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Pregnancy, Race, and Health

May 16, 2022
by Gillian Clouser

A pregnant person’s birthing practices reflect cultural identity, relationships, and the societal influences on birth and reproduction. Race, class, and other social markers of identity will influence not only a woman’s relationship to birth but her and her infant’s birth outcomes. Over the past couple of years, the pandemic has affected birthing practices due to changes in social distancing in physician-patient interactions. COVID-19 also has altered availability of prenatal visits, medical services, home birthing, and many other facets of birth experience. These changing medical conditions, in addition to the effects of factors such as race, wealth, or health interact to influence birth statistics and patterns in the United States.

These factors negatively and disproportionately affect women of color, particularly Black women. One’s race should not implicate health outcomes. However, systems of oppression, structural violence, economic barriers to health care, and racism continue to threaten the health and wellness of women of color and their children.

As a White woman with the privileges of an ongoing Yale education, how can I react to this inequity? Can I write about this when this is not my story that I am telling? I say that I must try. Women of color have endured multiple systems of oppression in this country, including within the medical sphere. I am committed to building feminist alliances that help to tell this story and to center the voices of women of color .

What Is Happening Now?

A recent report suggests that during the first month of the pandemic in March of 2020, rates for preterm births by cesarean section delivery dropped by 6.5 percent in the United States. This pattern held steady during the year the researchers accumulated data. The study analyzed over 38 million births of singletons, or the birth of one child as opposed to multiples, beginning in 2010. The study’s lead author largely attributed the drop in C-sections to fewer interactions between patients and their physicians over the pandemic, especially at the beginning. This lower level of interaction could have triggered a cascade of effects including the C-section rate dropping and lower levels of prenatal care.

In 2020, 3.6 million babies were born in the United States, with 10 percent of infants being born preterm (or birth before 37 weeks of gestation). Preterm birth rates vary widely across the country based on a series of risk factors, including high blood pressure, sexually transmitted infections, diabetes, obesity, age, stress, and a lack of health care during pregnancy. Racism is considered a risk factor for women of color.

Black mothers are at the greatest risk of having a preterm infant followed by Indigenous and Latina mothers.

Chronic stress can lead to preterm birth, and the daily emotional stress from systemic racism is exactly the kind of chronic stress that we know can lead to higher preterm births.

These statistics have been attributed to socioeconomic disadvantage and a greater prevalence of other risk factors among women of color. However, studies suggest that low-risk, highly-educated, and economically advantaged Black women are still much more likely to have preterm deliveries than White women with lower levels of education.

Chronic stress can lead to preterm birth, and the daily emotional stress from systemic racism is exactly the kind of chronic stress that we know can lead to higher preterm births.

Lack of prenatal care is associated with a 40 percent increase in the risk of neonatal death. And women who already face other risk factors for their pregnancies — especially those related to wealth inequality, housing issues, education, or race — are the most likely to lose access (or never have access) to quality prenatal care. Black and Latina women are two-to-three times less likely than any other racial group to receive prenatal care.

Poverty, a community living in fear (for example, due to enhanced police surveillance), and fewer resources available in communities of color are rooted in systemic racism. Research has demonstrated how such effects of structural and cultural racism and individual racial discrimination are linked to many conditions and diseases that disproportionately affect people of color. These include hypertension, depression, and diabetes. Because of these ongoing harms, people of color often face inequity as it concerns their overall health.

Since this piece demonstrates some of the harsh, inequitable realities of pregnancy and prenatal care, I hope it will spur conversations about medical racism and health inequity and perhaps together, we can help change the systems that harm women of color. We must rally to promote health and wellness for all women, help those voices that have been oppressed, and improve health outcomes. For my next post, I will write about more of the history of maternal mortality among Black women.

Submitted by Rick Harrison on May 16, 2022