Race, sex, bias
die from pregnancy-related deaths than white women. 4 This pattern has been for many years being shown in various amounts of data and studies conducted by health researchers. A study looking at the rise in pregnancy deaths in US women by the Centres for Disease Control and Prevention (CDC) during 1987- 1990 concluded that there needed to be emphasis on ‘black women as a high -risk group for pregnancy- related mortality’ 5 as by 1990 there had been a 56% increase in maternal deaths in black women, 3.4 times greater than white women. 6 More specifically, among the data for causes of specific pregnancy-related mortality such as haemorrhaging (29% of deaths), embolism (20%) and hypertension (18%), black women ’s mortality ratios were substantially greater. 7 This included the maternal deaths due to cardiac muscle disorder, which showed black women being 5.4 times likely to die in comparison to white women and their risks of death due to anaesthesia being 6.6 times greater. 8 From these reports it’s clear that there is a lack of awareness and action taking place in healthcare spaces for the prevention of pregnancy-related diseases disproportionately affecting black women. Evidently, theses disparities in health care are deep-rooted in structural racism. The societal structures embedded in health care in certain areas means that for black women, they are most affected by socioeconomic factors but also the discrimination in the treatment they may receive. A survey carried out by NPR showed that 1 in 3 people said that they had been discriminated against with 1 in 5 also saying that they had avoided going to hospital out of concern that they would be discriminated against. 9 Concerns regarding treatment have a great impact on the quality of care pregnant black women may receive, as it can disrupt key communication that the patient and their healthcare provider could have established. For the most part black female patients avoid certain levels of communication with their doctors or nurses to curtail certain emotions that society is so quickly to guise as an ‘Angry Black W oman’. However, by doing so it has led many black females to not receive the adequate care and to not be listened to when speaking of pain. The notion that ‘black people’s skin is thicker than white people’ (which alludes to the false narrative that black people have a higher pain tolerance than white people, harboured bymanymedical students as recently as 2016 10 ) most likely had a great impact on the health outcomes of many black patients as misconceptions in their pain tolerance could have contributed to the racial disparities in treatment. A study conducted in 2019 asked subjects to identify pain expressed in photos of people of different racial groups. It was concluded that white subjects more readily identified expression of pain on the white participants as opposed to the black participants, outlining the implicit bias white/non-ethnic providers held even if it was unintentional. 11 From these studies, it can be said that theses biases come from a place of miseducation; a marriage of complex societal influences producing the implicit biases black people experience not only in hospital environments but in places of work, public events and other day-to-day experiences.
However, these biases are proving to have a detrimental effect on black women’s maternal health. In January 2017, a black woman named Shalon Irving died from what an autopsy later revealed as
4 BBC News, Why are black mothers at more risk of dying, 2019. 5 Family Planning Perspectives, Rise in pregnancy-related mortality is found to be greatest in women, 1996. 6 Ibid. 7 Ibid. 8 Ibid. 9 Code Switch, The racism is killing me, 2018. 10 AAMC, How we fail black patients in pain, 2020. 11 American Psychological Association, Perceptual Contribution to Racial Bias in Pain Recognition , 2019.
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