce its maternal mortality rate, there is one aspect of the crisis that is going to be harder to solve: Black women are more likely to die while pregnant or after giving birth than women from other racial or ethnic groups.
According to the Centers for Disease Control and Prevention, black mothers in the U.S. die at three to four times the rate of white mothers. In Texas, 11 percent of births in 2011-2012 were to black women, yet they made up 30 percent of the reported maternal deaths in the state.
Maddy Oden, who lives in Oakland, Calif., lost her daughter about 17 years ago. Tatia Oden French was pregnant with her first child at 32 years old.
“She was African-American,” Oden says. “She had just gotten her Ph.D. She was getting ready to go into medical school, actually. She had been a vegetarian for way over 15 years. She was totally healthy. The baby was totally healthy.”
But Tatia was about 10 days overdue, and Oden says her doctors wanted to induce labor.
“She didn’t want to be induced,” she says. “She wanted a natural birth, and they put a lot of pressure on her, specifically saying, 'Well, you don’t want to go home with a dead baby do you?'”
Eventually, Tatia was given a drug used to induce labor.
“Ten hours after they gave it to her, she was dead and the baby was dead,” Oden says. “And so I decided that I was going to focus on getting the drug out of the toolbox of induction.”
Oden does that work now through a foundation she created with her daughter’s name. She also became a doula and works predominately with black women. She says she sees what happened to her daughter happen to a lot of her clients.
“It’s a very common type of attitude: disrespect, you know, total disregard for what the mom wants,” she says. “They want you to do what they want you to do.”
Oden says the problem is rooted in racism, which makes it difficult to fix. Even though California has cut its overall maternal mortality rate in half, she says, the disproportionate effect on black women hasn’t gone anywhere.
“There is still a tremendous amount of work to be done even in California,” Oden says. “And then again, quite frankly, it depends on who you are and how dark your skin is.”
As California successfully brought down its rate, that gap between black and white women remained.
“In California, our African-American rate fell similarly to our overall rate – fell in half,” says Elliott Main, the director of California Maternal Quality Care Collaborative (CMQCC). “But at the end of the day, it was still three times higher.”
Main has been largely credited with leading the effort to drastically bring down the maternal mortality and morbidity rates in California. He says this race disparity is not just alarming and hard to fix; it’s also a unique problem.
“That is the biggest racial disparity among any public health measure,” he says. “We pay attention to infant mortality, we look at prematurity rates, we look at cancer deaths – those are all higher in African-Americans in general.”
Those rates, Main says, are up to two times higher among black people. Maternal mortality is three to four times higher. And in New York City, for example, it’s up to 12 times higher.
“This is a disgrace,” Main says, “and a national imperative that we really have to address."
Main says California is starting some pilot programs aimed at closing the gap.
It’s going to be tough, though. Advocates who pay attention to the issue say it isn’t about tackling specific health issues like hypertension; it’s about tackling a much thornier issue: racism.
Darline Turner, a physician’s assistant and doula in Austin, became interested in maternal health among black women several years ago after her own tough pregnancy.
“We had some spotting. We had cramping,” she says. “We had – you know, I had lost one before her. We had so many different things going on.”
Then, Turner says, she went into labor early, and that presented another set of problems because she had recently had uterine surgery.
“I was at great risk for uterine rupture,” she says. “So we were playing beat the baby to get the baby out.”
Turner says giving birth was an overwhelming experience, and she felt bad for her husband who had no idea what was going on.
“And he was just standing there watching this cacophony of instruments being thrown, baby being whisked away, wife throwing up and being gassed because I was just kind of crazed," she says, "and there was no one there [for him]."
Turner became a doula because she wants to be in the room helping people through deliveries – particularly black mothers, like her.
“You know, now doing doula work, it’s interesting ... the things that I will sometimes hear come out of health care providers’ mouths,” she says. “And I'll turn [and say], 'Did you really say that to her?’"
Sometimes medical professionals don’t really listen to black women, she says. Turner says the daughter of one of her clients was pregnant with twins. She was feeling bad throughout the pregnancy and had gone to the emergency room 22 times.
“Who goes to the ER 22 times?” she says. “After two or three you admit her and like, ‘Why are you here again?’”
But the hospital didn’t admit her. Each time, Turner says, the woman was told she was “being alarmist” and sent home. Turner says she eventually died.
According to the latest report from Texas' maternal mortality task force, a lot of black women are dying after pregnancy-related hospital stays. In fact, they are twice as likely to die than women of any other ethnic or racial group.
Turner says saving black women’s lives will require a shift in how the medical community treats these women. It’s going to be hard to fix the small things without that shift.
“It’s not that hard – treat people kindly,” she says. “That’s the bottom line: Treat people kindly.”
Unlike most of what the state has to learn from California’s success in decreasing maternal mortality, there is no framework on how to make these changes.
Back in Oakland, Oden says to prevent another woman like her daughter from dying it will require larger cultural shifts.
“The disparities exist and will continue to exist until racism in the medical institution, along with the other institutions in this country, is significantly addressed and reversed,” she says. “Which is not going to happen to tomorrow.”