The quality of care at hospitals where a disproportionate number of African-American women give birth is an important factor in black women being more likely to suffer serious complications during childbirth than white women, an analysis by ProPublica finds.
Previous research has found that black women in the United States are three to four times more likely than white women to die of pregnancy- or childbirth-related causes. While the disparity can be attributed in part to factors such as poverty and inadequate access to health care, the pattern persists even when controlled for educational attainment, obesity, and poverty level. According to ProPublica, there is growing evidence that points to the quality of care at hospitals where a disproportionate number of black women deliver as an important contributing factor in the disparity.
Using two years of hospital inpatient discharge data from New York, Illinois, and Florida, ProPublica analyzed how well different facilities treated women who experienced hemorrhages while giving birth. Across the three states, about one in ten hospitals served African-American mothers as a significant share of their patients. The analysis found that, on average, rates of complications from hemorrhage at "high black-serving" hospitals were far worse than at "low black-serving" hospitals — 21 percent higher in New York and 11 percent higher in Illinois and Florida.
Earlier studies by Elizabeth Howell, a professor of obstetrics and gynecology at the Icahn School of Medicine at Mount Sinai Hospital, found that black mothers were twice as likely as white mothers to suffer harm when delivering a baby, and that the rate of harm for black women would fall by nearly 50 percent if they gave birth at the same hospitals as white women. Given that three-quarters of black mothers deliver in about a quarter of the country's hospitals, Howell told ProPublica, racial disparities could be reduced if hospitals that disproportionately serve black women improved their care. In California, complications related to obstetric hemorrhage fell by about 20 percent in hospitals that adopted protocols promoted by Elliott Main, medical director of the California Maternal Quality Care Collaborative. But Main's protocols have not been universally adopted in California, let alone elsewhere in the U.S., and many hospitals go their own way, ProPublica reports.
The New York City Department of Health and Mental Hygiene has published reports showing that even as the overall maternal mortality rate across the city has dropped, the disparity in maternal mortality rates between black and white mothers has grown wider. The highest rates of complications were concentrated in an area of central Brooklyn largely untouched by the wave of gentrification that has swept through the borough, with mothers served by hospitals there up to four times as likely to experience a complication as mothers served by hospitals in neighborhoods a few subway stops away. What's more, between three-quarters and nearly 90 percent of mothers who delivered at the three medical centers in the ungentrified neighborhood were black, ProPublica's analysis found, while more than half the mothers who hemorrhaged during delivery experienced complications. SUNY Downstate, where 90 percent of the women who give birth are black, had one of the highest complication rates for hemorrhage across all three states: on average, 62 percent of women who hemorrhaged while giving birth there experienced significant complications, compared with 34 percent at New York hospitals overall. The city's health department has begun to target the area with services in recent years, supporting prenatal programs and the By My Side initiative, which pairs up women with doulas who can advocate for them during birth.
"We used to say we are not sure why we are seeing these racial disparities. Now we say unequivocally that racism causes these problems," said Deborah Kaplan, the city's assistant commissioner for maternal, infant, and reproductive health. Kaplan emphasized that the factors involved in the disparity encompass not only health care but all aspects of life in the city, from housing to schools. "If we provide equally to everyone, we could widen the inequity," Kaplan said. "We have to prioritize putting resources in neighborhoods with the highest rates of severe maternal morbidity and the least access."