A UN report published this month found that racism from health care providers is likely contributing to higher rates of pregnancy-related deaths among people of African descent in North and South America. The analysis, led by the UN Population Fund (UNPF), made three key findings:
1. Afrodescendent women and girls in the Americas are disadvantaged before, during, and after pregnancy.
2. Afrodescendent maternal deaths in particular are alarmingly high in both absolute terms and when compared to those of non-Afrodescendent and non-Indigenous women in the region.
3. Structural racism and sexism are evident in maternal health disparities that exist across income levels and national and regional borders.
The UNPF pointed to a variety of reasons why these disparities continue to exist, including discriminatory behaviors by health care providers. According to the report, providers demonstrate racism toward pregnant patients of African descent by being verbally and physically abusive, denying initial hospital visits, providing substandard prenatal and newborn care, and withholding anesthetics to relieve pain. The report also identified racially biased medical education as a cause of the disparate treatment. In addition to the fact that medical textbooks only model childbirth on pelvic presentations common to European women, the report identified flawed history as a factor as well. It reads:
Deep linkages exist between the advances in the field of gynecology and racism, as surgical techniques for performing caesarean sections and repairing obstetric fistula were invented through experimentation on enslaved African women who were thought not to “feel pain in the same way as whites.” This racialized science continues in medical education, with students and physicians still reporting a belief that “Black people’s nerve endings are less sensitive than white people’s nerve endings.”
The report also named data aggregation as a cause of these disparities. While aggregated data is used to identify trends and optimize treatment decisions, it can be harmful by hiding poor health outcomes for particular demographic groups. As a result, patients of African descent are not often identified as a group that experiences barriers to health.
To equalize pregnancy outcomes among childbearers, the UNPF made several recommendations to governments and international organizations, including the increased availability of disaggregated data, the inclusion of Afrodescendant participants in maternal health policy design and the health workforce, and the adoption of a universal health care model. The report also suggested that establishing interventions to mitigate mistreatment in health care facilities and addressing racist ideologies in the medical curriculum can help reduce disparities in maternal mortality.
Within the US, there continues to be a sharp divide in abortion access following the decision in Dobbs v. Jackson Women’s Health Organization. While states like Arizona have recently added protections for abortions, other states like North Dakota and Iowa have passed some of the nation’s strictest bans. These decisions may have stark consequences for maternal health, as research shows that rates of maternal mortality are higher in states with restrictions on abortions.
