Racism is unlikely to be the cause of the Black maternal mortality crisis

Everyone “knows” that the Black maternal mortality crisis is due to racism.

According to Ms. Magazine:

Maternal mortality is one of the most compelling indicators that America runs on racism. Here’s what we need to do to overcome this legacy and current reality.

WGBH Boston reported:

Despite all the modern advances in medical care, pregnancy and birthing can be dangerous for women of color. Massachusetts boasts some of the best hospitals in the world, yet here in the Bay State, Black women are nearly two times more likely to die from pregnancy-related causes than white women.

It’s a sobering statistic, and racism is largely to blame, local experts [claim} … Black women are often disregarded and ignored when raising concerns about their symptoms.

Hulu is about to release a documentary on Black maternal mortality entitled Aftershock:

The statistics speak for themselves: According to the CDC, Black and Native women are two to three times more likely to die from pregnancy-related causes than white women in this country. “Aftershock” is the result of tragedy, and the collaborative efforts of families who have endured the outcomes of systemic racial discrimination in reproductive health.

But for every complex problem there is a solution that is clear, simple … and more than likely wrong.

Such is the case with the effort to place the blame for the massive rates of Black maternal mortality on racism. While it is depressingly true that racism in America is active, ugly and apparently growing, the statistics about race and maternal mortality do speak for themselves — and they show there is no clear relationship between racism and maternal mortality.

Black people are hardly the only victims of racism in the US. Latinos, Native Americans and those of Asian descent are also victimized.

If racism were the proximate cause of maternal mortality we would expect to see mortality rates among ethnic groups proportionate to the likelihood of racism. But that’s not what we find.

These are the latest maternal mortality statistics from the CDC:

If racism were the cause of maternal mortality we would expect Hispanic women to have maternal mortality rates substantially higher than those of white women but not as high as Black women. Yet that’s not what we find. Instead Hispanic women have maternal mortality rates even lower than those of white women. So discrimination is not linearly related to maternal mortality.

That’s in contrast to factors like age and socio-economic status that are linearly related suggesting that — unlike racism — they are major contributors to maternal mortality.

If racism were the cause of increased mortality it would not be confined just to the weeks and months after birth. Overall mortality would also reflect the level of discrimination. Yet that’s not what we find. Instead Hispanic people have the highest life expectancy.

Mortality statistics from the CDC:

Moreover, women — who arguably face much higher rates of discrimination than men —nonetheless have higher life expectancy.

In my view, blaming racism as the primary driver of Black maternal mortality while satisfying to some is too easy and likely to be ineffective since there is no clear relationship of racism to mortality.

Consider that cardiovascular disorders are the leading cause of maternal mortality in the US, and Black women have higher rates of pregnancy-related heart attack, stroke, peripartum cardiomyopathy, and pulmonary embolism than White women, even when differences in age, health conditions, cesarean section rate, socioeconomic factors, and access to health care are taken into account.

Blaming racism isn’t going to help these women avoid cardiac complications or recover from them. That would require a commitment to increase the number of perinatologists and obstetric ICUs and to provide expensive interventions. It’s much easier and cheaper to pretend that Black doulas could improve maternal outcomes by ameliorating racism.

I would never deny the existence of virulent racism in the US. But just because racism exists and Black women die in appalling numbers does not mean that the former causes the latter. I fear that as long we focus on racism, and not on providing high tech obstetric care, Black women will continue to die in heart-breaking numbers.