Amid a global pandemic and a year of social unrest, a long-standing public health crisis was highlighted: racial disparities in maternal health outcomes.
Black and Native American women are three to four times more likely to die from a pregnancy-related cause than a white woman, according to the most recent Centers for Disease Control and Prevention reports in 2017. Research suggests more than half of these deaths are preventable.
Compounded with COVID-19, whose disparate impacts by race mirrors that of maternal mortality in the U.S., Black pregnant women faced significant risks during childbirth this year.
“Black women right now are hesitant to go to the hospital knowing that these disparities are real,” said Dr. Rachel Bervell, an OBGYN resident physician at the University of California Irvine Medical Center.
That’s why advocates and lawmakers say that the Black Maternal Health “Momnibus” Act of 2020 is critical to pass, especially now.
Rep. Lauren Underwood (IL-14), Rep. Alma Adams (NC-12) and Vice President-elect Kamala Harris introduced the Momnibus Act in Congress on March 9 – mere days before the World Health Organization declared COVID-19 a global pandemic.
The Momnibus Act is designed to enhance existing policies that address America’s Black maternal health crisis and fill gaps in legislation. The act is composed of nine individual bills, all of which target a different element of the issue, including social factors, funding and support for specific demographics.
One of the largest priorities of the Momnibus Act is to invest in the social determinants of health – the social and physical environments that contribute to a person’s overall health such as nutrition, transportation and housing.
“You can’t address maternal health outcomes without addressing where mothers come from and the experiences they have day-to-day,” said Dr. Tamandra Morgan, an OBGYN resident physician at the University of California San Francisco.
Local health experts say this is especially relevant in Chicago, where Black birthing people experience 2.5 times more severe complications than their white counterparts, according to 2018 reports from the Chicago Department of Public Health.
In a city with a growing maternal health desert and neighborhoods with stagnant economic development, it’s time to recognize the impact social components have on health, Dr. Shelley Amuh said.
Amuh is an OBGYN hospitalist at Advocate Trinity Hospital on the Southeast Side. She grew up nearby on 101st and King Drive.
“There’s been no economic development since I left high school in 1979,” she said. “How can someone there be doing well right now?”
This year, the barriers to accessible maternal care were heightened when five community hospitals on the South Side closed their Labor & Delivery departments or completely shut down. Not only did this disrupt the continuum of prenatal care for many pregnant people, but it also overwhelmed the capacity of the few hospitals that were still standing.
“For some women this summer, the only hospitals left standing were far enough that you might not make it before you deliver,” Amuh said.
Studies show that investing in social determinants such as transportation and housing improves health. But worse pregnancy-related outcomes among Black and Native American communities can’t only be attributed to unequal access to care. Highly educated and financially secure Black women also have documented dangerous pregnancy-related complications.
In 2018, tennis icon Serena Williams revealed her life-threatening experience during childbirth. She shared how difficult it was for her – an elite athlete – to receive appropriate care.
“If Serena, who is wealthy and very well-known, wasn’t trusted and believed by her physician, what does that say for a person with limited education or unemployed?” said Jessica Davenport-Williams, an advocate for Black women and children in Chicago. She added that Williams’ story sheds light on the prevalence of systemic racism and discrimination in medicine.
To address this, the Momnibus Act also commits to investing in grassroots organizations that work directly in communities to improve maternal health outcomes and increasing the diversity of perinatal workforce. These elements in tandem would allow more patients to receive care from providers they trust, agreed Bervell and Morgan.
The broadness of the Momnibus Act comprehensively addresses many dimensions of the Black maternal health crisis, but it’s not an encompassing solution, said Davenport-Williams, who co-founded the non-profit organization Black Girls Break Bread.
“We need to take an interprofessional approach,” she said. “We need to reach across sectors and involve urban planning commissioners and hospital administrators.”
But if the Momnibus Act is passed, it would be an important first step.
“I’m tired of studies that come out that say ‘Black women this’ and ‘Black women that.’ We know,” Morgan said. “What are we going to do about it?”