Reducing Maternal Mortality Disparities: Addressing its Roots in Racialized Pseudoscience

Leticia Sefia

Despite being one of the most developed nations in the world, the United States continues to suffer from disparities in healthcare. An important but overlooked reason stems from racially motivated ideologies within the medical field that correspond to higher rates of complications and deaths for groups of people. According to a report published by the Centers for Disease Control and Prevention (CDC) on maternal mortality rates in 2020, the rate of deaths for non-Hispanic Black women was almost three times the mortality rate of non-Hispanic White women.¹ However, according to a second report by the CDC looking at data from 2008-2017, two-thirds of these pregnancy-related deaths were preventable.² This discrepancy in maternal deaths among Black women is a detrimental consequence of pseudoscientific ideologies that have plagued the development of biology’s foundational beliefs, the U.S. legislative system, and the inequality of care in medical procedures. To mitigate this disparity, the political, scientific, and medical communities need to address the pervasiveness of racialized pseudoscience. Following this acknowledgment, systematic change must occur in these various domains to protect the rights of Black women, especially during pregnancy and labor.

Systemically, there is a prevalent belief that Black people have a higher pain tolerance than White people, which contributes to the undertreatment of Black people during medical procedures, such as childbirth. This harmful concept can be traced back to the theories of pro-slavery thinkers who attempted to justify the inhumane treatment of enslaved Africans. One such thinker is Dr. Benjamin Moseley, who claimed, in his work, “A Treatise on Tropical Diseases; and on the Climate of the West-Indies”, that Black people can tolerate more painful surgeries than White people.³ Adopting this baseless theory, Dr. James Marion Sims, the father of modern gynecology, conducted painful surgeries on Black women, including repeatedly cutting off their genitals to perfect a surgical technique used during complications in childbirth without the use of anesthesia.³ Although institutionalized slavery has been abolished in the United States for over 150 years, pseudoscientific beliefs about the increased pain tolerance of Black people persist in the modern day. For example, a 2016 study investigated the relationship between racial bias and biological beliefs founded upon pseudoscience. Among the participants, who were medical students and residents, around half of the sample assumed that a false belief about reduced pain perception among Black people — such as having thicker skin or less sensitive nerve endings — was factual. As a result, these same medical professionals recommended less effective pain treatment for Black patients.⁴ It is important to note that many of these racially biased beliefs continue to be taught within medical institutions, despite their pseudoscientific origins. ⁵

Focusing on expectant mothers, Black women’s concerns about potential complications during labor are often overlooked by medical professionals. Unfortunately, this negligence is indirectly permitted by current legislation. Within Section 1867 of the Social Security Act, the Emergency Medical Treatment and Labor Act (EMTALA) details the rights that people within the emergency sector of a hospital have if they are determined by a physician to be undergoing an emergency medical condition. A hospital may be released from its EMTALA obligations if a medical professional has decided that the patient does not have an emergency medical condition, even if there is an underlying condition that sparked the initial concern.⁶ Therefore, the decision to address or ignore Black women’s health concerns during the vulnerable process of labor is at the discretion of medical providers. Unfortunately, in conjunction with the false belief that Black women have a higher pain tolerance, EMTALA allows for negligent practices, such as the withholding of pain medication during labor, to persist. Within medical facilities, Black people often have negative interactions with medical professionals. In a survey conducted by the Pew Research Center in 2021, 34% of Black adults noted that their pain was not regarded as a serious issue by medical professionals. Additionally, among Black women, 34% of the women surveyed stated that their concerns were not taken seriously by medical professionals.⁷ Anecdotally, among Black women who survived pregnancy and the families of those who succumbed to complications, mothers and witnesses often cite disbelief and negligence from clinicians after the expectant mothers disclose adverse symptoms. In a study investigating the quality of care that expectant mothers face during pregnancy and childbirth, about one in six women noted instances of mistreatment through the belittlement and neglect of their complaints. Of this subgroup, 22.5% of these women identified as Black.⁸

Because the tragic disparity of maternal mortality rates among Black women is multi-layered, we need multifaceted interventions. Beginning within the setting of the hospital itself, we need to increase the number of Black medical professionals. In a landmark study investigating the effect of having Black doctors administer preventive care to Black men, Alsan and colleagues found that this racial homogeneity between patients and physicians correlated to a 19% reduction in cardiovascular mortality among Black men.⁹ Although this study investigated preventive cardiovascular care among Black men, the reduction in mortality rates due to matching racial identities among patients and medical professionals is likely to apply to Black women as well.

Moreover, a shift in legislation to highlight and mitigate maternal mortality rates is necessary to protect Black expectant mothers. Fortunately, some laws addressing these issues are already being passed. For example, the Preventing Maternal Deaths Act of 2018, an amendment of the Public Health Service Act, enables maternal mortality review committees of the CDC to publicize data regarding pregnancy-related deaths.¹⁰ Additionally, other bills are being introduced to address maternal health. For example, the Maternal Care Access and Reducing Emergencies Act, or the Maternal CARE Act, has been introduced to appropriate subcommittees within the House and Senate. The bill aims to reduce preventable complications and deaths among mothers, along with eliminating racial disparities in maternal mortality rates. Additionally, this act proposes that grants should be offered to integrate implicit bias training into the curricula of medical and nursing schools. Also, this bill intends to introduce medical programs that enable healthcare providers to integrate perinatal care into their healthcare services for pregnant women.^11/sup>

From a scientific perspective, more studies should be conducted to replace pseudoscientific assumptions with scientific explanations behind disparities regarding Black health. For example, due to institutionalized racism, Black people frequently experience high levels of stress, which contributes to higher mortality rates. These chronically high-stress levels correlate with the phenomenon of “weathering”, or premature aging, among Black people.¹² In a study analyzing the biological markers of diverse populations aged 18-64, Black people experienced cellular deterioration at a significantly higher rate and earlier in life than White people; the levels of cellular deterioration for Black people were equivalent to levels for White people who were 10 years older.¹³ Moreover, Black women experienced this genetic corrosion at a greater rate than Black men. The researchers cited stressful circumstances, such as existing in a society of systemic discrimination, as a factor that increases biological aging among Black people.¹³ Because babies and mothers are more likely to experience complications if the expectant mother is older, a Black woman’s older biological age may increase their likelihood of health issues during pregnancy, even if the mother is physically younger and should be considered low-risk for complications.¹³ In other words, scientific research on weathering note that the prevalence of racism and other systemic inequities enable the phenomenon of biological weathering among affected groups, which corresponds to disparate health outcomes. On a systemic scale, progress has already begun since the director of the CDC declared racism as a “serious threat” to the progression of public health in 2021.¹⁴ Additionally, in recent years, media outlets have published articles highlighting the role of systemic inequality in health disparities, utilizing both anecdotal accounts from victims and loved ones on the worsened quality of care patients received during childbirth, and summaries of studies that emphasize the correlation between racism and disparate care among Black women.¹⁵ Recognizing the role of systemic racism in disparate quality of care should extend to various fields that contribute to public health as well. Specifically, educational institutions, such as medical schools, should acknowledge that many beliefs about the biological mechanisms of Black people derive from pseudoscientific propaganda. Many of these ideologies were originally used to justify slavery and the inhumane treatment of Black people; teachings founded upon racialized pseudoscience should be replaced with anti-racist curricula.

The prevalence of maternal mortality in the United States is a paradoxical tragedy for such a developed country. More concerningly, there is a clear pattern that certain racial groups experience increased maternal mortality rates. Although this issue of disparity across racial lines is being addressed, because the causes and effects of this phenomenon are multi-layered and self-reinforcing, it is not enough to mitigate one surface-level issue if the underlying factors remain. Therefore, to reduce maternal mortality rates among Black women, it is necessary to analyze the source of this issue itself, racialized pseudoscience, and replace the associated beliefs with scientific experimentation and findings focused on Black health. Only through a transformation of the way Black health is regarded, in addition to increased representation in the fields affected by pseudoscience, can systemic and impactful progress be made.

References

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