Black mothers giving birth in hospitals are 53% more likely to die during childbirth than are Hispanic and White women, according to researchers who attributed the gap at least in part to bias among physicians and the healthcare system.
The United States is in the midst of a maternal healthcare crisis, said Robert White, MD, assistant professor of anesthesiology at Weill Cornell Medical College, New York City, and lead author of the study. The maternal death rate among US women in 2018, for instance, was 17.4 per 100,000 births, more than twice the figure in Canada (8.6 per 100,000 live births) and the United Kingdom (6.5 per 100,000 live births in 2016), according to the Commonwealth Fund.
“At baseline, our maternal mortality rates are higher than other comparable Western nations, and at the same time, there’s a huge spread in the maternal mortality ratio between White mothers and Black mothers, where Black mothers are experiencing maternal mortality about two or three times higher,” White told Medscape Medical News.
Previous research has shown racial disparities in rates of maternal mortality. But White said that his study controlled for income level, type of insurance, and other social factors that may have affected the health of the women.
“The research that I conducted is one of the largest of its kind, and the logistic regression model that we were able to run was able to control for a lot of these factors,” he said.
For the new study, presented at the 2022 annual meeting of the American Society of Anesthesiologists, White and his team analyzed data from 9.5 million deliveries across six states (California, Florida, Kentucky, Maryland, New York, and Washington) between 2007 and 2018. They found that 49,472 mothers (0.5%) either died in the hospital or experienced an injury during childbirth, which included damages to the brain, heart, eyes, or kidneys.
Overall, 0.8% of Black women experienced either a death or an injury compared with 0.5% of Hispanic women and 0.4% of White women. The researchers concluded that Black women had a 53% increased chance of dying during childbirth in a hospital, even after adjusting for factors such as insurance type, hospital type, and income.
If income, insurance type, and other social factors aren’t driving this disparity in maternal mortality, what is? White said that the study didn’t uncover the underlying cause, but in his opinion, racial bias and systemic racism are likely contributing to the gap in deaths.
“I think the takeaway for physicians should be that we should humbly accept that prejudice, bias, and racism does exist among physicians,” White said.
Adi Davidov, MD, associate chair of obstetrics and gynecology at Staten Island University Hospital in Staten Island, New York, said that both anesthesiologists and ob/gyns have been aware of these disparate health outcomes for years but have historically attributed the higher odds of injuries and death amongst Black women to health issues rather than racism.
“It is now quite evident that there is more to the story and that there is a degree of unconscious bias as well as systemic racism in health care that contributes to the disparities in outcomes,” Davidov, who was not involved in the study, said.
Meanwhile, new data show that maternal mortality worsened during the COVID-19 pandemic, particularly for Black women. The rate of maternal death for Black women was 44 per 100,000 live births in 2019, 55.3 in 2020, and 68.9 in 2021, according to the US Government Accountability Office. In contrast, White women had death rates of 17.9, 19.1, and 26.1, respectively.
“Bias or discrimination within the health care system can create communication challenges between providers and their patients, which may increase the risk of adverse outcomes,” the report stated.
What Can Be Done
The most important thing physicians can do is to understand and acknowledge unconscious bias, Davidov told Medscape Medical News. “It is important to learn how to identify biases and make sure that it does not affect your medical decision making,” he said.
He also urged physicians closely follow protocols for standard care for their discipline.
“Standardized care protocols have been shown to reduce variance between care of patients of different social structures and shown to decrease this disparity gap,” he said.
The study was supported by a Foundation for Anesthesia Education and Research Mentored Research Training Grant. White and Davidov report no relevant financial relationships.
ANESTHESIOLOGY 2022 annual meeting: #1080. Presented October 22, 2022
Wendy Wisner is a health writer and international board-certified lactation consultant.