Black women in America are dying during pregnancy or from complications from childbirth at alarming rates. As overall staggering national maternal mortality rates reflect a troubling obstacle in the U.S., racial disparities in maternal mortality continue to impact black women gravely.

In America, black women are three to four times more likely to die from childbirth or pregnancy-related complications than white women, according to the CDC. Research has revealed that even wider racial disparities in maternal deaths exist in cities and states across the country. Such is the case in New York City, where recently reported data suggested black women were 12 times more likely than white women to die from pregnancy-related causes.

In an exclusive interview with Blavity, New York City government officials say the city has implemented a new plan to address its racial disparity in maternal deaths. The initiative, under Mayor Bill de Blasio’s administration and with the help of First Lady Chirlane McCray, will address structural racism and implicit bias in health care as it relates to black mothers, among other objectives.

The city says it aims to eliminate its most substantial disparity in maternal deaths — which is between black and white women — in five years. It also aims to reduce by half the numbers of life-threatening complications of childbirth throughout the city’s five boroughs.

New York City Deputy Mayor for Health and Human Services (HHS) Dr. Herminia Palacio told Blavity the city believes it’s “beyond time” to both address and eliminate the racial disparity in maternal death.

“This is a really critically important issue, and one that we really wanted to make sure that the general public understands and, in particular, women of color understand, and families of color understand because it’s an issue that’s not often present in conversations,” Palacio said.

In New York City, nearly 3,000 women experience a life-threatening event during childbirth every year, Palacio noted, with about 30 women dying from pregnancy and childbirth-related causes each year. The CDC defines maternal mortality as the death of a woman while she’s pregnant or within one year of the end of the pregnancy “from any cause related to or aggravated by the pregnancy or its management.”

“New York City is making women’s health care priority number one,” First Lady Chirlane McCray said in a statement to Blavity. “No mother in this great city, of world-class health providers, should ever worry about the quality of care she’ll receive when building her family, before, during or after childbirth.”

City officials told Blavity that its most recent preliminary data suggest new statistics in disparities in maternal deaths. Black women in New York City are reportedly eight times more likely – down from 12 – to die from causes related to pregnancy or childbirth than white women.

But a significant racial disparity in a city that boasts world-class medical facilities persists nonetheless.

“This has historical origins in structural racism, historical origins in centuries of social constructs,” Palacio said about the disparity.

The city launched a four-point plan aimed at saving as many mothers’ lives as possible and eliminating racial disparities in maternal deaths, which city officials say would result in 50 fewer black maternal death cases over five years.

New York City’s four-point plan includes the creation of the following:

1. a new city-wide maternal hospital quality improvement network

2. comprehensive maternity care at NYC Health and Hospitals

3. enhancement of data quality and timeliness (and releasing maternal mortality data annually)

4. a public awareness campaign on pregnancy-related health risks

A spokesperson for the mayor’s office told Blavity the city is investing $12.8 million over the next three years to implement the new initiative.

Over the next four years, city officials say its new quality improvement network will aim to enlist 23 public and private maternity hospitals and develop recommendations of best practices to prevent maternal mortality. It will prioritize providers in neighborhoods with high rates of pregnancy complications. The network will also address issues identified by the city’s Maternal Mortality and Morbidity Review Committee, which was created in 2017.

First Deputy Commissioner of New York City’s Department of Health and Mental Hygiene Dr. Oxiris Barbot told Blavity the quality improvement network would also aim to tackle community-related issues and implicit bias in clinical settings.

“Improving outcomes for women of reproductive age isn’t just about what happens in the clinical setting; it’s about what happens in the community, as well,” Barbot said.

She added the network would implement a “disparities platform” where its participating hospitals will undergo implicit bias training.

Indeed, overall, the four-point plan, as Palacio explained, addresses how implicit bias impacts black mothers.

“…Implicit bias, those aspects that influence everyday minor decisions and that creep into systems like health care settings, not because people are bad, but because we are all products of the societies in which we live,” she said.

 Studies on implicit bias in health care in the U.S. have revealed that black people are systemically undertreated for pain compared to white people. Furthermore, an in-depth report by NPR and ProPublica found that many maternal deaths in the U.S. could have been prevented; it also noted that structural racism had a heightened influence on the disparity in these deaths for black women.

Dr. Wendy Wilcox, chairwoman of the obstetrics and gynecology department at Kings County Hospital, told Blavity that structural racism in severe maternal morbidity (childbirth complications causing either short-term or long-term health consequences) closely follows the impact it has on other chronic medical conditions.

 “We know that there are a lot of factors that can increase a woman’s risk of having either a severe, life-threatening problem in pregnancy or death in pregnancy,” Wilcox said. “Some of those clinical issues are high blood pressure or hypertension, obesity, diabetes, as well, among a few. There are other social determinants of health which are not within our control within the walls of the hospital that can also make a woman’s delivery [not] as safe.”

Atrium at Bellevue (NYC Health + Hospitals main facility)

As part of the four-point plan, city agencies will hire maternal care coordinators to work in NYC Health and Hospitals facilities to support, officials say, 2,000 high-risk women during pregnancy and postpartum. The plan will aim to enhance training in hospitals on top causes of maternal death like postpartum hemorrhage and thromboembolism. Coordinators will help mothers keep their doctor appointments and assist them by providing information on access to health care benefits, among other initiatives.

America’s history of systemic racism that has created disparities in the racial wealth gap, access to housingemployment and access to quality healthy food, by way of redlining districts and other divisions, as Wilcox noted, all play critical roles in maternal morbidity and mortality disparities.

But as Wilcox, Palacio and Barbot all told Blavity, the initiative acknowledges that the cause for racial disparities in maternal deaths is complex, with wide-ranging factors to consider. One, in particular, is learning how chronic stress (and societal racism can be a chronic stressor) for black women affects the body's physiology, Palacio noted.

As a New York Times report uncovered, income, class and education provide no protections in racial maternal morbidity disparities. In fact, the 2016 New York City health report revealed that black non-Latina women, with at least a college degree, had higher rates of severe maternal morbidity than women of any other race with less than a high school degree, according to data between 2008 – 2012.

Furthermore, the NPR and ProPublica report that collected more than 200 stories from black women in the U.S. revealed a common theme of feeling devalued and disrespected by medical providers, and the problem transcended socioeconomic statuses. 

Such was blatantly highlighted with tennis superstar Serena Williams, who shared her life-threatening experience of suffering complications after giving birth to her daughter last year. Williams notably said “doctors aren't listening to us” as she addressed implicit bias in healthcare settings.  

Stories like Williams’ have propelled the maternal morbidity and mortality crisis to national public conversations, similarly with the death of activist Erica Garner, who died following a heart attack months after giving birth to her son last year.

Palacio told Blavity that the city’s new initiative would entail public education campaigns to encourage women to “know and feel empowered to articulate when something is not right” in healthcare settings.

“We don’t want moms to have life-threatening illnesses; we don’t want moms to die,” Palacio said. “That mother is more than just an incubator. That mother is a life of her own; we need to pay attention to the mom.”