May 26 Through a combination of data and extensive community discussion, a recent study published by the Frederick County Department of Health identified factors influencing pregnancy and birth inequalities for Black mothers in Frederick County.
The study sought to contextualize data showing a higher rate of adverse health outcomes, including preterm birth and low birth weight for Black mothers and babies in the county compared to non-Black mothers and babies.
The county engaged Washington, DC-based Health Management Associates (HMA), a research and consulting firm specializing in health policy, to help conduct the study. The county health department assisted HMA.
Then-Frederick County Executive Jan Gardner allocated $300,000 in American Rescue Plan Act funding in early 2022 to fund the study.
Report contributors and community members gathered for a virtual forum earlier this month to discuss its findings and the path toward further research.
\”So we know what the data says: that Black women are experiencing these inequalities at a greater rate than their counterparts,\” said Brandin Bowden, a senior associate at HMA. \”But we really wanted to know and define that experience by what was actually happening in the field.\”
To do so, the study drew on the experiences of Black mothers in Frederick County and, through discussion, tracked down the causes of the disparities identified by those affected.
The root cause of such inequalities, according to the study, is anchored in systemic racism.
The study authors identified the influence of systemic racism by controlling for certain factors to find that disparities exist in Black maternal health outcomes regardless of health care quality and health behaviors.
\”The disparities are not explained by income, age, marital status or education,\” said Danielle Haskin, director of the county health department\’s Equity Office. \”Also [Black] families who are in a higher socioeconomic class have a disproportionate and higher risk of death.\”
The influence of systemic racism manifests itself in a variety of cultural and socioeconomic factors that hinder the quality of care Black mothers receive and their ability to access medical services, according to the study.
Together, the two organizations hosted five 5-hour retreats between July and November of 2022 with a community advisory board of 15 Black mothers advising the study through their lived experiences.
To lower barriers to participation, women who attended at least four retreats received a wage of $25 per hour for their participation and were offered additional stipends for childcare and transportation expenses.
Driving those retreats were the participants\’ personal experiences, as well as stark county-level and national data revealing significant differences in both the rate of care Black mothers receive and the negative health outcomes for them and their babies. .
For example, black women in the United States are three times more likely to die from pregnancy-related causes than white women, according to the study.
In Frederick County, Black women are more likely than white or Hispanic women to give birth by cesarean section, receive no early antenatal care, and give birth before being 37 weeks pregnant, according to data from the 2022 Community Health Needs Assessment. which the county cited in its report.
In 2017, according to the CHNA, the infant mortality rate for black children was more than double the rate for white children, 15.5 per 1,000 children, compared to 6.1 per 1,000.
The culmination of these statistics and the personal experiences of participating Black mothers identified five major factors, stemming from systemic racism, that lead to health disparities.
In one driver identified by the study, participants highlighted how inadequate health insurance prevents Black mothers from accessing high-quality care.
And, when black mothers receive care, participants said there is a shortage of culturally competent providers in Frederick County, where non-Hispanic black residents make up 11 percent of the county\’s population, according to US Census data. United States of 2022.
Also present in the participants\’ birthing experiences are racial tropes, Bowden said, which further complicate getting proper care.
“This systemic racism, as a root, is influencing and directly attributed to the strong trope of the Black woman,” Bowden said. “Which means there is very little wiggle room for a Black woman to not show herself strong and able to persevere despite the systems and structures against them.”
When receiving care from black providers in other cities, participants compared their experiences to the care they received in Frederick County, which they perceived more negatively.
Past traumas during pregnancies or childbirth experiences further hinder access to quality care, the study notes.
Participants also said that living in a predominantly white geographic area like Frederick County makes it difficult to connect with other black women and share information or support.
The study went on to link these experiences to data on antenatal care, preterm birth, and low birth weight by race or ethnicity.
A statistic cited by the report shows that between 2016 and 2020, 59 percent of Black Frederick County women sought early prenatal care, compared to 73 percent of white women.
\”… [F]eedback suggests that there is a strong possibility that poor access, intertwined with perceived poor quality of care delivery, may intersect to influence the receipt of early antenatal care,\” the report said.
Discussing the report\’s findings in the virtual forum, Dr Chidinma Ibe, an associate professor of medicine at Johns Hopkins University, said she was not surprised by the participants\’ experiences.
However, Ibe said, \”What I found very encouraging was the level of passion all CAB members brought to the table and the vulnerability with which they shared.\”
Ibe praised the participants\’ intense thinking about the broad theoretical concepts outlined and their acknowledgment that Black maternal health outcomes were negative, and went a step further to ask what could be done about it.
\”It got to the point where they felt like, \’We\’ve heard enough, we\’ve seen enough in our lives. It\’s time for action,\’ and I really admired that so much and found it very inspiring,\” she said. said Ibe. .
Yewande Oladeinde is an adjunct professor of public health at Hood College and founder of Black Mamas Building Bridges, a group of Black mothers whose analysis of these serious maternal health outcomes in 2020 helped create the study.
At the end of the study, she outlined how her findings could be acted upon to improve health outcomes for Black mothers and discussed where more research is needed to develop best practices.
The collaboration with Black Mamas Building Bridges is integral to that future, according to the studio. In an interview, Oladeinde suggested key efforts to build on the study\’s findings.
“The solution must be a collaborative effort with stakeholders,” Oladeinde said, referring to the CAB members.
This includes working with physicians at Frederick Health Hospital and local OB-GYN practices to unpack study findings and make them aware of the lived experiences people of color bring with them when they walk through the doors of a clinic.
Such advances can be achieved not only by having a more diverse workforce of black and brown health care workers, Oldadeinde said, but also by ensuring cultural sensitivity among current doctors.
\”The goal is really to have a workforce that is culturally congruent and culturally humble enough\” to acknowledge what they don\’t know about their patients and actively listen, Oladeinde said.
Like Oladeinde, Haskin said on the virtual forum that the crucial first step taken by this study is to fully assess how disparities in Black maternal health outcomes arise in order to be better informed before seeking solutions.
“It was really important that we could say yes, this is happening nationally, yes, this is happening in the state and connecting it to our local community,” Haskin said. \”Because that\’s going to be really important as we look at what solutions are … to addressing these things that are directly in line with what our community sees and what our community is able to leverage.\”
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