Maternal Mortality Among Black Mothers in Massachusetts
Submitted by Samantha Normius
In Massachusetts, from 2011 to 2020, Black mothers have had the highest rates of severe maternal morbidity, with rates rising 10.1% each year (Massachusetts Department of Public Health, 2023). In Boston, this issue is prevalent in the Black and Haitian immigrant populations primarily due to a lack of culturally equipped providers, language barriers, and healthcare discrimination. These social determinants of health that Black and Haitian mothers are experiencing cause poor communication with providers, limit access to prenatal care, and cause difficulties for mothers navigating the system. I am asking for state officials to increase state funding that would aid in expanding the services in community health centers that serve Black and Haitian mothers. This funding would go towards hiring translators, culturally equipped experts, and providers to care for Black and Haitian mothers in Boston. This would create more access to doula services, midwifery care, and physician care for expectant mothers in these marginalized communities.
In 2023, a Black Haitian mother went to go deliver her first child at a local hospital, and the experience started okay, but she soon saw herself in a crisis that started with complaints of low-grade pain, different from the contractions she was experiencing. English is not her first language and she speaks predominantly Haitian Creole. As a result, she struggled to express her discomfort, and the providers struggled to show any urgency as the hospital did not have an available translator to aid in expressing her needs. As a result, this mother had a delayed diagnosis os bleeding that led to an emergency c-section, and during this c-section, she had undergone major blood loss that almost caused her to lose both of her ovaries. In the end, she and the baby left the hospital healthy, but she was traumatized from the experience, so much so that she ended up changing hospitals and her OBGYN for her subsequent delivery. This story highlights the need for an increase in services for mothers in this population to combat the language barrier and combat implicit bias by care providers. I was compelled to share this story because not only is this person someone in my direct community, but I have also seen an experience when the concerns of a birthing Black mother were ignored by providers, which resulted in a less than ideal delivery. Although this experience did not lead to maternal or fetal mortality, it highlights
the gaps in healthcare that may lead to a sentinel event.
In terms of data, the Massachusetts Department of Public Health has noted that Black women in Massachusetts have experienced pregnancy-related deaths twice the rate of white women (Massachusetts Department of Public Health, 2023). This highlights the urgency of this issue, that in 2023, Black women in Massachusetts are still dying at an alarming rate in childbirth. The effects of a language barrier on proper access to prenatal care are discussed in the study by Maxime Eslier et al. Eslier et al report that “Migrant women with language barrier have a higher risk of inadequate PCU than those without” (Eslier et al., 2023). PCU refers to prenatal care utilization, meaning these women are not getting the prenatal care they need simply due to not being able to communicate with providers. This is prevalent in the Creole-speaking community in Boston due to the high volume of patients compared to the low volume of providers/translators available.. The best way to combat this issue is by increasing funding to organizations and hospitals that would allow the hiring of more providers/translators, thus increasing the access for patients who need it.
I am asking again that Massachusetts state officials create programs and legislation that increase the funding of community health centers that cater to Black and Haitian maternal communities to combat the rising rates of maternal deaths due to the inequalities they still face in care. The increase in resources could lead to more hiring of Creole-speaking providers and support staff and more training on culturally sensitive care to providers. The increase in care for these issues will reduce the rapidly rising rates of Black and Haitian maternal mortality and reduce pregnancy-related complications. Black and Haitian maternal rising mortality and morbidity rates require the attention of all primary care providers in the maternal sector. We all need to take a personal responsibility in assuring that no mothers are dying from childbirth due to implicit bias or lack of provider education. It is evident that although policies and resources have been created, more can be done since Black and Haitian mothers are still dying at an alarming rate in our communities. I encourage all incoming and current nurse practitioners to take ownership of this issue so that we can all be advocates for the patients impacted by these issues.
References
Eslier, M., Deneux-Tharaux, C., Schmitz, T., Luton, D., Mandelbrot, L., Estellat, C., Radjack, R., & Azria, E. (2023). Association between language barrier and inadequate prenatal care utilization among migrant women in the Precare Prospective Cohort Study. European Journal of Public Health, 33(3), 403–410. https://doi.org/10.1093/eurpub/ckad078
Massachusetts Department of Public Health (2023) New DPH report reveals rates of severe maternal morbidity in Massachusetts nearly doubled over a decade. https://www.mass.gov/news/new-dph-report-reveals-rates-of-severe-maternal-morbidity-in-massachusetts-nearly-doubled-over-a-decade?utm_source=chatgpt.com