Is Childbirth More Dangerous for Black Women Than for White Women?

Pat A. Camillo, PhD, RN, APRN-BC

Disclosures

August 12, 2008

Question

I believe that black women are more likely to die from pregnancy-related complications. Why is this?

Response From the Expert

 

Pat A. Camillo, PhD, RN, APRN-BC
Associate Professor of Nursing, Minnesota State University, Makato, Minnesota; Private Consulting Practice, Eden Prairie, Minnesota

 

In a surveillance summary for the years 1991-1999, the Centers for Disease Control and Prevention (CDC) found that the leading causes of maternal death following a live birth were essentially the same for black and white women.[1] However, for each cause of death, the pregnancy-related mortality ratio of black women was 3-4 times higher than that of white women. Leading causes of death included embolism (21%), pregnancy-induced hypertension (19%), and other medical conditions (17%). Especially alarming was the risk for death from cardiomyopathy and complications from anesthesia, each of which was 6 times higher for black women.[1]

Reasons for this disparity are still unclear. In one recent study, black women were found to have more severe hypertension, lower hemoglobin concentrations preceding hemorrhage, more antepartum hospital admissions, and a higher rate of obesity.[2] Of particular concern was the rate of surgical intervention required for hemorrhage in this population. Although the severity of hemorrhage was the same for both black and white women, the former were less likely to undergo procedures other than curettage.

Late entry into prenatal care has been identified as an important risk factor for maternal mortality[3] but even after controlling for significant risk factors and markers of socioeconomic status, race alone emerged as a significant factor.[4] This could indicate a genetic basis for the disparity in maternal mortality and/or possible differences in the process of obtaining care. The latter prompted an investigation by the Institute of Medicine that resulted in identifying "system-level" and "care-process" variables that might explain disparities among minority populations.[5] Nursing has long recognized the need to understand the culture of those seeking care, but it is critical that providers also be aware of their own possible biases.

A CDC interim progress report on Healthy People 2010 noted that "movement in the wrong direction" had occurred regarding the maternal mortality goal of no more than 3.3 maternal deaths per 100,000 live births.[6] However, with a more focused and improved surveillance system, the actual recorded number of maternal deaths is likely to increase over the next decade. This will provide a larger pool of data for analysis in exploring the reasons behind this disturbing disparity.

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