Maternal Mortality

Black mothers more at risk for pregnancy-related deaths

BY HANNAH HERNER

In Tennessee, racism can be one of the leading reasons a woman loses her life during or in the year that follows pregnancy, according to a recent report from the state’s Maternal Mortality Review and Prevention Committee.

In 2017 through 2019, Tennessee has lost a total of 222 women to pregnancy-associated causes. Thirty percent of them were Black women while just 17 percent of Tennesseans are Black. The report also shows that Black women are nearly four times as likely to turn up on this report at all than white women, and 100 percent of their deaths were deemed preventable.

Systemic racism or racism while receiving care can impact a pregnancy for a mother.

“When we try to understand the why of this. The variability and risk of death by race may be due to several factors,” says Dr. Elizabeth Harvey, member of the committee. “It could be access to care, quality of care, the prevalence of chronic diseases, structural racism and implicit biases. And so, when we do look at recommendations, we look at the different levels of implementations of recommendations and recognize that each of these different levels has a role to play.”

This isn’t news to Kristen Meija. It was clear that things weren’t equitable when she became a doula, trained in a mostly white space. She felt ill-prepared for dealing with infant or mother death. It was just something that wasn’t talked about much, because it’s not affecting the white community as much, she says.

And when she had her first white client, she noticed differences in the way she was treated during labor and delivery compared to Black mothers in similar situations. This client was in labor for more than two days and it had stalled.

“She was given the choice of, like, the option to keep going,” Meija says. “And for Black women it’s not that all the time. And it’s more of this, OK, like, come on, let’s get it done. What’s up? You already been here. You’ve been here for two days. Let’s have a baby already.”

“Giving birth shouldn’t cost a dime, let alone somebody’s life,” — KRISTEN MEIJA, HOMELAND HEARTS

Photos courtesy of Homeland Hearts

Meija founded Homeland Hearts, a doula service led by and just for Black women, in a pledge to change the statistics. The organization also trains new doulas in offering non-medical, non-judgemental, evidence-based birth support.

“I had somebody ask me, isn’t that kind of discriminatory? Isn’t your program discriminatory?,” she says. “And I was like, well, if you think about the history of America, had it not been for discrimination in the first place, we wouldn’t actually be here and my program wouldn’t be a necessity.”

Homeland Hearts provides emotional and mental support during birth and throughout pregnancy. They seek to be a bridge between care providers and the mom and give support for the partners, too.

“Women are not always comfortable voicing their concerns in the doctor’s appointment,” Meija says. “I’ve been in doctor’s appointments with my clients, where sometimes I’ve had to stop the doctor and say, ‘OK, now can you explain that to us in a different way, as though we were not your medical school classmates?’”

For seven area zip codes, care is free — reimbursed by the Metro Health Department’s Strong Babies program. Outside of that, they work on a sliding scale, with the highest price being $750, and this always includes a birth doula, a postpartum doula, and a lactation peer counselor. Area doulas often cost more than $1,000.

Homeland Hearts also recommend doctors and hospitals where former clients have had the best experiences.

“We look for what we call dismissive care,” Meija says. “And those reports come from our clients. We have clients that can say that they feel like they’ve been put in a racial profiling situation during a prenatal appointment. We have clients that say they can tell that they don’t really feel like their doctor is listening to them, or I’ve had the experience with [hospitals] often not having enough beds for moms but then they schedule inductions.”

The Maternal Mortality Review identified contributing factors to the passing of those 222 women over three years, and categorized them into one of five factor categories in which change in the outcome could have happened. These categories were patient/family, provider, facility, systems of care and community.

All of the deaths studied by the review council are considered pregnancy-associated because they happened close to a pregnancy, while 30 percent are actually pregnancy-related, meaning it’s a chain of events caused by pregnancy or an unrelated condition aggravated by pregnancy and eventually leading to death.

In the three years studied, overdose has actually been the leading cause of death for all of them. Where moms live and how much money they make also makes a difference. The most deaths happened in the Western region of Tennessee, and the fewest in the central region. Overall, 55 percent were in a rural county and 45 percent in a metropolitan county.

And the fact that they live in Tennessee at all makes a difference. In 2018 the national rate of maternal mortality is 17.4, per 100,000 live births while in Tennessee it was 101. Sixty-eight percent of moms were on TennCare at the time of their death.

Before 2017, pregnancy associated deaths in Tennessee weren’t looked at very closely. A checkbox for pregnancy on a death certificate was only introduced in 2012, but it wasn’t necessarily accurate and there was no investigation into the nature of the death, or if it was preventable. The pre-2017 data isn’t even comparable to the data analyzed by the multidisciplinary Maternal Mortality Review and Prevention Committee, which was formed in 2017.

The 2021 report that came out in mid-March tells us about deaths in 2017 through 2019. There’s always going to be a lag so the committee can look at the year following a pregnancy, get the medical records and analyze them. Because of this, we won’t know if COVID-19 played a role in any maternal deaths until 2022’s report.

“Whether it’s personal stories of women or of our family members who either experienced a severe event or near death event, or women who have passed away,” Harvey says. “Those open up a conversation to think about, is it just that one story or what’s behind that? And I think that’s where maternal mortality review committees have really played a big role in terms of keeping these issues grounded in evidence and grounded in the data.”

Homeland Hearts has been denied three state grants, including one from Tennessee State Department of Health’s Office of Minority Health and Disparities Elimination, and the Maternal Mortality board, Meija says, so they’ve pivoted to just community-led funding.

“Despite any white people that may want to help or may really want to do the work that we’re doing, it’s not going to have the same impact,” she says. “And so we know that we have to be the ones to do it. And we’re OK with being the ones to do it. We just want to be able to feed our families too.”

The Maternal Mortality state committee and Homeland Hearts are coming at the issue of maternal mortality from very different places, but what drives them both is the fact that these deaths are largely preventable. Seventy-four percent of all the maternal deaths were determined to be preventable, with 21 percent having a ‘good chance’ of being prevented and 53 percent of having some chance of being prevented.

“Giving birth shouldn’t cost a dime, let alone somebody’s life,” Meija says.