In Jan. 2017, just six weeks before 21-year-old Simone Landrum was set to deliver her daughter, her symptoms should have been enough to show any doctor that something was wrong. Landrum complained of swelling, headaches, and feeling ill, achy, and tired—all symptoms of preeclampsia, a pregnancy complication of threatening high blood pressure. Instead, she tells The New York Times, the doctors ignored her complaints, instead telling her to “calm down” and to take Tylenol. As a result of neglect, Landrum almost bled to death and lost her child.
The same thing happened to someone who you’d think receives the best care available: Serena Williams. When she gave birth to her daughter in Sept. 2017, the medical team ignored her requests of a CT scan and blood thinner. The 39-time Grand Slam winner had previously suffered from a pulmonary embolism, a condition that creates blockage in one of the arteries in the lungs. Her symptoms mimicked the same ones she experienced from life-threatening blood clots in 2011, and as a result, she knew how to check for them. When she alerted a nurse that she was having trouble breathing and feared blood clots were forming in her lungs, the team performed an ultrasound on her legs instead. After the ultrasound came back clear, the team performed a CT scan that revealed several blood clots in both of her lungs, proving that Williams was right in diagnosing herself.
The commonality between both Landrum and Williams is race. According to the Centers for Disease Control and Prevention (CDC), black women are three to four times more likely to have a pregnancy-related death than white and Hispanic women. Research also finds that three in five of those deaths are preventable.
There are several complex reasons causing this disparity. For decades, medical professionals blamed black women’s pregnancy-related deaths on poor health. While it is true that black women are more likely to suffer from medical problems like high blood pressure, heart disease, and diabetes, the higher risk of pregnancy-related complications does not only exist because of their health conditions.
Women with lower incomes are more likely to receive poor-quality healthcare, and black women are more likely to be uninsured (pdf) and face more financial barriers for care than white women, resulting in poorer health. One 2007 study concluded that black women are two to three times more likely to have a pregnancy-related death than white women with the same medical condition. Another study (pdf) published in 2016 found that, in New York City, black women with a college degree are more likely to die from complications of birth or pregnancy than white women who did not graduate high school.
The health system in general is biased against black women, who are systematically undervalued and dismissed, and whose health is not monitored as closely as that of white women. Bias, conscious or not, among medical staff leads to black patients being inadequately treated for pain or simply ignored. Cases like Serena Williams’ show that success and affluence are not strong enough to combat years of systemic racism in healthcare against black women. So what is?
Concern and outrage over the crisis of the maternal deaths of black women has reached such a fever pitch that the 2020 Democratic presidential candidates have added the topic to their platforms. (Republican candidates have yet to enter the discussion.) Here’s how the top four Democratic candidates plan to address racial disparity among black women during pregnancy:
Former Vice President Joe Biden plans to invest in resources that gather data and investigate pregnancy-related deaths, as well as provide funding that would improve health care of women from the start of their pregnancy through postnatal care. In an emailed statement to Self, Biden stated he will follow the same blueprint as the California Maternal Quality Care Collaborative implemented in 2006, expanding it nationwide. Though Biden’s plan sounds good in theory, it might not be effective against the spate of maternal deaths specifically among black women; though California’s legislation reduced the number of maternal deaths as a whole, black women in California are still dying at a substantially higher rate than white women.
Senator Elizabeth Warren believes the deaths of black mothers are related to “structural problems that require structural solutions.” In an op-ed for Essence, Warren suggests holding health systems accountable for protecting black mothers by setting one price for an entire episode of care from beginning of pregnancy to the postpartum period, rather than paying for each procedure and doctor’s visit. Health systems would cover key services based on the providers’ effectiveness to encourage better treatment. Health systems that produce positive outcomes would receive a bonus, while struggling systems will be monitored more closely. Like other successful reforms, Warren believes her plan should be tested and evaluated on a local level before carried out around the US.
Senator Bernie Sanders is focusing on a Medicare For All initiative that he believes will close the racial gap in health care as a whole. In an interview with Self, a rep explains that, if Sanders were president, the Department of Health would conduct an evaluation of health disparities and then submit a proposal to Congress based on its findings. The plan also involves placing medical professionals and resources in low-income areas. Aside from his own plan, Sanders co-sponsored Kamala Harris’ Maternal CARE Act and the maternal health legislation launched in March by senators Dick Durbin (D-IL), Robin Kelly (D-IL02), and Tammy Duckworth (D-IL).
Senator Kamala Harris isn’t waiting to be elected president to start addressing the crisis of maternal mortality among black women. In May 2019 the democratic candidate introduced a bill that she hopes will lessen discrepancies in treatment between patients of all races. The Maternal Care Access and Reducing Emergencies (CARE) Act (pdf) would create two grant programs. One would provide implicit bias training in all medical facilities, and the second would motivate maternal healthcare providers to reduce negative health outcomes, deaths, and racial disparities through culturally competent healthcare programs. Starting in 2018, Harris also designated April 11-17 as Black Maternal Health Week to bring national awareness to the issue.
Of the four plans listed above, Harris, Warren, and Sanders are attacking the racial disparity issue directly, while Biden is offering a much broader plan to serve women as a whole. But only Harris’ plan includes elements to combat implicit bias, a driving factor in systemic racism inside and outside of health settings. While universal healthcare will give everyone access to high-quality healthcare, it does not eliminate the biases medical professionals have formed for decades about black women. Harris’ plan to provide implicit bias training has the power to fix deep-rooted issues and potentially eliminate preventable deaths for black mothers.
“We must increase the provision of culturally-competent care through training and regional centers of excellence focused on improving clinician education and ensuring that the voices and lived experiences of women of color are incorporated into patient safety work,” Ted L. Anderson, president of the American College of Obstetricians and Gynecologists (ACOG), tells Quartz. “Successful interventions to reduce health disparities should be multifaceted and incremental in nature, taking aim at the root causes of suboptimal outcomes and care.”
Expecting mothers of all races should have access to good healthcare and live without fear of dying during childbirth, but a broad proposal will not solve niche and complex differences that are responsible for a huge gap between black and white mothers. Black women are being treated differently and unfairly in health settings, resulting in a need for an objective that directly targets the care for black women, in addition to a plan that focuses on women as a whole.