An Untold Story: Black Maternal Mortality in the United States

Morgan Taylor

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In April 2016, Kira Johnson, 39, and her husband were excited to bring their second child into the world. After delivering via C-section, her husband noticed something wrong. He alerted the medical staff that there was blood in Kira’s catheter. While the staff promised to immediately do blood work and order a CT scan, it would be ten hours before the abnormalities in her blood work would spur action. She was taken back into the operating room, where doctors discovered that she had been hemorrhaging since her delivery.

Stories like Kira’s are not unique in the Black community. Many Black mothers have died or come close to death as a result of poor treatment during their pregnancies. Kira died from internal bleeding, but she also died from neglect and lack of medical care, on account of her race. This is the Black female maternal mortality crisis.

This crisis is not new in the United States and its roots stretch back to the 1940s. But it has only started to gain substantial attention in the last decade. Why? To answer this, we must examine the individualized blame narrative that has been placed on Black mothers. Since Black maternal mortality was first documented in the 1940s, physicians, policy officials, and the media have played a role in constructing this narrative. This narrative places the responsibility and onus for the crisis on Black women, while larger systemic issues have been ignored. Yet, in the past ten years, increased advocacy, stemming from Black mothers, has begun to dismantle the existing narrative and bring awareness to the long-existing issue.

In 1940, Black maternal mortality was first addressed by the Children’s Bureau report The Health Situation of Negro Mothers and Babies in the United States, with data from 1936 to 1938.^[1] It serves as a milestone in the recognition of Black maternal health, but it also fails to properly problematize the issue. It labeled Black women as ignorant, noncompliant, and racially predisposed to complications but ignored any societal implications, like lack of access to physicians, prenatal resources, and that most Black women had to work. This report did not bring Black women into the maternal mortality story; instead it served as the origin of the Black maternal blame narrative.^[2]

In the 1960s, physicians and public health officials began prescribing prenatal care as the “cure” to maternal mortality, thus putting the onus on mothers to have a healthy pregnancy and leaving them responsible for complications that took place without such care. This general prescription ignored the realities of systemic racism – namely, that access to adequate prenatal care was not a possibility for many Black women. This allowed physicians and society to blame Black mothers if they succumbed to complications. In addition, placing responsibility for largely unattainable goals on Black mothers contributed to the stereotype of unfit Black mothers.^[3]

This characterization of the unfit mother continued through the 1980s. In the 1986 CBS special The Vanishing Family: Crisis in Black America, Bill Moyer focused on Black mothers as solely responsible for “moral depravity” in the Black community. The report supported the broader characterization of these women as reliant on the state, sexually promiscuous, and unconnected to their children’s fathers. Combined with the negative impact of deeming prenatal care curative, reports like these put the responsibility for the entire Black community on mothers.^[4]

Black maternal mortality continued to be sidelined through the early twenty-first century. In contrast, during this time, there was increasing dialogue in the public health and medical community that racial biases were negatively impacting the care of Black patients. While some physicians refuted the influence of race in medical disparities, others argued for its centrality. In a New York Times article, Dr. Sally Satel stated, “in practicing medicine, I am not color-blind. . . . I always take note of my patient’s race. So do many of my colleagues. We do it because certain diseases and treatment responses cluster by race. . . . When it comes to practicing medicine stereotyping often works.”^[5]

As racism in medicine continued to be debated, Black mothers continued to have to navigate its presence in their maternal care, as in the case of Bethany Matthews. a young black woman from an upper-middle-class family in New York City. In 1999, Matthews was pregnant with her first child. For the majority of her pregnancy, Matthews felt like she had received adequate prenatal care. But, at thirty-five weeks, Matthews developed Braxton Hicks contractions and her baby stopped moving.^[6]

When Matthews arrived at New York-Presbyterian Hospital, she sat in the waiting room for three hours. While waiting, she did not receive a preliminary examination, anything to quell her symptoms or even water. When she went on her own to get water, she was confronted by a white nurse who rolled her eyes at her and yelled at her for drinking water. Matthews felt like this was due to the nurse assuming that she was a Black woman on welfare.^[7]

When Matthews’s physician arrived, the nurse was reprimanded and eventually was let go. Upon reflection, Matthews knew that she was being treated as a second-class patient because of her race and because the nurse made the general assumption that a young Black mother had to be on welfare. These assumptions made it possible for the nurse to blame Matthews for the predicament she was in and apparently deem her unworthy of proper treatment.^[8]

Leading into the 2000s, many Americans believed that implicit bias in the medical system was eradicated and that experiences like Matthews’s could not be caused by race. But, from her narrative, we can infer that racial biases in the form of blaming the mother were still deeply influencing medical practices. In the late 2000s, another mother’s two pregnancies were negatively affected for the worse due to racialized medicine.

Deidre Johnson is a mother of two, with a history of good health and degrees from Princeton and Yale. As reported in the New York Times, during both her pregnancies, she came close to death due to HELLP syndrome, a severe derivative of preeclampsia, and neglectful maternal care.

During her first delivery, Johnson alerted her medical team about her alarmingly high blood pressure, but her concerns were dismissed by a nurse when she said “you people usually have higher blood pressure.” The nurse was placing the blame for Johnson’s complication back on herself. Johnson is convinced that she would not have survived the delivery if family members had not been in the delivery room. They were able to advocate for her and get in contact with another OBGYN, who confirmed the seriousness of her condition and got her proper treatment.

To prevent this from happening with her second pregnancy, Johnson researched her condition so she could talk to her medical team in their own “language,” and she chose to deliver her second child at a hospital that specialized in complicated births. During that delivery, she tried to explain to physicians that she had a history with HELLP syndrome and used terminology like “vascular headaches” and “high protein urine” to convey that she knew what was happening. But, once again, hospital staff brushed off her concerns and only took them seriously when her family threatened to sue the hospital.

Stories like those of Matthews and Johnson are not uncommon in the Black community. Many mothers have experiences that mirror theirs, often not realizing the similarity until they reflect upon it.

This is one reason it has become increasingly important for Black mothers to share their stories, which help other mothers go into pregnancy with more awareness. The commonalities among Black mothers’ stories, spanning across generations, shows the sheer longevity of systemic racism within our medical system. Black women today are still four to five times more likely to die from childbirth-related complications, a statistic initially cited in 1940 that remains unchanged.^[9]

Over the past decade, Black women have increasingly shared their concerns in widely read publications, including the New York Times, which has raised awareness among white physicians, public health officials, and others who did not recognize the problem. Furthermore, Black advocacy groups like SisterSong and Black Mammas Matter Alliance have worked to change the narrative and they have involved physicians, public health officials, and other advocates who are interested in the issue.

In the future, advocates must continue the work of dismantling the individualized blame narrative that has been in place for over seventy years. As more Black mothers and families share their stories and perspectives on maternal treatment, we will all be privy to an experience that we may have not had. We cannot simply say that healthcare is equitable and that a problem does not exist. The underlying issues, including racial and gender discrimination, have to be addressed to see any substantial change. The first step is pulling back the curtain for Black women and families to share their stories.

Notes

1. Elizabeth Carpenter Tandy, The Health Situation of Negro Mothers and Babies in the United States … (US Children’s Bureau, 1940). ↑
2. Morgan Taylor. “An Untold Story: Understanding the Black Maternal Mortality Crisis through Preeclampsia, 1940–2020.” BA thesis, University of Pennsylvania, 2021. ↑
3. Taylor, “An Untold Story.” ↑
4. Dorothy E. Roberts, Killing The Black Body: Race, Reproduction, and the Meaning of Liberty. (Pantheon Books, 1997), 151 ↑
5. Taylor, “An Untold Story”. ↑
6. Bethany Matthews, Oral History Interview with Author, July 25, 2020 ↑
7. Matthews, Oral History Interview. ↑
8. Matthews, Oral History Interview. ↑
9. Taylor, “An Untold Story.” ↑

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Featured image caption: Pregnant belly. (Courtesy Dayvison de Oliveira Silva from Pexels)