Kamala Harris Is Fighting to Protect Black Mothers from Medical Bias

From Oprah Magazine

• 2020 vice presidential nominee Kamala Harris is passionate about improving maternal health in the U.S., and lowering the higher-than-average death rate of Black women who give birth.

• Harris's Maternal CARE Act, and Black Maternal Health Momnibus Act of 2020, would close gaps in access to quality medical care—and educate providers about implicit bias.

• Here's why the issue is so important to Harris.

In April of this year, Sen. Kamala Harris dedicated a column in Essence to “the grave ongoing crisis of Black maternal mortality,” or the notably-higher rates at which American Black women die during pregnancy, childbirth, or in the postpartum months afterward.

Since accepting a position as former Vice President Joe Biden's running mate, much of the dialogue around Harris has revolved around her husband Douglas Emhoff and their family, or her record as a former California prosecutor and Attorney General. But the efforts Harris has made to improve Black maternal health—including introducing the Maternal CARE Act, and Black Maternal Health Momnibus Act of 2020—have been a crucial step toward repairingn racial inequalities in the United States.

"Every day, pregnant women walk into their doctor’s office for checkups, advice and treatment; but that experience is very different for Black women," Harris wrote. "Black women are three to four times more likely than white women to die from pregnancy-related causes and twice as likely to suffer from life-threatening pregnancy-related complications. These disparities persist regardless of one’s income or education level," Harris wrote.

Claiming at least 700 lives a year, the U.S. has the worst rate of maternal death in the developed world, per a six-month-long study by NPR and Propublica. American mothers of all races are more than three times likelier to die while pregnant, or within a year of a pregnancy's end, than Canadian moms (and six times more likely than Scandinavians). In every 100,000 live births in the U.S., 13 white non-Hispanic women die, according to the CDC. For Black non-Hispanic women, that number skyrockets to 42.4.

Worse, a constellation of CDC-approved experts have affirmed that 60 percent of these fatalities are preventable.

As Harris notes in her column, the alarming and largely avoidable deaths of Black mothers can't be solely pinned on poor lifestyle choices or a dearth of good prenatal care. Tennis icon Serena Williams's terrifying, nearly-fatal complications following the birth of her daughter Olympia may be the most infamous example of what can happen when medical professionals don't take a Black patient's complaints seriously. Knowing her own past experience with pulmonary embolisms, Willams alerted a nurse about her shortness of breath while recovering from her C-section. As recounted in Rob Haskell's 2018 Vogue profile:

Williams's disregarded clots led to coughs that ruptured her C-section scar, and during surgery, doctors subsequently discovered a hematoma caused by blood thinners in her abdomen. In a profit-driven healthcare system where the pressure on healthcare providers can often lead to hurried, impersonal encounters with patients who don't feel heard, we’ve all been told to “be our own advocate” at some point. But if self-advocating didn’t work for one of the wealthiest and most famous Black women in the country, the fact that so many non-celebrity Black mothers—such as Shalon Irving, and Amber Rose Isaac—have died of post-childbirth complications should horrify, but not surprise.

"A decade ago, we didn’t fully understand the problem, or even know there was a such a large problem, because we didn't have the data," Dr. Mary-Anne Etiebet, physician and Executive Director of Merck for Mothers, tells OprahMag.com. The CDC's Review to Action,—and their and establishment of state Maternal Mortality Review Committees—shed light on the fact that lack of access to quality pre- and postnatal care are indeed factors. "Women are entering pregnancy with other medical conditions that put them at greater risk for emergencies, and not all hospitals are prepared to identify and respond to some of these emergencies during childbirth."

But the data also confirmed that external factors play a major role, even when you adjust for things like age and pre-existing conditions. "We're hearing from from Black women that many times they're not listened to, their experiences aren't respected, and their needs aren't addressed," says Dr. Etiebet. "Systemic racism has created structural, institutional, and behavioral barriers that are affecting whether, where, how and what type of care Black women receive, regardless of their income or educational background."

Additionally, the relentless emotional effects of those barriers over time "can lead to chronic stress, which research has shown may ultimately contribute to preterm birth and maternal mortality," she adds.

In both 2018 and 2019, Harris introduced versions of what would become the Maternal CARE Act. Essentially a two-pronged plan, it aims to allocate a $125 million grant toward equal access to quality healthcare for all Black women, incentivizing health providers to identify and treat high-risk pregnancies as early as possible. It also puts $25 million toward fighting racial bias in medicine by ensuring medical schools, nursing schools, and other training programs include implicit bias training as part of their curriculum.

Dr. Etiebet agrees that educating all healthcare providers—not just doctors, but nurses, technicians, orderlies, etc.—on their own biases is essential. She points to 2019 research led by Columbia University, which spoke to women of color receiving maternity care, as well as multiple members of their care team and other hospital staff.

"The women recounted incidents ranging from verbal abuse and condescending communication to disrespect, discrimination and racism," she says. "Providers reported witnessing many of the same things, and felt overwhelmed from working in difficult work environments within a fragmented health system."

"All these experiences were contributing to a mutual cycle of distrust, creating a perfect storm for bias to flourish," Dr. Etiebet added. In addition to being intentionally anti-racist in addressing the Black maternal health crisis, she points out, "Black women’s voices and experiences need to be at the center of the solutions being created. When we listen and respond to the needs of all women, our solutions become stronger."

As the latest version of the bill Harris introduced is currently in the House of Representatives, the Senator is leading efforts to pass the Black Maternal Health Momnibus Act of 2020. Made of nine bills, it builds on the goals of the Maternal CARE Act, while expanding to address the needs of more moms and mothers-to-be, including veterans and women who are incarcerated.

“We must acknowledge that there are two problems when it comes to Black maternal mortality: ongoing systematic disparities and implicit bias,” Harris wrote in Essence. “And we need solutions to address both.”

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