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Cultural Considerations for African American Mothers in the Maternal Setting

The birth of a child is one of the happiest moments in a mother’s life. The joy of parenting your little one when you leave the hospital with unknown expectations. However, for African American mothers are facing proportionately higher risks for maternal post-natal maternal deaths. Black women are three to four times more likely to experience a pregnancy or childbirth-related death than White women. Recognizing these issues increases the feelings of depression and anxiety, which can increase Black women’s risk of developing postpartum depression.

The United States has long struggled with having one of the highest maternal mortality rates among wealthy and industrialized nations. And the number of people in the nation dying from ­pregnancy-related complications is on the rise; more than 850 people died in 2020 compared with around 750 in 2019 and around 650 in 2018 (Hoyert, D. L., National Center for Health Statistics, 2022). But Black women suffer the greatest impact, as they are three times more likely to die during and after childbirth than White people. Similarly, Black birthing people are also more likely to experience long-lasting mental health concerns after childbirth than their non-Black counterparts, even though they typically get less treatment for postpartum depression.

The reproductive health of Black women has long been compromised by interpersonal, institutional, and structural racism. In addition to contending with social and economic drivers of poor health that undermine Black Americans, they have experienced discriminatory health care practices and abuse from slavery to the present.

From non-consensual medical experimentation, to failing to listen to patients or providing an adequate standard of care, health care itself has been a driver of the death and severe complications that Black birthing people face. Cynthia Prather, Taleria R. Fuller, William L. Jeffries IV, Khiya J. Marshall, A. Vyann Howell, et al. “Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity,” Health Equity, September 24, 2018, http://doi.org/10.1089/heq.2017.0045 

Why are Black women at risk for maternal Health Crisis?

Research points to several reasons why this racial and socioeconomic disparity exists for Black people, such as lack of access to high-quality health care, missed or delayed diagnoses of issues like hypertension (Peterson, E. E., et al. Morbidity and Mortality Weekly Report, Vol. 68, No. 18, 2019), and lack of action or knowledge from providers around warning signs. Data from the U.S. Centers for Disease Control and Prevention (CDC) suggest that 60% or more of maternal deaths could have been prevented by addressing these types of issues. Many psychologists say stress is another factor that can contribute to poor maternal health outcomes for Black people.

To Solve Black Maternal Health Crisis:

Three interventions that can help are niche therapies and sister circles, patient advocacy, and self-advocacy and ­cultural-sensitivity training (Knight, M., et al., Saving Lives, Improving Mothers’ Care, 2015).

Neal-Barnett started the Spirit of Motherhood Program in 2021, which screens expectant mothers for PTSD and chronic stress, with the hopes that treatment of these symptoms can reduce maternal mortality rates.

The program builds upon prior work around an intervention she calls “sister circles,” which are support groups. These build upon existing friendships, culturally relevant discussions, kin networks, and a sense of community to help reduce anxiety and stress among Black women (Clinical Psychology: Science and Practice, Vol. 18, No. 3, 2011).

 Therapists could help translate some of their patients’ concerns to their physicians or tell them that they need to do a better job of listening to their patients.

Transform the Delivery of Black Maternal Care

Congress must pass the Black Maternal Health Momnibus Act (S. 1606 and H. R. 3305), which addresses every driver of maternal mortality, morbidity, and disparity in the country by making investments in social drivers of health that influence maternal health outcomes.

Destigmatize and Treat Black Maternal Mental Health

Sixty percent of Black mothers do not receive any treatment or support services for prenatal and postpartum emotional complications due to lack of insurance coverage.

Protect and Expand Access to Reproductive Health Care

A National Partnership for Women & Families analysis reveals that Black women who have recently given birth are more likely than other women to live in a state that has banned abortion or is likely to ban it.

Conclusion

In conclusion, healthcare organizations could consider a few interventions that can help ease the brunt of the maternal health crisis.  

A few interventions that were named:

  • niche therapies 
  • sister circles
  • patient advocacy
  • self-advocacy 
  • cultural-sensitivity training

Even consideration such as rounding therapy on the OB GYN floor could help provide a sounding board to moms who need to be heard.

Community interventions after discharge such as a resource kit from The Color of Wellness Media, that provides patient education via digital media:

Dedicated health magazine by black nurses for black moms,  Private podcasts full of  similar information, as well as video series that moms can watch on demand to help carry them through the post partum period. 

For more information regarding the above resources, please connect with The Color of Wellness  at: www.colorofwellness.co

References

Chatlani, S. (2022). Focusing on maternity and postpartum care for Black mothers leads to better outcomes. Apa.org. https://www.apa.org/monitor/2022/10/better-care-black-mothers

Gray, et al, V. (2023, November). Fact Sheet: Black Women’s Maternal Health. National Partnership for Women & Families. https://nationalpartnership.org/report/black-womens-maternal-health-fact-sheet/