UAMS Hosts Panel Discussion on Black Maternal Mortality

By Kalee Sexton

UAMS Division for Diversity, Equity and Inclusion (DDEI), in partnership with the Little Rock (AR) Chapter of The Links, Inc. and the National Healthy Start Association, hosted several virtual viewings of the film followed by community discussions on Black maternal mortality rates in the weeks leading up to the panel discussion.

Gloria Richard-Davis, M.D., executive director of UAMS DDEI and vice president of the Little Rock (AR) Chapter of The Links, Inc., said The Links, Inc. has a national initiative to raise awareness about Black maternal mortality rates and to improve maternal health. With Arkansas’ high maternal mortality rates, it is a critical and needed discussion for our communities.

Amber Nicole Booth-McCoy, UAMS manager of intercultural education, moderated the discussion, which featured panelists Haywood Brown, M.D., of the University of South Florida Health and former president of the American Congress of Obstetrics and Gynecology; Veronica Gillespie, M.D., of Ochsner Health in Louisiana and medical director of the Louisiana Perinatal Quality Collaborative and Pregnancy Associated Mortality Review; William Greenfield, M.D., of the UAMS Department of Obstetrics and Gynecology and chair of the Arkansas Maternal Mortality Review Committee; and Deborah Frazier, RN, CEO of the National Healthy Start Association.

Toxic follows Nina, a pregnant Black woman navigating her career, marriage and motherhood while dealing with race-related stress. Throughout the film, which shows just one day in her life, she experiences several microaggressions involving her co-workers, her son’s teacher and a convenience store attendant. She also expresses concern over her pregnancy symptoms to her doctor only to be quickly brushed off.

Currently, Black women in the United States are three to four times more likely to die from complications of pregnancy and childbirth than white women are. Additionally, babies born to Black women are two to three times more like to die before their first birthday. In Arkansas, the maternal mortality rate is 50% higher than the national rate.

Brown discussed common medical causes for maternal mortality, including hemorrhage, embolism, preeclampsia and sepsis. However, he wanted to focus on what he called the “hidden causes” of maternal mortality.

“The things that I really am most anxiously concerned about are the social determinants that we can’t do a lot about,” he said.

While doctors have been able to successfully treat medical causes, he outlined the preventable causes such as suicide, homicide and substance abuse, which play a major role in maternal mortality rates.

“We have a higher maternal mortality rate than Iran, Libya and Turkey,” he said.

He also outlined how pregnant Black women have been treated in the U.S. over the past 400 years when the first slaves arrived in the country.

“Health disparities are rooted in generational stress in Black women,” Brown said. Health care providers must overcome the effects of this stress, which include premature births and fetal growth restriction, leading to the potential for diabetes, hypertension and obesity.

Gillespie discussed steps taken in Louisiana to improve birth outcomes and decrease the disparity gap. She said in her state, maternal deaths are defined as the death of an individual while pregnant or within one year of the end of pregnancy, while many other states restrict the definition to within 42 days after the end of pregnancy.

The longer postpartum period “gives us a wider view of what’s happening to women, and we’re able to see the social determinants of health,” she said.

In the 2021 review of maternal deaths in Louisiana, the three top causes were accidental overdoses, motor vehicle collisions and homicide.

“If we’re going to address maternal mortality and disparities, no matter what the disparity is, we have to address implicit bias and systemic racism,” Gillespie said. “That is the root of all of our disparities in health care.”

It’s not just providers and hospitals that need to make changes, she said, but social, political and research communities.

“If we’re going to decrease maternal mortality, it takes all of us,” she said.

Greenfield gave an overview of Arkansas’ efforts to address health disparities in pregnant women. Arkansas currently ranks 46 out of 50 for maternal mortality. In 2019, two pieces of state legislation were passed leading to the creation of the Maternal Mortality Review Committee and the Perinatal Outcomes Quality Review Committee. Both groups have reviewed pregnancy-associated and pregnancy-related deaths up to one year after birth and work to identify how to close health care disparity gaps for pregnant women.

Frazier outlined the initiatives that the National Healthy Start Program is involved in. The organization works with the Maternal Child Health Bureau and federal government programs that research maternal morbidity and mortality. It is a community-driven program that seeks to help areas of the country that have an infant mortality rate of at least one and a half times the national average.

“Infant and maternal mortality is a societal and a moral failure,” she said.

She used the analogy that if a jumbo jet carrying 400 people crashed once per week in the U.S., the country would shut down air travel and call for a national investigation after just a couple of crashes.

“But that’s how many babies die in this country every year,” Frazier said, referring to about 400 infant deaths per week. “We should really have a national outcry about that.”

“When you think about the fact that about two and a half times as many Black babies die as white babies die, it really puts it in perspective,” she said.

While health care providers need to work on their end to address racial gaps, it is equally important for communities to advocate for improvements as well, she said.

One action that all panelists agreed would help is Medicaid expansion to ensure postpartum women have the care they need for a longer period after birth. Only 34 states currently have extended postpartum coverage. Arkansas is not one of them.

Brown mentioned a “fourth trimester,” and all panelists said people have to stop thinking of pregnancy as something that ends after a woman delivers a baby since many fatal complications can occur up to a year after birth.

Each community discussion session ended with a call to action to end race-related disparities for Black mothers. Participants were encouraged to call for national, state and local policymakers to develop plans to address social determinants of health at the community level.

Black Maternal Health Week is April 11-17. The White House issued a proclamation recognizing the week on April 8, and Arkansas Gov. Asa Hutchinson signed a proclamation declaring April as Arkansas Minority Health Month.

The virtual events and panel discussion were just the first steps the UAMS Maternal Mortality Awareness Planning Committee plans to take to raise awareness about the issue. More events will be announced throughout the coming months.

To watch the distinguished panel discussion, click here.

To learn more about Black maternal and infant mortality, click here.