Tori Bowie and The Epidemic of US Black Maternal Mortality and Morbidity

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The untimely and tragic death of U. S track and field star Tori Bowie renews the conversation about the epidemic of black maternal mortality and morbidity in the United States. Black women, more than any other race of women, are more likely to develop deadly complications or die during, before or after giving birth. I've covered this topic before, but it bears repeating black women are dying while giving birth, dying while carrying babies.

And it is absurd black women. Are you aware of the risks we face when we are pregnant? Well, I've got some explaining to do. Let's get into it. 

 Hey, welcome back Allianz to another episode of Ayanna Explains It All. I'm recording this podcast on June 19th, 2023. Yes, it is Juneteenth and I am a black person working.

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When they announced that Tori Bowie had passed away. I thought it was strange because she was 33 years old. And anytime a black person passes away young, you always want to know why, like we have this yearning desire to know why, because young people don't die. Right? I mean, they do, but anytime I hear a celebrity dies, and I've mentioned this before, I'm always worried.

Because if they're black, I know it's because of something, um, we've talked about in the past that black people have a higher rate of dying from cardiovascular disease. And it tends to be that cardiovascular disease or breathing disorder or natural causes, as they say, those are natural causes, but it could also be drug overdose.

It could be. A car accident or, or what have you, but this time when they finally, when the coroner finally announced her cause of death, that Tori Bowie had died during childbirth, that she had developed eclampsia, I was like, Oh my God, this is just ridiculous. This is ridiculous. This is, it's, it's, it's insanity.

It's insanity. This is happening to healthy black women, unhealthy black women, black women of all ages, black women of all socioeconomic backgrounds, professionals, unemployed women, black women are dying Hmm? While giving birth, black women are dying while pregnant, black women are dying after giving birth, but they're also developing all of these diseases and disorders that are not controlled while they are pregnant and it complicates their pregnancy and affects the fetus.

And. I keep hearing that it's an epidemic and I keep seeing that it's an epidemic, but my God, it is not being treated as if it is an epidemic. And what I mean by that is that people are not scrambling to save the lives of black women. People and the government are not scrambling to save the lives of black women like they would if this were the drug epidemic or if this were a global pandemic.

They see the disease spreading and they bring all of the resources of the government to bear to stop it from spreading. And when you hear that black women are dying while giving birth and your response is, well, we were, we'll look into that. It's ridiculous because it's happening right now. What are you going to do right now?

And I understand that you can't reach into every home into every woman's life and manage it to a point where you, you're essentially trying to prevent her from dying while she's pregnant and giving birth and after she gives birth. But there are things that we can do to stop the spread of this epidemic, and I'm gonna get into those.  But before I do that, I want to talk about the statistics. Black women in the US are three to four times more likely to die from pregnancy related causes. This disparity persists across all socio.

economic levels, education levels, and even when controlling for factors like age or prenatal care. The maternal mortality rate in 2021 was 89% higher than the rate in 2018. But more than 80% of pregnancy related deaths are preventable.

And this information is coming from the National Institute of Health and the Center for Disease Control. They reported statistics through the National Vital Statistics System. In 2021, the maternal mortality rate for non Hispanic black women was 69. 9 deaths per 100, 000 live births, 2. 6 times the rate for non Hispanic whites.

Rates for black women were significantly higher than rates for white and Hispanic women. The increase, the increases from 2020. To 2021 for all in 2021, as I said before, in 2021, the maternal as I, as previously mentioned in 2021, the more as previously mentioned in 2021, the maternal mortality rate for non Hispanic blacks.

The increases from 2020 to 2021 for all race and Hispanic origin groups were significant. Race in rates increased with maternal age rates in 2021 were 20 point. Four were 20.4 deaths per 100,000 live births for women under age 25 and 31.3 for those aged 25 to 39 and 138.5 for those age 40 and over. So the older you get, the higher the risk of developing, uh, complications that could lead to the death of the mother during childbirth.

The rate for women aged 40 and over was 6. 8 times higher. Then the rate for women under age 25 differences in the rates between age groups were statistically significant. The increases in the rates between 2020 and 2021 for each of these age groups were statistically significant.

And the rates of death only increased with maternal age. For instance, rates in 2021 were 20. 4 deaths per 100, 000 live births for women under age 25, 31. 3 for those aged 25 to 39, and 138. 5 for those aged 40 and over. The rate for women over age 40. And over the rate for women aged 40 and over was 6. 8 times higher than the rate for women under age 25.

 But this is a complex issue, with deep roots in systemic racism and healthcare inequities. And it's not just the mortality rates. It's also maternal morbidity or the occurrence of adverse health outcomes and complications experienced by black women during pregnancy, childbirth, and the postpartum period.

It encompasses a range of physical and mental health conditions that can have significant short term and long term consequences for the well being of the mother and the child. Black women also face higher rates of complications during pregnancy, such as preterm birth, low birth weight, and gestational diabetes.

The disparities are alarming and demand urgent attention. It's time for action. For a time when I was pregnant with my son and this was in, I was pregnant 2003, 2004, in my third trimester, I had excruciating.

Leg pain. I didn't know it at the time, but it was nerve pain. It was sciatic nerve pain and it started in my lower back and it would go into my legs to the point that it hurt to move my legs and I didn't know what the hell was wrong with me. I thought this was just, um, just something that happens when you're pregnant.

You know, I was big and pregnant. Um, I was carrying a big baby. My son was 10 at birth. He was overdue, but whatever, but the pressure of that large sack with the large baby and all the fluid on my lower back was such that it was creating this nerve pain and it was radiating into my left leg, my right leg, into my.

foot. My feet hurt. My feet were swollen. And I went to my doctor, you know, during one of my routine checkups. And I was like, Oh, my back hurts so bad. My legs hurt. My feet hurt. And she was like, Oh, it's probably just from, you know, carrying the weight of the baby and you're not really moving around much. So here's a I'm going to physical therapy and you can go there and, and this should make you feel better.

Now, at the time I did not have reliable transportation because I was dealing with a spouse who needed the car during the day to go to work. I wasn't working and there was no way I was getting to physical therapy. I was, I, there was just no way. So I just blew it off. I said, whatever, I guess I'll just have to endure it.

When women are pregnant, we think we just have to endure these things to carry a baby and we don't, we do not, you don't have to endure pain and discomfort simply because you are pregnant. Sometimes that pain and discomfort is a sign of something else, but we don't, it doesn't click for us because a lot of us, when we're pregnant, especially Black women, we're not, we don't have a doctor who sits down with us and says, this can go wrong.

This can go wrong. This can go wrong. This is what you need to look out for. You know, they give you that prescription for prenatal vitamins and you think, oh, okay, I'll just take my vitamins and I'll just, you know, eat sufficiently and I'll be fine. You know, when Tori Bowie, when she died, she was 96 pounds.

But there are things that people don't tell us when we're pregnant about nutrition, about our blood pressure, about the different things internally that are going on with us, about the organs have to move around to make room for the the fetus, about how your heart is pumping more. Your heart is working harder, your liver is working harder, your kidneys are working, everything is working harder.

And the baby is essentially sucking the nutrients from you. And so you might need a lot of dental work after you deliver because you'll develop a lot of cavities or you'll develop, um, carpal tunnel syndrome because, yeah, and, or you'll develop, you know, knee pain, ankle pain, you'll, you might break a bone.

I mean, it's, it's, it's all of these things that could happen and no one tells us this. People say, Oh, well, here's this book, go read this book. Or here are these papers about, you know, all of these things to look out for and call 9 1 1 if you feel anything strange. And no, we need, we need better education.

We need better education when it comes to being pregnant. And I feel like that's maybe what Tori Bowie needed. But according to her publicist, she kind of lived in a world that was. closed off from much of her friends and family, like she had a very few friends and she grew up in foster care. So her family situation was kind of, um, was not that close knit.

So her neighbors observed that she was, you know, as one said, big and pregnant. And so when she died, it was a surprise to everyone. Like nobody knew she had been dead for a week inside of her house and nobody knew because there weren't people checking up on her. There weren't people that she talked to every day who at one, you know, if you don't hear from her for one day, somebody is concerned.

No, you could go weeks probably without hearing from her and would think it was totally normal. But because she was pregnant, her publicist thought it was abnormal to not have heard from her. Um, And I believe I don't think she was 28 weeks, uh, something like that. So when she passed away, the fact that she was severely underweight and she had developed eclampsia meant that she was probably having seizures.

She probably went into a coma. And she may have died in that manner. You, we don't really know, but that's usually what happens. And when asked to comment on the story, her teammate from the, um, I think it was the four by 100 meter relay that they ran together in Rio de Janeiro. That's where they won their Olympic gold medal.

 Alison Felix, who famously. Famously left Nike because they were not supportive of her while she was pregnant and her desire to want to put her career aside just momentarily to give birth. Her teammate, Allison Felix, said that

Actually, three gold medalist, including herself from that four by 100 relay team in Rio set out to become mothers. Three of them, all black women had serious complications. Tiana Madison had shared that she went into labor at 26 weeks and entered the hospital with my medical advanced directive and my will and Tori passed away and Allison Felix developed preeclampsia and had to be hospitalized.

 And she points out, as I said, it's absurd that black women are dying while giving birth. It is absurd. And most of these things that are happening to us while we are pregnant and giving birth are completely preventable. They're preventable. Imagine an epidemic caused by something that is preventable.

Right. It's like if, um, the flu is preventable, but there's a flu epidemic, there's a flu outbreak. So they give everybody flu vaccines, uh, other diseases that are treatable with penicillin. Those things become epidemics and they're out of control. And so you treat everybody with penicillin and everything is fine.

Okay. So black women dying during childbirth, it's out of control. It's an epidemic. What are you going to do about it? You can't give us pills. Obviously you can't give us a shot. It requires something more in depth, but I feel like the reason this is not being explored and treated as well as it should is because as with anything in this country, the history of why it is the way it is, is very uncomfortable for a lot of people.

You have to confront old demons. You have to confront those old haunts of slavery. And racism in the United States, you have to deal with it. In order to reconcile what is happening with black women today in health care and giving birth. So in 2021, the maternal mortality rate for black women in the United States was 69. 9 deaths. per 100, 000 live births. And that's almost three times the rate for white women per the Center for Disease Control. And that's the latest statistic that we have. Black women who have more access to maternal health care are still Okay.

Listen to this. Black women who have more access to maternal health care are still at higher risk of dying during or after childbirth than white women who live in underserved areas. And that's coming from Axios. So having insurance coverage doesn't even matter. It doesn't matter. Insurance is not enough.

Having coverage is not enough. It's not enough to say, well, they have insurance now, so they'll go to the doctor. No, no. You have to look at the reasons why some people do not go to the doctor. Tori Bowie, for instance, didn't want to deliver in a hospital. She probably had a mistrust of doctors in the medical field and et cetera, et cetera.

But a lot of people feel that way. A lot of women want to give birth at home or under their own birth plan. Under their own circumstances, they want to use a Dola. They want to do it in a large birthing pool at home or at a birthing center or what have you. They don't want to do it at a hospital. They don't want to be surrounded by doctors and And, uh, all this sterile environment, they want to be comfortable.

They want to feel relaxed when they're experiencing that pain. And I don't blame them. I don't blame them. You know, I had a friend who delivered her, her last, her, um, her son at a hospital. This was many years ago. But after she delivered him, he developed a staph infection from being in the hospital, a newborn baby with a staph infection.

I mean, anything can happen. Anything can happen. And so we want to be able to take control of how we give birth and how we, um, approach our. Pregnancy. So it's not enough just to say, Hey, they have insurance. They'll be okay. No, because we're still dying at a higher rate than women than white women who live in underserved areas.

And now with the multitude of changes in abortion laws, more women, more women, not just black women, I understand, but more women period will be forced to carry and deliver babies. But for black women, we will not be warned of the risks or given preventative information or guided through our pregnancies.

Again, insurance coverage is not enough. Not when you live in a country that has the highest maternal mortality rate of any high income country and significant disparities in outcomes and the crisis is only worsening.  inequities experienced by black women are not merely a cross section of time or the result of a singular incident. Race and ethnicity are sociocultural constructs that reflect common geographic origins, cultures, and social histories of groups that are defined by societies in time dependent contexts.

No discussion of health. Equity among black women is complete unless it considers the impacts of institutional and individual level forms of racism and discrimination against black people, period. Nor is a review of health equity among black women complete without an understanding of the intersectionality of gender and race and the historical context that have accumulated to influence black women's health.

In the United States, research consistently has documented the continued impacts of systemic oppression, bias, and unequal treatment of black women. Substantial evidence exists that racial differences in socioeconomic and housing outcomes among women are the result of segregation. Discrimination and historical laws purposed to oppress blacks and women in the United States.

And so the reason why we receive the treatment that we receive, the reason why our health is the way that it is, is because of the legacy of segregation, racism, and American slavery. The, the researchers at the National Institute of Health go on to say that black women earn on average 5, 500 less per year and experience higher unemployment and poverty rates than the U.

S. average for women. Black women are more likely to be the head of household than their white counterparts, supporting more dependents with fewer resources. And black women live in neighborhoods that are more racially segregated and have lower property values than their white counterparts.

Some of this is due to mortgage lending discrimination, think redlining and residential segregation. Is a fundamental cause of racial disparities and health operating through many social institutions, including labor markets and education to affect health. The intersectionality of gender and race and its impact on the health of black women also is important.

Black women are subjected to high levels of racism, sexism, and discrimination at levels not experienced by black men or white women.  Again. The intersectionality of gender and race and its impact on the health of black women also is important. Black women are subjected to high levels of racism, sexism, and discrimination at levels not experienced by black men or white women.

In contrast to black women, U. S. white women benefited from living in a politically, culturally, and socioeconomically white dominated society, which accumulated across generations, creating a cycle of overt and covert privileges not afforded to black women, such as wage gap differentials and the invisibility of whiteness.

I. e. not having to think about one's race.  These privileges do not mean that all white women are similarly advantaged, nor are all black women similarly disadvantaged. 

But it does explain why black women, despite having health coverage, experience maternal mortality at a higher rate even of those white women who live in underserved regions. These are the social determinants of health that create health disparities where we are born, live, work, and play.

These factors determine health outcomes and for black women contribute to the high maternal mortality rate in the U. S. And because these social conditions exist and persist, the health disparities exist and persist. We are at a disadvantage. Not simply because we are Black and women, but because health disparities exist and persist for Black women that do not exist at all for other women.

We have to address the social determinants of health that disproportionately affect Black women if we are to stop the epidemic of rising Black maternal mortality and morbidity in the United States. Also, access to gynecology contributes to health disparities. We know that black women's access to health care in the United States has been for decades limited by our environments and occupations where we live, but also is rooted in American slavery.

Black women were chattel. They were servants. They were breeders. Black women's bodies were abused and their health disregarded for the gain of their enslavers. Black women were not allowed charge over their bodies and had limited to no access to health care. Even after slavery. This condition persisted and the development of gynecological medicine saw black women used as subjects in gruesome medical experiments.

And at what point were black women taught to take control of our bodies and our health? When did we feel empowered to make medical decisions in our best interest? And I'm not talking about how to make ourselves more apt for carrying and delivering babies or how to look more appealing to men. I'm talking about making decisions for our health that were in our best interest, our personal best interest.

And if you grew up in a conservative religious environment as I did, you were not empowered about your own body or taught how to make these important decisions for yourself. You were taught that your body is for your husband and your body is to birth babies and to feed babies. And that is it. You get a period and you don't get a period.

You were not taught empowerment over your body. You were not taught how to protect your body. You were sexually assaulted. You were sexually molested. You were abused and you were told not to talk about it. When did black women receive agency over our bodies? When did we become empowered? to make medical decisions in our best interest.

Given the history of black women in the U S and the accumulation of these disadvantages, black women are at the forefront of a public health emergency and change is not accumulating to address this life threatening crisis. It does not make sense. That despite the achievements of black women in this country, that we have to continuously advocate for ourselves to receive better care from medical practitioners and facilities and advocate for access to treatment opportunities that our white counterparts receive.

We are grateful. Still begging to be treated in a manner in which our white counterparts are treated. We are still begging to receive the best treatment. We are still begging to be treated like human beings. We are still begging to be allowed agency over our own bodies.  Slavery ended in 1865 and here we are still begging for power over our bodies.

So what do we do? How do we ameliorate this? Talking about it is great. Discussing is discussing it as great discussing it with your friends, your family, girls in your family, women in your family, your aunts or your grannies, your, your mom, your siblings. When you go on your girls trips, talk about it, talk about not just how excited you are to get pregnant and be pregnant and raise a family, but acknowledge the risk that comes with it for black women in the United States.

You think you're insulated because you have a neat career it doesn't matter. An epidemic doesn't care who you are. You've seen the drug epidemic in this, in this country. It doesn't care if you're rich or poor, if you're doing well or doing not so well. It'll come for all of us. You don't expect that a U.

S. Track and field gold medalist is going to die during childbirth. You don't expect that a, uh, a grand slam majors champion in tennis is going to nearly die giving birth to her daughter. That happened to Serena Williams, you don't expect a woman who, who is an attorney, who has a career in law, would develop complications during childbirth and have to beg to be given a c section.

After hours of laboring and watching her baby's heart rate drop while she's giving birth. You don't expect it, but that happened to me. 

We need to acknowledge that racism and implicit bias exist within the healthcare systems. It's vital to provide cultural competency training to healthcare professionals and implement anti bias strategies.

Additionally, we need to expand access to high quality prenatal care and reproductive healthcare services in underserved communities. This includes ensuring affordable and comprehensive healthcare coverage for all. We have Obamacare, we have expanded Medicaid, but there are still people who are not being served.

There are still people who don't have health insurance and in all states when you're pregnant, you can get Medicaid, but only in, uh, 41 states and including DC, do you still have a year of services?

There are still 10 states that have not expanded Medicaid. And so when you have your baby, that's it. The baby is covered. You're not. And there are still places where you make too much money to qualify for certain insurance programs, but you don't make enough money to pay for insurance on your own. And so there's that gap.

There are people who fall into these gaps who have no health insurance coverage, but again, having health insurance coverage is not enough because what if you also don't have reliable transportation? What if you don't have internet help? What if you can't read? If someone gives you a book to read about pregnancy and you don't know how to read or you're not poised enough to understand the information that you've read.

Then it's not going to help you. Maybe you need a class. Maybe you can take an online class about the risks of pregnancy, what can go wrong, what to look out for. Or maybe you could just have a doctor available. Or maybe you could have a doctor available to you or a nurse. Ask a nurse to talk to you when you have questions.

Sure, you can go on the internet and enter in pregnancy complications in Google. and get scared out of your fucking mind. Or you can have some comprehensive conversations with people where they make sure that you understand and are, and are assured where you are looked after, where you are treated with care, where you are treated as if you matter.

That it's not just about the fetus, but it's about the whole person. We also need research and data collection. A lot of it has been done, but maybe more still needs to be done. Robust data collection and research focusing on Black maternal health are needed to inform evidence based policies. Of course, you need evidence to come up with policies.

If you don't see that it's a problem, then you're not going to go to Congress or to the Senate and say, Hey, This is a solution, and they're going to say a solution to what? Well, this problem. How do you know it's a problem? You have to have statistics. This includes conducting studies to understand the unique challenges faced by black women during pregnancy and childbirth and using the findings to develop targeted solutions.

Key Democrats in the U. S. Senate and the House have reintroduced a bill called the Momnibus. Mom!

It is made up of 13 bills sponsored by the black maternal health caucus. And one of the aims of this bill is to make critical investments in social determinants of health that influence maternal health outcomes like housing, transportation, and nutrition.

U. S. Senator Cory Booker. And U. S. Representative Lauren Underwood of Illinois and Alma Adams reintroduced the bicameral Black Maternal Health Momnibus Act, historic legislation to save moms lives and address every driver of maternal mortality, morbidity, and disparities in the United States. And the bill has large support in both the Senate and the House.

And hopefully this gets passed because the addition of resources from the government will ensure that more communities can be reached and more information about this epidemic can get out and healthcare, healthcare industries can receive more resources and underserved communities, communities can receive more resources to reach out to pregnant women or women who have unwanted pregnant pregnancies and who need assistance.

Anything that a pregnant woman would need, she should not be afraid or have to wonder if this exists in her community for assistance. It should be there. It's not about the baby. It's not about the fetus. It's not about the child that's coming. It's about the person who's carrying it. We need to focus as well on the person carrying.

The fetus, as we do on the fetus itself. And like I said, Medicaid expansion remains a major key in improving black maternal health and reducing mortality and morbidity. Medicaid pays for more than 40% of us births. More than 50% of births where states haven't expanded Medicaid and 65% of births to black mothers.

So it's paying for the majority of births from black women in this country think about that. Think about that. So expanding and enhancing Medicaid coverage must be a part of the comprehensive strategy to address the black maternal health crisis. States that expanded Medicaid under the affordable care act and also under the American rescue act in 2021 have seen a significant rise in health coverage among women of reproductive age.

This has improved their access to preconception and prenatal services that make pregnancy and birth safer for parent and baby. Research also shows that Medicaid expansion is associated with reduced rates of maternal death, particularly for black women. However, as I mentioned, there are 10 states that have not expanded Medicaid.

This includes Wyoming, Kansas, Texas, Wisconsin, Tennessee, Mississippi, Alabama, Georgia, South Carolina, And therefore women are not entitled to preconception care or post conception care for the now 12 months offered under expanded Medicaid programs. And in those states, Medicaid pays for more than 50%. of the births, but Medicaid coverage must be comprehensive anyway and offer evidence informed services that are free of discrimination.

And it must identify and reduce risks associated with poor pregnancy outcomes for women of color, including those due to toxic stress, poverty, and racism. Also, Okay. We must build trust between doctors and patients. And that begins with health care providers actively listening to their parent, to their patients, valuing their experiences and concerns.

We need to create spaces where black patients Feel heard and respected. Diversifying the healthcare workforce is also crucial. When patients see providers who look like them and understand their cultural experiences, it fosters trust and improves health outcomes. I'd also like to emphasize the importance of centering the experiences of black mothers themselves.

Stories like those from Tori Bowie, Alison Felix, Serena Williams. They're very moving. They're very moving and, and sad. But there are so many cases like there's so many, and we need to involve black women in the decision making processes, research and policy development when it comes to developing strategies to tackle black maternal mortality and morbidity in the United States.

Our voices are essential in shaping solutions that address our unique needs and challenges. And remember, as I told you before, our needs are unique because we are black and we are women affected by segregation, discrimination. Racism and American slavery that set us up to have the social determinants that affect our health outcomes.

Our voices are essential in shaping solutions that address our unique needs and challenges. Inclusivity and empowerment are key. Also, communities and individuals can contribute to improving black maternal health as well. But education and awareness are key. We need to educate ourselves and others about the disparities and advocate for change.

Individuals can support organizations and initiatives focused on black maternal health. You can donate to community health centers and participate in grassroots movements aimed at addressing these disparities. Engaging with local policy makers and holding them accountable for prioritizing equitable maternal health outcomes is also important.

And it's essential for all of us to uplift the voices of black women and center our experiences and discussions and decision making processes. It is important for everyone to understand the disparities and advocate for change. Get involved with local organizations working on maternal health issues and support policies and initiatives that prioritize equity.

It could be as simple as starting a conversation with family and friends to raise awareness. Support initiatives that provide resources and services to black mothers, such as DOLA programs and community health centers. And remember, this is a long term commitment. Black women will never stop having babies.

This is a long term commitment. Sustainable change will require ongoing efforts. So let's remain vigilant and persistent. And this has been Ayanna Explains It All. Brought to you by facts, figures, and enlightenment.  Take care.