Expectant mothers in the United States have plenty to worry about, from concerns about medical costs and childcare expenses to wondering what, if any, parental leave they'll get. What millions of American mothers-to-be may not know, however, is that one of the big worries is actually about their own health. Fusion's new documentary, Death By Delivery, which airs Wednesday night at 9pm, demonstrates why maternal mortality should be a real and pressing concern for thousands of women per year. Even more alarming, Black women face the biggest risks of all.
Most American women probably don't spend much time worrying about the medical complications they may face during childbirth. It's the same reason you don't worry about polio, scurvy, or malaria — these are all, supposedly, medical traumas that only affect women without access to modern healthcare. Yet, as Death By Delivery documentarian Nelufar Hedayat discovered, maternal mortality rates are higher today than they were in 1987. Black women, moreover, are nearly four times more likely to die during childbirth than their white counterparts. This statistic is all the more stunning because, according to the documentary, the discrepancies persist even when researchers controlled for socioeconomic status and education.
"You can be a college-educated black woman and you will have, in probability, a worse birth outcome than if you were a high school-educated, nonworking white woman," Hedayat tells Bustle. "This is not an issue about poverty," she adds, "but about racial discrimination."
If controlling for poverty doesn't eliminate the difference, what could be the cause of the maternity health gap between black and white women? Hedayat tells Bustle that the most compelling explanation reveals a story about the cumulative effects of growing up black in the United States. "This idea that the minute you're born as a young black woman, you're already at the bottom of the political capital pile ... you're not a middle-class white man, so already society is geared to not listen to you," she explains.
The double jeopardy of being black and female.
Simply being listened to can make an enormous difference in the healthcare system, and it explains at least part of why marginalized groups experience worse health outcomes. A University of Maryland study demonstrated that women's pain is not taken as seriously as men's by healthcare providers; consequently, women are less likely to be adequately treated for pain. Similarly, The Boston Globe reported that black pain patients are less likely to receive pain medication than their white peers — and even when black patients are given pain medicine, they receive less.
Black women, of course, are at the intersection of each of these areas of disparate treatment. It's what Dr. Fleda Jackson, a health researcher interviewed in Death By Delivery, calls "the double jeopardy of being black and female."
Hedayat, who grew up in the United Kingdom, tells Bustle that she was surprised by the severity of the racial discrepancy in America. "I was noticing this with every mother I was speaking to, they don't live in the America that we see from the outside," she says. While filming Delivery, Hedayat says she "was experiencing a very divided states of America."
However, solving the problem is not simple. It's as much about training doctors as it is also about addressing other ways in which black women are literally and figuratively marginalized.
Hedayat spoke with expectant mothers who live very far away from hospitals equipped with good prenatal facilities and with others who can only afford subpar care — a "qualitative and quantitative issue," she tells Bustle, that "creat[es] this spiral downwards for black women."
Conversations about reproductive justice tend to revolve around access to abortion and contraception — both of which are critical components of women's rights — but equal access to quality medical care for wanted pregnancies is just as important.
Fortunately, American women are fighting back. Death By Delivery profiles activists like the founders of Black Mamas Matter, a group dedicated to improving health outcomes for black expectant mothers; and Marsha Ford, an Atlanta midwife who works to help her clients have safe and comfortable birthing experiences.
Putting pressure on elected officials to address the problem is another key component of solving it.
"Policymakers and ... the government have not made this an urgent public health and human rights issue," writes Dr. Joia Crear Perry, president of the National Birth Equity Collective, in an essay for The Root.
In an article on Fusion's website, Hedayat cites a number of actions that government officials could take, including lending their support to a bipartisan bill, the Preventing Maternal Deaths Act, which was introduced in Congress last week. The bill seeks to help states create committees to review maternal mortality issues, to improve relevant data collection, and to help identify specific solutions to connect black American women with the healthcare they need.
Despite the myriad challenges of fighting back against a problem caused, at least in part, by entrenched, structural racism, Hedayat believes that the problem of black maternal mortality is solvable.
"America isn't the basin of all things treacherous," she tells Bustle. "It's a land of hope, a land of opportunity, and a land where people have done amazing things."
If Death By Delivery and groups like Black Mamas Matter succeed in raising awareness of this dire problem, perhaps reducing black maternal mortality rates — thereby saving black lives — will be one of those "amazing things" before long.