While poor maternal outcomes among Black women in the U.S. is not new, improving it is imperative. U.S. policymakers can look to sub-Saharan Africa for guidance on reversing this trend. Credit: Ernest Ankomah/IPS
By Ifeanyi Nsofor
ABUJA, Jun 2 2023 – New research shows that Black mothers in the United States disproportionately live in counties with higher maternal vulnerability and face greater risk of preterm death for the fetus, greater risk of low birth weight for a baby, and a higher number of maternal deaths.
While poor maternal outcomes among Black women in the U.S. is not new, improving it is imperative. U.S. policymakers can look to sub-Saharan Africa for guidance on reversing this trend.
The problem of poor maternal health for Black women in the U.S. is dire. Too many Black women die during pregnancy and childbirth due to preventable causes. For instance, the 2020 maternal mortality data rates released by the U.S. Centers for Disease Control showed overwhelming maternal deaths among Black women compared to other women over a 3-year period (2018 – 2020).
The 2020 maternal mortality data rates released by the U.S. Centers for Disease Control showed overwhelming maternal deaths among Black women compared to other women over a 3-year period (2018 – 2020). To put it in context, maternal deaths among Black women in the U.S. is worse than African countries like Namibia, Botswana, South Africa, Libya, Tunisia and Egypt.
To put it in context, maternal deaths among Black women in the U.S. is worse than African countries like Namibia, Botswana, South Africa, Libya, Tunisia and Egypt.
Further, according to the Kaiser Family Foundation, maternal and infant health disparities are symptoms of broader underlying social and economic inequities that are rooted in racism and discrimination.
In a previous piece, I wrote about the way that institutionalized racism is keeping Black Americans sick. Therefore, healthcare providers and policymakers across the U.S. must ensure respectful maternity care for all women during pregnancy, childbirth and afterwards.
The United Nations Office of the High Commissioner for Human Rights says respectful maternity care“encompasses respect for women’s basic human rights, including recognition of and support for women’s autonomy, dignity, feelings, choices, and preferences, such as choice of companionship wherever possible”.
Unfortunately, there is overwhelming evidence that Black American women face disrespect and profound indignity during pregnancy and childbirth. Tennis player and businesswoman Serena Williams almost died due to blood clots after giving birth because her nurse refused to listen to her cry for help. That clot could have led to a stroke. Her doctor eventually listened to her, and this saved her. If one of the most influential and most powerful women can have such a near-death experience, what is the fate of other Black American women who are not as privileged? Respectful maternity care is a way to ensure equity irrespective of class and race.
These are three lessons American policymakers can learn from successful maternal health projects across countries in sub-Saharan Africa as they try to save Black American lives.
First, is the continuum of care – prevention of postpartum hemorrhage project, implemented by Pathfinder International in Nigeria. It was a novel project that deployed several evidence-based interventions to prevent excessive bleeding after childbirth across the country.
These included the use of misoprostol to ensure adequate uterine contraction after the delivery of the baby; use of a plastic sheet with a pouch for blood loss estimation and active management of the third stage of labor to ensure the placenta is properly separated after the baby is delivered. These interventions led to a reduction in women who bled excessively after childbirth and improved the overall survival of women in participating health facilities.
For example, a new study on the efficacy of the plastic sheet carried out in 80 hospitals across 4 African countries, showed a reduction in the number of women experiencing severe bleeding by 60%.
A second example is the maternal nutrition program, implemented by Garden Health International in Rwanda. Adequate nutrition during pregnancy is imperative for the wellbeing of the unborn child.
The first 1000 days of life are even more crucial. Through the Maternal Nutrition curriculum, pregnant women are encouraged to attend antenatal classes at least four times in health facilities where they are educated on how to address the factors that can contribute to malnutrition. Women are taught how to prepare a balanced meal, the importance of hygiene and food safety in preventing malnutrition, the importance of the timely introduction of breastfeeding and complementary feeding, and postnatal care.
For instance, through the “one pot, one hour” cooking initiative, families are taught to use readily available foods to prepare nutritious meals is a core component of this program. Its success led to its adoption by the Rwandan Ministry of Health and it was implemented by 44,000 community health workers across the country.
A last example is the Kangaroo Mother Care for very low birth weight infants in South Africa. Very low birth weight infants are prone to hypothermia – a significant and potentially dangerous drop in body temperature.
According to the WHO, Kangaroo Mother Care involves infants being carried, usually by the mother, with skin-to-skin contact. If the mother is unable to fulfill the role, the father or other members of the family can take on the responsibility of skin-to-skin contact and provide warmth for the infant. A study of Kangaroo mother care of 981 very low birth weight infants admitted at Charlotte Maxeke Johannesburg Academic Hospital over a six-year period showed increased weight gain, lower rates of complications of prematurity and low overall mortality.
A multi-country study by the World Health Organization showed that in Ethiopia, government leadership; an understanding by health workers that kangaroo mother care is the standard of care; and acceptance of the practice from women and families helped improve the implementation of kangaroo mother care.
Institutionalized racism over many decades has put Black Americans in the most vulnerable counties in the U.S. Health policymakers, healthcare providers, donors, non-profit organisations and all stakeholders involved in maternal healthcare in the U.S. must implement interventions that are shown to save lives. The African continent is a great place to look.
Dr. Ifeanyi M. Nsofor, MBBS, MCommH (Liverpool) is Senior New Voices Fellow at the Aspen Institute, Senior Atlantic Fellow for Health Equity at George Washington University, 2006 Ford Foundation International Fellow