Racism in health care: staggering death rate for pregnant Black women

By Monica Moorehead, Workers World, 26 August 1999

“Racism … needs to be studied if we want to understand health differences between Blacks and whites.” This simple but profound statement was made by Dr. Richard David, associate professor at the College of Medicine at the University of Illinois, two years ago at a conference organized by the Northern New Jersey Maternal Child Health Consortium.

The words ring just as true today.

They appeared in a front-page article in the Aug. 8 New York Times titled, “Black Mothers' Mortality Rate Under Scrutiny.” The article focused attention on a study released this past spring by the Centers for Disease Control in Atlanta.

The study was a compilation of statistics exposing the fact that Black women in the U.S. are nearly four times more likely to die during childbirth than white women. The numbers include both poor, working-poor and middle-class Black women.

The statistics speak for themselves.

From 1987 until 1996, one out of every 5,102 Black women died in childbirth. The number for white women was one out of every 18,868.

This disturbing disparity has remained relatively constant over the past four decades. This particular gap ranks among the highest in U.S. public health. And it comes at a time when the overall infant mortality rate has decreased.

The factors that make pregnant Black women at high-risk include hypertension, diabetes and obesity—which are closely associated with malnutrition and poor diet.

The lack of adequate pre-natal care is tied to the increased levels of poverty due to President Clinton's eradication of welfare.

Drug and alcohol abuse, as well as exposure to environmental toxins and violence, are important factors as well.

All of these conditions have made Black women more prone to high levels of stress on the job and in their daily lives as they struggle to survive in a racist and sexist society.

‘OFF THE SCALE’

Even the U.S. surgeon general, Dr. David Satcher—who is Black—has spoken out on this issue. He stated that “the disparity is important… If we were comparing Black women in this country with women in Tanzania, we would be talking about how great we are doing. We are not.

“In this country, we have a certain standard of expectation about the risk of women in pregnancy, and Black women are off the scale right now.”

No other city has felt this crisis more profoundly than Washington, D.C.

D.C. is truly a tale of two cities. One part of the city is home to the administrative branch of U.S. imperialism, while the other part is home to a deeply impoverished and colonized African American community.

At D.C. General Hospital, the city's largest public health facility, three quarters of pregnant Black women are classified as high risk. It is no wonder that the mortality rate of Black mothers there is the highest in the entire country.

The mortality rate of Black mothers cannot be separated from the mortality rate of Black infants.

Black infants are two-and-a-half times more likely to die before the age of 1 than white infants. The CDC estimates that by the year 2000, the rate will climb to three times as high. In the poorer neighborhoods, the rates are even more astronomical.

The Black infant mortality rate in the U.S. is the highest among the most industrialized countries, and is even higher than some developing ones.

For example, the ratio of infant mortality in Washington is twice that of socialist Havana, Cuba. Seventy-nine countries have a/ lower infant mortality rate than Harlem, according to Harper's Index.

HEALTH CARE: WHO CAN AFFORD IT?

Cutbacks in health care, especially in the poorer neighborhoods, have had a devastating impact.

There has been a general policy of closing down hospitals in the inner cities. In Chicago alone, 10 hospitals have been shut down recently—all in Black and Latino neighborhoods.

In the remaining hospitals, access to care has been severely reduced. In Cook County Hospital, with a clientele that is 90 percent people of color, the waiting period for an appointment can be upwards of six months.

Local private hospitals use a policy called “patient dumping” whereby huge numbers of patients who come through their doors without health insurance are transferred to Cook County—no matter how severe the health problem may be.

Another study, released this spring, concluded that the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and Medicaid helped to reduce infant deaths.

Dr. Karen P. Carver from Penn State stated, “WIC and Medicaid have helped poor women reduce infant mortality on two levels. First, WIC and Medicaid participants have lower infant death rates associated with pregnancy and delivery.

“Second, WIC participation by mothers is beneficial for infants at risk of death due primarily to environmental or external causes, including infectious and contagious diseases and accidents.”

The vast majority of women participating in the WIC program are African American, young and very poor. While the WIC program has remained intact for the moment, millions of single, poor women and their children lost their Medicaid coverage when they were eliminated from the welfare rolls.

The U.S. health care system is a vital institution riddled with racism. The only concern of this profit-driven industry is to rake in billions of dollars. Health care under capitalism is creating a genocidal crisis for millions of people.

Only a social revolution can assure that health care can be a right for all and not just a privilege for those who can afford it.