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Health

Black Iowans face a startlingly high maternal mortality rate, and it's a systemic problem

Felecia Brown, Kamiko Farris
Rogelio V. Solis
/
AP File
In 2020, the maternal mortality rate for pregnant non-Hispanic Black people was three times the rate for white individuals. And in Iowa those numbers are even starker: Black people in Iowa are six times more likely to die during or shortly after childbirth than white individuals.

Sofia DeMartino almost died due to complications from childbirth. Twice.

DeMartino was a 15-year-old living in Iowa City when she had her first child. The day she had her son, she’d gone to school to turn in her entry for an essay contest (which she won). She went into labor during her first period class, then went to the hospital. “I had a really hard time with people taking me seriously, with people listening to me, with people understanding some of the challenges that I was going through.”

At the hospital, she was given Oxytocin, a hormone that is used to induce labor. “And my son actually ended up arriving into the world so fast that I burst two blood vessels, and I had two hematomas, one the size of a grapefruit and one the size of an apple.”

DeMartino was rushed into emergency surgery and had to stay at the hospital for two weeks, longer than her new son.

And the second time around, unfortunately, was not better.

After having her second child years later, DeMartino developed a cyst. While having it removed, the doctor cut an artery without realizing it and sent her home, where she started hemorrhaging. Her mother rushed her to the emergency room.

“I had a male doctor who was standing over my bedside, a white male doctor who was telling me, ‘I think it's just that time of the month,’” says DeMartino, who is Black. “I'd had two children. I was really cognizant of the difference between 'that time of the month' and something is seriously wrong.”

Over the course of about four hours, DeMartino says she lost about half of the blood in her body.

“The only reason that they caught what had gone on is that my mother went into the hallway and summoned all of her Karen abilities and said, 'bring a woman doctor in here.' And the woman immediately recognized that I was bleeding from the artery and sent me to surgery. And that's what saved my life.”

The statistics

More Americans die from pregnancy-related complications than in any other industrialized country. The CDC reports that about 700 people die each year due to complications from pregnancy, and about two in three of those deaths are preventable. Within these figures, there are significant racial disparities. A 2020 report found that the maternal mortality rate for pregnant non-Hispanic Black people was three times the rate for white individuals. And in Iowa those numbers are even starker: Black Iowans are six times more likely to die during or shortly after childbirth than white women.

“The only reason that they caught what had gone on is that my mother went into the hallway and summoned all of her Karen abilities and said, 'bring a woman doctor in here.' And the woman immediately recognized that I was bleeding from the artery and sent me to surgery. And that's what saved my life.”
Sofia DeMartino

DeMartino says that she isn’t sure why health outcomes are worse in Iowa than in the rest of the country. “What I can say is that there was a study a few years ago that indicated that Iowa, and specifically the Cedar Falls, Waterloo areas, are some of the worst places in the country for Black people to live. We see disparities that are greater here related to criminal justice. We see disparities here that are greater related to unemployment. So it's not really surprising that that would extend to maternal health as well.”

Today, DeMartino is a community relations and grants director with Horizons, a family service alliance, as well as an editorial fellow with The Gazette, where she has written about Black maternal mortality.

“The knee jerk reaction is to try and separate these bad things from ourselves. And so we say, 'Oh, well, maybe it’s diet. Well, maybe it's income or maybe it's access or maybe it's education,'” DeMartino says. “But the statistics hold even when you control for income, even when you control for education and socioeconomic status.”

In 2017, Serena Williams and Beyoncé Knowles-Carter both faced serious pregnancy complications and underwent emergency cesarean sections. “If Serena is not safe, if Beyoncé’s not, none of us are safe,” DeMartino says.

A systemic problem

When we're looking at the statistics, the majority of the women who are dying are Black women who are highly educated.
La Tashia DeLoach

“The Black maternal health issue that is the most surprising for me is that, most of the time, it's preventable.” La Tashia DeLoach is the president of the board for Sankofa Outreach Connect, an organization that was created to support and connect women of color. “When we're looking at the statistics, the majority of the women who are dying are Black women who are highly educated. And so we're looking like, what's going on? Why is this happening?”

One factor may be isolation. Being one of the only people of color in the community can be an isolating experience, and has a  correlation with health outcomes. “You can't help but notice,” says DeLoach. “I have an eight year old daughter. She's like: ‘Mom, we're the only Black people here,’ so it's everywhere that you go.”

“People are not being listened to. It's not just that, but they're not being believed. And that's where the bias comes in. That's where the structural racism comes in,” says DeLoach. “…It's a part of the structure. You have basically been taught from the beginning of medical school to not listen to Black women as much when they're speaking, because Black women in society literally have been ignored and invisible for centuries. And so you are inherently working in a system that was not created for Black women, nor did it ever tend to care for Black women.”

And so you are inherently working in a system that was not created for Black women, nor did it ever tend to care for Black women.”
La Tashia DeLoach

Many medical schools and health care facilities are working to address racism in the healthcare system and the resulting inequities. However, as DeLoach notes, the methods are often treated as a one-off or semester-long class, while health care for white people is the default.

“The biggest mistake that organizations, education, businesses make is that they forget to include the diversity inclusion type of lessons as a part of the entire curriculum,” she says. “They want you to take one class on cultural competence so you can check a box. But the reality is every single topic we do, it impacts people different culturally. So why wouldn’t these things be interwoven into those different classes?”

Addressing the problem

In addition to more and better diversity, inclusion and equity training, studies have shown that Black patients with Black doctors have better outcomes “So the more that we can create pathways and access for more Black students to become Black doctors will be better off,” DeMartino says.

“Imagine going into a hospital where you're way less likely to see someone who looks like you, to be able to really, truly explain some of your cultural needs and your cultural wants with your birthing experience.”
La Tashia DeLoach

“Imagine going into a hospital where you're way less likely to see someone who looks like you, to be able to really, truly explain some of your cultural needs and your cultural wants with your birthing experience,” says DeLoach. “That's a part of that isolation. Basically ‘I already feel invisible. What is the point of me saying anything?’”

One way to address this need in hospitals is by getting more doulas in delivery rooms.

“We talk a lot about Black maternal mortality and Black infant mortality, and we could stay on that subject forever. But really getting down to it, right, is addressing the bias,” said Jazzmine Brooks, a certified doula and lactation specialist, and she’s the cofounder of the Iowa Black Doula Collective. “The ways in which I'm trying to do that is being a doula in that medical space, functioning as the person that addresses the gap.”

A certified doula provides education and physical and emotional support for pregnant people during and after pregnancy, including during labor. They can be an advocate for their clients and act as a “bridge” to other health care professionals, like obstetricians. A 2013 study found that individuals who were assisted by doulas were two times less likely to experience complications during birth. Another study from 2019 found that doulas can “mitigate the negative effects of social determinants of health, specifically racism and classism.”

Brooks says a doula is there to “make sure that they're in that place, knowing all of their choices, to make sure their voice is amplified, their support person is amplified, and they feel empowered regardless of what that outcome looks like.”

It can be difficult to get a doula in Iowa right now. In 2021 the state Department of Public Health launched the Iowa Title V Community-Based Doula Project for African American Families, with the capacity to offer doula services to 40 Black families at no cost. Even so, doula care can be very challenging to obtain, and many doulas report having to turn potential clients away because they were at capacity.

It won't just "get better," but...

Outside of addressing the needs in the health care system, Brooks says community support, like the kind that can be found through Horizons, HealthyStart and Sankofa Outreach Connect can be instrumental to one’s health.

“It’s huge to know that somebody else is like ‘I've been through that. I will go with you to a doctor's appointment if you need to, or you can call me afterwards and we could talk through it.’ We may not be doulas, but we are other mothers and we're willing to hold people's hands through it or to support them in any way that we can.”

DeMartino, DeLoach and Brooks made their comments on Talk of Iowa. You can listen to that episode here.