The U.S. Commission on Civil Rights (USCCR) released a report Wednesday that stated the federal government should intervene to end “racial disparities” in maternal health caused by systemic racism, a claim at least one commissioner states could encourage minorities to view medical professionals as racist and “hostile.”
The report, which was sent to President Joe Biden, Vice President Kamala Harris, and House Speaker Nancy Pelosi (D-CA), claims black women in the United States “are three to four times more likely to die from pregnancy-related complications than white women in the U.S.”
Additionally, the report makes the assertion that “Native American women are more than two times more likely to die from pregnancy-related complications than white women in the U.S.”
“These disparities have become more severe over the last thirty years,” the report claims.
Norma V. Cantú, USCCR chair, said in a press statement:
At the federal level, efforts can be made to improve hospital quality, particularly for women of color if maternal health disparities are to be eliminated. Improvements in safety culture are linked with improved maternal health outcomes. One recommendation for improving safety in maternal healthcare is to implement standardized care practices across hospitals and health systems and to standardize data collection systems.
The Commission reports it held a virtual briefing in November 2020, during which it heard the testimony of various government officials, service providers, and women who claim to have experienced discrimination in health care during pregnancy. USCCR stated it reviewed public comments as well and conducted its own independent research of studies focused on racial disparities in maternal health outcomes.
In its letter to Biden, Harris, and Pelosi, USCCR wrote:
Taken together, the information the Commission reviewed underscores the many contributing factors to racial disparities in maternal health and outcomes. These disparities have become more severe over the last thirty years, with the rates of Black maternal mortality increasing since with 1990s. Social determinants of health, access and quality of healthcare, and bias all play a significant role in outcomes. Crucially, even controlling for wealth and education levels does not eliminate the disparity in outcomes. As attention of these disparities increases, so does the focus on the stark statistical disparities by decisionmakers and the public. Currently, data show that the large majority of maternal deaths are preventable, increasing the urgency for reliable, consistent statistical data. There are several proposed responses to these disparities which our report explores.
Several commissioners, however, delivered dissenting statements, including Commissioner Gail L. Heriot, who wrote, “Alas, like many of our Commission reports, this one is a disappointment.”
She proceeded to make the effort to “sort out fact from fiction,” including the issue she asserts is the “most serious,” that of the “repeated allegation” that “’racism’ is what’s causing racial disparities in maternal mortality.”
“This allegation … will not help us reduce maternal deaths,” the commissioner said. “Instead, it will encourage racial minority mothers to view medical professionals as hostile or even malicious. That is much more likely to make things worse than better.”
Heriot elaborated on the point that “it is unlikely that American women are dying in childbirth today at rates 50% higher than they did a generation ago.”
“If the rate of maternal mortality were indeed up 50%, that would be alarming,” Heriot asserted. “But this is unlikely. All or nearly all of this alleged increase appears to be an artifact of changes in how the United States keeps track of maternal mortality.”
The commissioner noted the Centers for Disease Control and Prevention (CDC) observed that, at the start of the 20th century, six to nine women in the U.S. died of pregnancy-related complications for every 1,000 births. However, by 1997, that rate “declined almost 99% to less than 0.1 reported deaths per 1000 live births.”
“Let me restate it,” Heriot stressed. “Maternal death declined almost 99% over the course of the 20th century. That’s not just improvement. It’s a medical triumph.”
She agreed it is nevertheless “fair” to ask why maternal mortality rates have not declined or have “stalled,” if, in fact, the data are correct:
A significant part of the answer might be that in recent decades more Americans have become obese, and more obesity means more hypertension and more diabetes, both of which lead to higher maternal mortality rates. Another part of the answer might be that a higher percentage of births are to women over 40, and maternal mortality rates for women over 40 have always been much higher than those for younger mothers.
Heriot also noted that, if the claim that systemic racism is to account for differing maternal mortality rates in the nation, the expectation is the same would be true for all minority races, “not just African Americans and American Indian/Alaska Natives.”
“But the facts are otherwise,” she wrote. “The pregnancy-related mortality rates for Hispanic and very likely for Asian American mothers are lower than the rates for whites [sic].”
“It is counterproductive to divert attention away from the factors that lead to maternal mortality with vague claims of racism,” Heriot warned. “We should not be trying to cause African American and other minority mothers to view the medical profession with unwarranted suspicion.”