Maternal Mortality Rate in Black Women: a small look into how the Social Determinants of Health influence life

ELIZABETH CONNER – By definition, the social determinants of health are conditions that affect health and quality of life. The CDC divides these determinants among five categories: economic stability, education access, health care access, environment, and social context. All five categories influence personal life and affect risks and outcomes in regards to health, and much of our daily life choices stem from what is available to use environmentally. For example, people living in locations with unhealthy grocery stores have less healthy options and therefore less nutrition. Additionally, people living in these areas often do not have the income to buy healthy options and thus the outcome of bad nutrition is again compounded. 

One major example of social determinants of health influencing quality of life outcomes is the issue of Maternal Mortality. Maternal mortality is the death of the mother during pregnancy, at delivery, or soon after giving birth. Although delivery, especially in the United States, is more often than not a smooth-running process, a staggering 700 women die while giving birth each year. As a result of maternal mortality children are often left in single-parent homes or even orphaned which can then spark a cyclical process of poverty and desperation. The death of the maternal figure has a profound domino effect; such a death influences family, community and more. 

Of the factors that  influence the mortality rate of women, many  correlate to the social determinants of health. Most often, those of higher incomes seek prenatal and postnatal care that supports the well-being of themselves and their child. Conversely, women with lower incomes often lack the resources for proper obstetric care. With the highest cause of pregnancy mortality being cardiovascular issues, the social determinants of health are again highlighted as well-educated, health care privileged, economically stable, socially favored and sustainable environment individuals are both informed and prepared to tackle the cardiovascular issues that may arise during pregnancy. As the maternal mortality rate in the United States has risen despite global increase, the role the social determinants of health play in this scenario is becoming a topic of interest. 

Unfortunately, a major factor in the mortality rate of mothers is  part of the ‘social context’ category and a subject that affects far too many: discrimination. The maternal mortality rate of black women is a shocking four times greater than that of non-hispanic white women, and more than one reason attributes to this statistic. First, black women are at higher risk for cardiovascular disease regardless of economic stability as well as preeclampsia and preterm birth. The disproportionate access to well-equipped housing, insurance, transportation, and partner support is a direct example of the social determinants of health playing out in the lives of others. Even when the concept of marriage was thought to deter the outcome of maternal mortality, black women were still affected even with partner protection. With 75% of black women being treated by minority hospitals, many effects coincide with this fact. Environment has a large impact on child birth and the urban, teaching hospitals who treat women were found to support a multitude of co-morbital conditions. Site of birth directly translated to a higher mortality rate during childbirth. In all aspects of childbirth, however, racial discrimination plays a large role. As racism influences the social community widely it similarly affects the healthcare world. Women who chose to participate in a questionnaire reported that they experienced a lower quality of prenatal care based on their race as determined by their either private or public insurance policy.  Even when prenatal care was sought, maternal death among black women still remained higher. 

Thus, what steps must be taken to resolve the issue of maternal mortality in black women? There are solutions to  problems surrounding this issue. First being that urban hospitals should be improved and better equipped to transfer patients needing extensive care to the proper obstetric support provider. Furthermore, more education on the subject of maternal mortality should be provided in all realms– especially in terms of how the social determinants of health influence the rate. Socioeconomic factors should not influence the life of a mother and her child and neither should systemic racism. As the social determinants of health become a more explored topic, my wish is that public policy recognizes the crisis of maternal mortality in black women and implements the goals of Health People 2030 of “social, physical, and economic environments that promote attaining the full potential for health and well-being for all.” 

To read more on this subject and possible solution: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384760/

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Photography Source: https://www1.racgp.org.au/newsgp/clinical/new-report-breaks-down-rates-of-maternal-deaths