Internship Research, (cont.)

 

Chapter Two: African-American Maternal Health

 

Our country's history of racial discrimination has led to an increase in preventable death among  African-American Women. Currently, African-American women are three times more likely to die from pregnancy-related causes than Caucasian women. As the woman ages, the risk of dying from these complications increases. The question is, why is this still happening. Considering the advancements the American healthcare system has been able to make, you would think the health of this population would be improving, not diminishing. Today’s topic focuses on uncovering the factors that are increasing this mortality rate as well as, identifying potential improvements that may be made by expanding Medicaid services.

One factor we have to consider is the African-American communities’ hesitation to receive healthcare services, due to previous discrimination and deception experienced in the past. I believe that a majority of the mistrust between the African-American community and the American healthcare system stems from the Tuskegee Syphilis Study. Here is a brief background on the subject. According to the Center for Disease Control and Prevention, “The study initially involved 600 black men – 399 with syphilis, 201 who did not have the disease. The study was conducted without the benefit of patients’ informed consent. Researchers told the men they were being treated for “bad blood,” a local term used to describe several ailments, including syphilis, anemia, and fatigue. In truth, they did not receive the proper treatment needed to cure their illness. In exchange for taking part in the study, the men received free medical exams, free meals, and burial insurance. Although originally projected to last 6 months, the study actually went on for 40 years,” (2020). The unethical components of this study would solidify some of the mistrust between the African-American community and the healthcare system. In 1945, penicillin was accepted as the appropriate treatment for syphilis. All of the healthcare professionals involved in this study knew that penicillin was the appropriate course of treatment, yet none of the participants were treated for syphilis. The study would not officially end until 1972 after an article is published condemning the study. While the Tuskegee experiment may have initiated the apprehension, it is not the sole reason.

I believe that discrimination would be the primary factor. The history of African-Americans in the United States is a story filled with entrapment, violence, and discrimination. Although today’s African-American individual has more rights then their grandparents and great-grandparents, there is still implicit bias and discrimination in the healthcare system towards African-Americans. The attitudes of the healthcare provider have been cited as a deterrent to receiving care. A study published in The American Journal of Public Health examined implicit racial and ethnic bias of healthcare providers’ effects on healthcare outcomes. The subsection entitled, Health Disparities and Provider Attitudes, stated that “Although overt discriminatory behavior in the United States may have declined in recent decades, covert discrimination and institutional bias are sustained by subtle, implicit attitudes that may influence provider behavior and treatment choices. As a result, patients of color may be kept waiting longer for assessment or treatment than their White counterparts, or providers may spend more time with White patients than with patients of color. In addition, providers may vary in the extent to which they collaborate with patients in systematic though non deliberate ways, in considering treatment options based on patients’ characteristics,” (Hall et al., 2015). Subtle biases, such as engaging the patient in a condescending or dominant tone, were cited as a tacit to decrease the patient’s control over the situation. From personal experience, I can say I see this form of bias extended more from older white males. I have seen this form of bias exhibited by an African-American male provider, but it is mostly exhibited by older white males.  The article also cited that many patients felt like their opinions were not considered and that subtle bias prevented some patients from receiving the best care.

These subtle biases become evident in many cases of pregnancy-related deaths with African-American Women. Some of the cases I have studied mentioned that the physicians did not acknowledge the patient’s concerns, specifically regarding pain. Despite the patient educational background and income level, many of their concerns were disregarded by physicians. Here are some cases identified in an NPR article published in 2017. “There was the new mother in Nebraska with a history of hypertension who couldn't get her doctors to believe she was having a heart attack until she had another one. The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair. The Chicago-area businesswoman with a high-risk pregnancy who was so upset at her doctor's attitude that she changed OB/GYNs in her seventh month, only to suffer a fatal postpartum stroke,” ( Martin & Montagne, 2017).  Tennis pro-Serena Williams had a similar experience after delivering her first child. Mrs. Williams has a history of blood clots. When she informed the medical staff that she was experiencing trouble breathing (a symptom she recognizes as her having a blood clot), and that she needed a CT scan and a blood thinner. Her concerns were initially ignored and the physician performed an ultrasound, which revealed nothing. The physician finally performed a CT scan, which revealed several blood clots in her leg. Had that CT scan not been performed, Serena Williams would probably have died from an embolism. I believe that these subtle biases may have a larger effect on black maternal mortality rates than access to care. African-American women who are well off and extremely educated are still experiencing the same lack of care that individuals from impoverished areas experience.

Access to maternal health services is still a barrier that many individuals are facing. We know the problem, but what is the solution? The issue is that the current Medicaid program is preventing women from addressing those postpartum complications with a physician. Current Medicaid policy allows for a woman to receive healthcare coverage up to 60 days after giving birth. The problem is that many women can develop postpartum complications after this 60 day period. “An increasing number of maternal deaths, which are defined as deaths during pregnancy and up to 365 days after, are occurring in the postpartum period. CDC data confirm that one-third of all pregnancy-related deaths occur one week to one year after pregnancy ends. In some states, the number is much higher. In Illinois, for example, 56 percent of pregnancy-associated deaths occurred between 43 and 364 days postpartum,” (Muller, 2020). For the women who do not have any other form of healthcare coverage, post 60 days could mean death. 

Currently, South Carolina has not expanded Medicaid services, but there may be a chance to reverse this decision. Democrats are currently trying to urge states to expand Medicaid services for expectant mothers. The Washington Post presented an article on the subject. The article stated that “This morning, the House Energy and Commerce Committee will hold a hearing on its piece of the $1.9 trillion relief bill moving through the House. The legislation includes a short provision (it’s only a sentence long) saying states, for a length of five years, can extend Medicaid eligibility to women for 12 months after giving birth,”(Cunningham, 2021). Implementation of this policy would allow low-income women the opportunity to receive quality prenatal and postpartum care. African-American women in low-income areas would have healthcare coverage, but that doesn’t solve the other barriers to accessing care. Individuals without transportation may still have trouble accessing maternal health services due to location. There is still the issue of implicit bias. While there is no quick way to resolve this issue. Some healthcare institutions are taking measures to reduce implicit bias, but only time will tell if the methods are effective.

Overall, simply addressing the concerns of African-American women will not be enough. In order to truly improve health services for African-American women, we must be willing to accept the fact that racial bias and discrimination still exist in our current society. Once this issue is addressed, we will be able to improve our entire healthcare system.

African-American Maternal HealthSummary: In the American healthcare system,  African-American women are at an increased disadvantage.  A long-standing history of discrimination and racial bias has caused many African-American women to forgo seeking prenatal care. Bias on the part of the healthcare provider has been cited as the primary reason for the hesitation in receiving care. “A study published in The American Journal of Public Health examined implicit racial and ethnic bias of healthcare providers effects on healthcare outcomes. The subsection entitled, Health Disparities and Provider Attitudes, stated that “Although overt discriminatory behavior in the United States may have declined in recent decades, covert discrimination and institutional bias are sustained by subtle, implicit attitudes that may influence provider behavior and treatment choices. As a result, patients of color may be kept waiting longer for assessment or treatment than their White counterparts, or providers may spend more time with White patients than with patients of color,”(Hall et al., 2015). This bias can be connected to some incidences of pregnancy-related death in African-American women. Many African-American women feel as if their medical concerns are being ignored by their physicians. African-American women who cannot afford or do not live near any maternal health services are unable to address any postpartum medical concerns. Medicaid does provide healthcare coverage up to 60 days after birth, but women who experience complications after this period will be unable to afford care. “An increasing number of maternal deaths, which are defined as deaths during pregnancy and up to 365 days after, are occurring in the postpartum period. CDC data confirm that one-third of all pregnancy-related deaths occur one week to one year after pregnancy ends. In some states, the number is much higher. In Illinois, for example, 56 percent of pregnancy-associated deaths occurred between 43 and 364 days postpartum,” (Muller, 2020). Extending Medicaid services to a year would allow women to receive care for any postpartum complications they may develop.

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