Physicians, advocates and concerned public officials are using April, which is National Minority Health Month, and this week – Black Maternal Health Week – to amplify concerns over disparities in maternal healthcare in Pennsylvania and nationally.
The 4th annual week-long initiative is dedicated to awareness, activism and deepening the conversation around maternal mortality in Black Americans, who are 2-3 times more likely to die of pregnancy-related causes than their white counterparts, according to Centers for Disease Control data.
Dr. Sharee Livingston, an obstetrician and gynecologist at UPMC Lititz, led her colleagues in a conversation about the causes of and possible solutions to the nation’s shockingly high maternal mortality rates, on Wednesday.
Livingston said she warned attendees that the subject matter would “not be a fun conversation.”
A 2018 report conducted by the Pennsylvania Department of Health’s Maternal Mortality Review Committee (PA MMRC) found that from 2013 to 2018, Pennsylvania saw a 21.4 percent increase in pregnancy-associated deaths, or the accidental/incidental death of a person while pregnant or within one year of the end of the pregnancy.
Non-Hispanic Black Pennsylvanians accounted for 23 percent of pregnancy-associated deaths in the commonwealth, despite only making up 14 percent of births during the same time period.
In Philadelphia, Non-Hispanic Black women accounted for 73 percent of pregnancy-related deaths in the city, according to March 2021 report.
Livingston said her fellow physicians were “highly upset at hearing the numbers” during her presentation.
“Most of us are good folks and most of us have a problem with these statistics,” Livingston told the Capital-Star. “We have to ask ourselves why.”
Livingston said she believes the increase in maternal mortality and morbidity is multi-faceted and can be attributed to several factors, including a lack of access to high-quality healthcare, distrust in healthcare providers and issues of systemic racism and implicit biases as well as other social determinants.
More than half (53 percent) of pregnancy-associated deaths in Pennsylvania that had payment information listed, were paid for by Medicaid and nearly half of the pregnancy-associated deaths reported between 2013 and 2018 did not receive adequate prenatal care, according to the Department of Health report.
But access to high-quality healthcare is just one slice of pie, Livingston said.
Historical abuse by healthcare providers has also caused many minority patients to be distrustful of healthcare providers.
“We don’t have to go too far back,” she said, noting the legacy of mistrust created by horrific examples of racism in medical care.
“Everyone talks about Tuskegee, but heavens know we can go back further than that,” Livingston said, citing the example of physician J. Marion Sims. Known as the father of gynecology, Sims experimented on at least 10 enslaved Black women without anesthesia or consent to develop medical techniques.
There’s also evidence to suggest that implicit biases, or the attitudes and behaviors of individuals, such as health care providers, as a contributing factor in racial health disparities.
“Implicit bias is real,” Livingston said, adding that stereotypes combined with providers’ quest for answers can lead to victim blaming.
Livingston’s calls to address systemic racism and implicit bias in healthcare are being echoed by others advocates across Pennsylvania.
Nia Arrington, Black organizing fellow for Planned Parenthood in western Pennsylvania, called the nation’s rate of 17 maternal deaths per 100,000 live births, a “health crisis.”
“The decision to give birth should not endanger any Black woman’s life,” Arrington said. “It’s a failing of America’s medical and government institutions that Black women in Pittsburgh are more likely to die during pregnancy than their peers in 97 percent of other U.S. cities.”
In a statement to the Capital-Star, Planned Parenthood Pennsylvania Advocates shared their support for bringing awareness to the issue.
“Planned Parenthood Pennsylvania Advocates (PPPA), is proud to follow the lead of the Black Mamas Matter Alliance and Black women across the country in bringing awareness to maternal health, rights, and justice for all Black mothers. We envision a world where Black people have reproductive freedom — freedom to choose their own path to parenthood and access to the highest standard of reproductive healthcare.”
Despite the myriad of factors contributing to high maternal mortality and morbidity rates in Pennsylvania and nationwide, Livingston said, “We have lots of good solutions.”
On her personal wish list, Livingston said she would like to see an increase in diversity in the medical profession, of which only 2 percent are Black women, continued review of pregnancy-related and associated deaths by review committees, the sharing of best practices by healthcare systems to providers in low-income communities and community awareness of preventable conditions.
Many of Livingston’s proposed solutions can be found in proposed legislation currently in Harrisburg.
In March, state Rep. Morgan Cephas, D-Philadelphia, who serves as vice chair of the PA Women’s Health Caucus, introduced several bills aimed at combating the commonwealth’s maternal mortality rate and healthcare disparities, including House Bills 1173, 1174 and 1175.
Cephas’ bills would:
- Require the secretary of the PA Department of Human Services to apply for a waiver that would extend Medicaid coverage for pregnancy-related and postpartum medical assistance for up to an additional 10 months,
- Add “severe maternal morbidity” to the list of reportable events in the PA Department of Health for proper data reporting,
- Extend Medicaid coverage to doula services and create a Doula Advisory Board, which would be responsible for determining the approved accreditation organizations for doulas, the competencies that should be required to ensure doulas are properly equipped to serve the mothers of Pennsylvania and setting standards based on best practices for doula professionals,
- And require all health-related boards overseen by the Pennsylvania Department of State to institute implicit bias training as part of each profession’s continuing education requirements.
“Women of color are still three times as likely to die giving birth than other women — this is racism in medicine at play and it’s unacceptable,” Cephas said in a statement announcing the bills. “Access to quality and affordable care should never be based on skin color, income or zip code, and my legislation would help abolish these discriminatory practices that result in highly fatal outcomes from our medical systems.”
Livingston called proposed legislation such as Cephas’ “exciting,” adding that the proposals had the potential to be “massively impactful” to pregnant persons of color.
But legislation isn’t the only potential solution. She believes a combination of legislative changes, healthcare reform, community activism and advocacy efforts will all be needed to institute the changes needed to combat the United States’ high maternal mortality rates.
“Obstetricians cannot do this alone,” Livingston said. ”There’s plenty of work to do.”