Although more than 80 percent of maternal deaths are preventable, women of color have the highest rates of pregnancy-related death, according to a new report from the Centers for Disease Control and Prevention (CDC).
In totality, 30 percent of Black women reported experiencing some form of mistreatment.
The most common types of mistreatment reported were:
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- Receiving no response to requests for help.
- Being shouted at or scolded.
- Not having their physical privacy protected.
- Being threatened with withholding treatment or made to accept unwanted treatment.
BlackDoctor.org spoke with Dr. LaTasha Perkins, a family physician based in Washington D.C., who has expertise in this area plus personal experience with her own high-risk and difficult pregnancy, to discuss what Black women need to know about these alarming statistics, what can be done to combat them and how she advocated for herself during her own pregnancy.
The recent report from the CDC highlights that about one in five women experienced mistreatment during maternity care and almost a third face discrimination. Could you dive into the main findings of this report and its effects on the BIPOC community?
There are two more things that kind of came out – one in five women of color (Black, Hispanic or multiracial women) actually experienced this treatment so it's a little bit higher than that one in five. Also, about 45 percent of women aren't comfortable bringing up concerns that come up during pregnancy or labor.
According to the report, the top reasons women don’t feel comfortable bringing up concerns include:
- Thinking, or being told by friends or family, what they were feeling was normal.
- Not wanting to make a big deal about it or being embarrassed to talk about it.
- Thinking their healthcare provider would think they’re being difficult.
- Thinking their healthcare provider seemed rushed.
- Not feeling confident that they knew what they were talking about.
As a physician, that's not something I want to hear that almost 50 percent of women who are pregnant don't feel comfortable having a conversation – having their concerns, especially with something that's as life-changing as birthing your child. It's important that we understand what the mistreatment is… Are they even aware of the things that come across as negative or significantly affecting their patients? We need to focus on once we have these numbers, figuring out why this is happening and trying to come up with solutions. My biggest pet peeve at this point when it comes to maternal health, particularly Black maternal health, we're collecting data, which is extremely important, and getting awareness, which is also important; but now that we're aware, it's time to come up with some solutions. I would like to talk about some things that we need to think about when it comes to solutions.
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From your standpoint, what do you envision as far as solutions for these women and for healthcare providers when they're treating their patients?
There are multiple levels to it. There are levels to everything, but particularly when it comes to this, there's a systemic level at the federal government level. The Biden administration had this almost 70-page blueprint for maternal health that they released last June and it came off the heels of this act called the Momma’s Act that was in the House of Representatives. I think it was introduced by Congresswoman Robin Kelly. But it was talking about those things that need to be done on the government level – things like making sure coverage is there and so on. The systemic level is important to think about because we're coming into an election year and you need to see what the incumbents are doing and then also ask the questions of the new people who are running for office… pay attention to what they’re saying when those questions are asked of them. Do you care about maternal health? Do you care about our lives? That's the systemic part when it comes to the medical system and clinicians being aware of their biases is definitely important… Also understanding patients culturally when it comes to labor pain is a big part of delivering. Pain is subjective – it is very cultural. Even if I don't scream and shout when I tell you I'm in pain, you should trust me when I say I'm in pain. I think that's an example of how clinicians need to look at their bodies and check their bodies and check what they've been taught, but also cultural humility is important. I'm using humility instead of competency because humility is learning… You have to continue to grow…When you're pregnant, there needs to be a tribe [of] friends and family – understanding what you're planning…The biggest thing for me as a physician is keeping the doctors on the team… In our community, we have to make sure the conversation is inclusive and that we hold the medical system to a level where they move to fix this because our lives matter. That's the levels I want us to think about systemically (both governmental and medical), but also within our community the conversations that we're having – just make sure that every pregnant woman has a team and a tribe that's around her supporting her and making sure that she lives – her baby lives.
A lot of your passion around the topic of implicit bias comes from being a Black physician and knowing what women of color go through. Is there any data that can support how physicians of color or women physicians might impact the maternal mortality rate of women?
There is definitely data that shows that a Black child is more likely to survive and also a mother is more likely to do better with a physician of color and have less of negative experiences. The maternal mortality rate goes down when you have a physician that looks like you and I think part of that is implicit bias and part cultural humility. Also, I've been there… so I'm going to take care of you like you are me and so there is research that shows that. The other thing we need to do is to get more of us in the workforce…It's a community thing to be aware [of] and make sure we have the data and information. But in the meantime, we need to make our colleagues care…I want you to feel treated well to have a great birthing experience… and then also make sure that you live.
The report Dr. Perkins is referring to is a study conducted by the National Library of Medicine that shows that although Black Americans make up about 13% of the U.S. population, they comprise only 5.4% of the physician workforce, and of these, only 2.8% are Black women.
You also dealt with your own high-risk and difficult pregnancy. Could you share some insights into how you advocated for yourself during your pregnancy?
My daughter is now four and a half. During my pregnancy, I went to my first OBGYN… they didn't pay attention to my age, and by the time the visit was over, we didn't address the fact that I was over 35, which comes with higher risk and because of that; it was kind of ignored and kind of joked [about] – ‘Oh well you look really young.’ I immediately changed my physician because we can do that…you can change your doctor anytime. Do not let anyone tell you anything different….I made it a point to get a Black female physician. We communicated well – she understood me. If I had a question, there wasn't as much pushback…And then my daughter changed position and I ended up having to be on bed rest and also have a C-section...But even when we decided that I had to go on bed rest, my specialist doctor listened to me. She was another woman of color and she made choices and gave me options because she wanted my baby to get here alive and healthy…It's important when you have questions to ask them even if it seems annoying. My husband was also very supportive and he had questions… And then ultimately having to have a primary C-section delivery also done by my OBGYN, which I definitely advocated for because I could schedule it with my doctor. I was able to have the delivery that I wanted as close as I could get it and have a healthy child and heal appropriately. At each step – whether it was changing the doctor, not realizing my age, almost having a second-trimester miscarriage, and then my daughter switching to the breech position and having a C-section – each challenge my doctor's ears were open to hear my concerns, which is why I'm alive and why my daughter is alive…I felt like let me get my affairs in order. Do I have my will together?… Because that's kind of what you start thinking about when you're a Black woman who is delivering in the U.S. It doesn't matter your education or access to healthcare or socioeconomic status. If you're Black in the U.S., you're still going to be three times more likely to die in childbirth regardless... I don't think that's fair.
You highlighted some key points for women when they're advocating for themselves as far as getting a second opinion and changing doctors if they're dismissive. Is there any other advice you could offer to women who may be in a similar situation as you?
We tend to have all these other responsibilities that we are responsible for when we're pregnant. Make sure you prioritize your pregnancy. The only person who can birth the child is you. Everything else can be done by someone else. Culturally, I believe we feel like we have to do everything, but just remember that everything else can be outsourced. Spend as much time as you can focusing on the growth of this human being that you're going to bring into the world because that's so important. Making sure we prioritize that in a way that's meaningful – I think is what keeps empowering you to advocate for yourself to learn about each stage, to read up, to understand what's going on with my body – let me go do some research, let me write some stuff down and take this into the doctor. Don't just go to the doctor and check your box. Go in with your questions. It is our job to answer your question. If you go in and you have questions that are not getting answered, then you need to think about changing your doctor. Making sure that we keep that international knowledge also in our toolbox… those generational tools and cultural tools are equally as important.
You mentioned the importance of not just collecting data, but being able to have some action behind that. From your perspective, how do you think we can effectively use this data to get these policy changes into effect?
We're going to need more data around why this is happening. We have a lot of data that is starting to show that this is happening. What we're lacking is data about why this is happening and so we should use the data that we have that shows one in three women of color are mistreated to understand why is that and how do we fix it. We say implicit bias – we say cultural humility. But once they get to the hospital, we're not asking not wanting to ask questions…We need to make sure you have the health literacy that you need you need to understand the why instead of just the cause…It's time to dig into the why…so we can use the information we have now to back up our research projects to really dig into that and then fix that so that we could actually stop dying…I think we need to spend a lot of time funding those kinds of projects… We need assistance to put funding and support behind fixing this in training our clinicians… Now you're aware you have biases, but what tools do you have to ensure that those biases don't come into play when you're making decisions for your patients? Making sure that health systems are funding programs to give clinicians tools to use to overcome, like coaching community issues, while we work on more understanding about why we're actually dying.
You mentioned something important with physicians being able to understand the implicit bias and being able to overcome that. You're in a unique position as a Black woman who has experienced these issues when giving birth and as a physician. Could you speak to some of the tools that physicians can take to overcome implicit bias?
Our system had a bias reduction training, which was really interesting. I was on the second floor and it made us aware. And then the second portion of it was to give us tools and figure out how we could overcome the bias. If you notice that you're more biased towards me – if I'm more biased towards someone who doesn't look like me when I speak to them – when I engage with them, trying to understand them as a patient. I like jazz, you like jazz… something that you have in common that we can talk about every time you come in… those kind of tools help you gradually get over any biases that you may have… Just get to know your patient and make sure your patient understands every step…based on their literacy level.
Lastly, you briefly mentioned some initiatives around finding out why so many Black women are dying. Are there any recent developments or initiatives that signal some progress toward achieving equity in healthcare for BIPOC individuals?
One initiative that I'm personally a part of is trying to develop a focus group of Black women who are past conception age but are pregnant and talking to them about things that stressed them out. What is your anxiety level on the day-to-day? What are things that cause you constant stress? I personally tend to believe that our lived experience and having to deal with racism or…the poverty gap of being the first generation to go to college – things like that are just a part of our normal day-to-day lives that could cause some level of stress that could help could cause some issues when you get pregnant… It’s basic things that I think we have in our lived experience – I think it's connected. So I'm hoping that more research will focus on what is your life like that when you get pregnant you have a higher risk.
