Is there an epidemic of black mothers dying in the delivery room? So it would seem, given the drumbeat of academic studies and media stories over the past few years, including from Oprah Winfrey and the Biden administration. Yet it turns out that these alarming reports have more to do with advancing the notion of systemic racism than medical reality. Instead of letting radical activists remake health care, America should invest in proven ways to reduce the small number of maternal mortality cases.
The Centers for Disease Control and Prevention has created the public concern about black maternal mortality. In February, the CDC released data showing that the maternal mortality rate for black women is 2.9 times higher than the rate for white women. It’s a worrisome statistic, yet the CDC’s own data, as well as a study from the CDC Foundation, provide crucial (and generally unreported) context.
To be clear, even a single death of a pregnant woman is one too many. But the overwhelming majority of women survive motherhood: in 2020, according to the CDC, 861 women in the United States died related to pregnancy, out of a total of about 3.6 million births—a rate of 0.02 percent. Just over 350 were white, while just under 300 were black. Scientifically speaking, it’s hard to draw society-wide conclusions from such a small sample. It’s even harder when you recognize that the CDC statistics include deaths that occurred up to a year after delivery, as well as those caused by underlying and preexisting medical conditions that pregnancy may have aggravated. And the CDC admits that the systems for identifying mortality rates are prone to error.
The CDC Foundation, which commissioned an expert panel to review maternal mortality statistics, dives deeper into the facts. After analyzing state data from the late-2000s to the mid-2010s, the panel found that only about a third of the reported deaths within a year of pregnancy were pregnancy-related. Furthermore, 42 percent of the deaths were not preventable, resulting from issues like cardiovascular disease and pulmonary embolism. Other contributing factors, such as hypertension and kidney disease, are often genetic. (A fuller discussion of this context is available on Do No Harm’s website.)
The panel found that less than about a third of the preventable deaths, across all races, were attributable to individual providers. It did not cite racial bias as the reason. Yet the academic and media narrative leads to the assumption that black mothers are dying because doctors and nurses are racist. This leads to a corresponding claim that black mothers would die less often if they saw black doctors, which some call “racial concordance.” These are strange assertions, since Hispanic maternal mortality is lower than the rate for whites, which wouldn’t be true if medical professionals were racist. Yet these claims are still being used to justify discriminatory and dangerous policies across health care.
Look at education. To achieve racial concordance, activists and academics are demanding increased diversity in medical school and training programs. That’s a noble goal, in the abstract, but medical schools are pursuing it by lowering standards, including dropping MCAT requirements for some minority applicants. The United States Medical Licensing Exam has abandoned objective numerical grading for a pass/fail system, the better to get minority students into competitive and prestigious training programs. These policies involve discrimination against white and Asian medical students, while endangering patient health by recruiting potentially less qualified future physicians.
A similar trend is underway in medical practice. The supposedly unequal treatment of black mothers helps drive the spread of “implicit bias” testing and training, which accuses white doctors and nurses of being inherently and irredeemably racist. And we can expect a full-throated campaign to give black mothers preferential access to care, which requires de-prioritizing mothers of other races. Such overtly discriminatory practices have already been announced in other medical fields, including in the cardiology department at one of Harvard’s teaching hospitals, and it’s only a matter of time before they come to maternity care.
These trends are rooted in ideology, not science, and given how they’re being implemented, they’re far more likely to hurt care for all mothers than help improve care for black mothers. That’s not to say that we can’t do anything to prevent black mothers from dying during or after pregnancy. Policymakers should focus on the hospitals that black mothers rely on, ensuring that they have the services and staffing necessary to deal with complicated pregnancies. They should also promote high-quality prenatal care, which black mothers are more likely to lack.
We should strive to end maternal mortality for mothers of all races, including black mothers. But we shouldn’t let woke ideologues stoke a panic and use it as cover to embed race-based policies and practices at every level of health care.
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