Links Roundup: Racial Disparities in Maternal Mortality

Higher rates of maternal death among Black women in the US have been evident in research for a long time but have lately gotten a lot more mainstream coverage. The increase in coverage is important to raising awareness and implementing changes in health care that would improve outcomes, but it has unfortunately come out of tragic deaths and near misses among new mothers, including Erica Garner and Shalon Irving.

 Serena Williams’ Birthing Experience Highlights The Danger Of Being Black And Postpartum (1.10.18 via Essence) Serena Williams, one of the greatest athletes of all time, experienced a near-fatal blood clot shortly after giving birth. Her own knowledge and self-advocacy helped clue medical professionals in to save her life.

Black mothers are dying: the toll of racism on maternal health (1.11.18 via STAT) This is an op-ed, so it doesn’t go quite as depth as some of the other articles I’m linking, but I think it’s a good one because it gives an overview of many of the factors that contribute to the racial disparity in maternal deaths, from preventative care and the policies that dictate accessibility, to institutional racism in medical professions.

Too many black women like Erica Garner are dying in America’s maternal mortality crisis (1.10.18 via Vox) Activist Erica Garner died within months of giving birth. Her death, particularly in light of her anti-racist activism, highlights the relationship between experience of racism and poor health outcomes for women of color. Vox writes:

Research has shown that a number of factors, including poor access to pre- and postnatal care, chronic stress, and the effects of racism, and inadequate medical treatment in the years preceding childbirth are all likely to play a role in a black woman’s likelihood to suffer life-threatening complications in the months that come before and after childbirth.

These issues might appear to suggest that the disparity between black women and white women dying from pregnancy-related causes is due to economic differences, but research has found that black women in higher economic brackets are still more likely than white women to die from pregnancy- and childbirth-related problems.

How Hospitals are Failing Black Mothers (12.27.17 via ProPublica) This is a really fascinating analysis by ProPublica (an organization that does really fascinating, in-depth reporting, support them!) into the differences in outcomes of maternal hemorrhage at hospitals in New York, Florida and Illinois. They found “that women who hemorrhage at disproportionately black-serving hospitals are far more likely to wind up with severe complications, from hysterectomies, which are more directly related to hemorrhage, to pulmonary embolisms, which can be indirectly related. When we looked at data for only the most healthy women, and for white women at black-serving hospitals, the pattern persisted.”

Nothing Protects Black Women from Dying in Pregnancy and Childbirth (12.7.17 via ProPublica and NPR) This is one you should sit down for and grab a box of tissues. Shalon Irving, a 36 year old CDC epidemiologist studying structural inequality and its relationship with poor health outcomes, died weeks after giving birth in 2017. There’s no pull quote I can find that really captures it, you really should just read the whole thing.


What is Reproductive Coercion?

Reproductive Coercion is getting some surprise attention this week after actors Nikki Reed and Ian Somerhalder went on Dr Berlin’s Informed Pregnancy Podcast and related their pregnancy story with a few red flags. (Note: Dr. Berlin is a prenatal chiropractor, chiropractors are not medical doctors.)

I’ve linked the podcast so you can listen for yourself (the section in question is within the first 8 minutes) as well as a Jezebel article that includes a partial transcript, but basically, Reed says Somerhalder knew way before she did that he definitely wanted children, after they were married Somerhalder wanted to have children around the same time his best friends’ did, and then one night on vacation with aforementioned best friends, he popped Reeds’ birth control pills out one by one into the toilet while their friends filmed it and Reed was “freaking out.” Somerhalder ends the story by admitting really he was the one who decided to get pregnant, rather than his earlier use of “we.”

Is this reproductive coercion? And what is reproductive coercion anyway?

Reproductive Coercion (RC) is a type of intimate partner violence where one partner seeks to limit or control the other partner’s ability to make choices about their reproductive health. RC is a spectrum of behaviors, which can range from pregnancy promoting behaviors like tampering with birth control, sexual assault, and preventing someone from seeking an abortion if they want one, to behaviors that attempt to pressure, control, or harm a pregnant person with the aim of ending the pregnancy against their will.

When you listen to the actual audio, it seems as if they’re trying to make this into a cute, jokey story, but I can’t shake the red-flag-feeling. Reed’s response on twitter, shortly after media outlets started picking up on the story on Friday, characterizes the controversy as something the media has blown out of proportion, while most fan replies to her tweets are encouraging and insist that they knew it was lighthearted.

Screen Shot 2017-09-23 at 5.42.03 PM

Here’s the thing – the narrative was their own. There are many times that a controversy over how something was reported in a profile of a celebrity – which come from much longer interviews that are condensed for publication and may only feature select quotes, but this came from a podcast where Reed and Somerhalder were speaking openly and unedited. The multiple journalists and outlets that picked up on the podcast (a podcast which I imagine rarely makes national headlines) raised the red flag over Somerhalder’s description of tossing her birth control in the toilet while Reed was upset, and that Reed asks about the video that was taken and wonders if she was too drunk to remember. These elements are alarming facts, and I when I listened to the actual audio the way they were told didn’t make me feel any better. Maybe they didn’t tell the story in an artful way, but these are tactics that are part of the spectrum of behaviors known as RC.

Reed and Somerhalder later put out a joint statement addressing the allegations of reproductive coercion:

Screen Shot 2017-09-25 at 7.53.19 AM

Celebrities are very often not experts on the topics they become associated with. This is true. However, it is a rare moment in pop culture that a relatively little-known public health problem is gaining some attention, which is ultimately a good place to start a conversation.

Mapping Abortion Access

Screen Shot 2017-09-12 at 9.06.57 AM

This visual representation of abortion access in the USA from The Pudding is really fantastic and informative –albeit depressing.

Since 1973, abortion has been legal (up to the third trimester of pregnancy) following the Supreme Court decision in Roe v. Wade that asserted that pregnancy termination is part of a pregnant person’s right to privacy. Prior to Roe v. Wade, death due to unsafe, illegal abortion accounted for a significant percentage of maternal deaths. Access to safe and legal abortion dramatically reduced maternal deaths and abortion is now one of the safest surgical procedures (safer than giving birth!)

The maps that The Pudding put together (a site I’d never heard of before but I love “visual essays” so goodbye to all of my free time) are really great because they help visualize the specific barriers that people seeking abortion face both in clinic location (the above screenshot) and availability of services according to location and gestation (below screenshot).

Screen Shot 2017-09-12 at 9.12.12 AM

Abortion is legal, but what is legality without access?

In the spring semester, I worked on a group project for a class about abortion access in Pennsylvania, and we plotted clinics that offer abortion services on a map. It becomes abundantly clear, when looking at the map, that the 20 or so providers are clustered in mainly urban areas. But people live in those in-between areas too! Population density is greater in those urban areas, but when you look at 2010 Census data, you can see that there are huge areas of the state where physical access is severely restricted. And these plots don’t even get into the specific restrictions each clinic may have on what types of services they offer.

As The Pudding explains, TRAP (Targeted Regulations of Abortion Providers) laws frequently limit access to abortion by instituting arbitrary rules for “safety,” but are actually medically unnecessary, political moves. It is expensive and time consuming to fight them. (If you’re interested in this – I recommend watching the documentary Trapped.)

Abortion access is an issue I care about a lot, but I think it’s really important to have these kinds of visual representations of data and access because it can succinctly and clearly translate these complicated issues. So check out the maps that The Pudding put together