Pregnant Afrodescendent women and girls across the Americas are more likely to die during childbirth than almost every other racial and ethnic group because of systemic racism in health care, according to a report from the United Nations sexual and reproductive health agency released Wednesday.
The report, produced by the UN Population Fund, compares maternal, sexual and reproductive health outcomes for Afrodescendent women and girls with those of non-Afrodescendent females (excluding Indigenous people) in nine countries.
The data show that the largest discrepancy in maternal death rates is in the United States, where non-Hispanic African-American women are three times more likely to die while pregnant or within six weeks of giving birth than non-Hispanic white women – a higher rate than in Brazil, Colombia and Suriname.
The trend in the U.S. continues regardless of income and education, the report said, with maternal deaths among African-American college graduates 1.6 times higher than white women with less than a high-school diploma.
Natalia Kanem, UNFPA’s executive director, said that when a Black woman dies during childbirth, whether it’s in Bogota or New York, it’s often attributed to her lifestyle or poor life decisions, or because she was predisposed to certain medical conditions. But the report categorically refutes those misconceptions, she told reporters during a press briefing on Wednesday.
“What the analysis reveals is horrendous.” Dr. Kanem said.
Afrodescendent women and girls face verbal and physical abuse in hospitals and are often denied pain relief because of “racist beliefs that date back to the era of enslavement that Black people are less sensitive to pain,” she said, adding that the result of such mistreatment is increased birth complications, delayed interventions and death.
The UN analysis covers Brazil, Colombia, Costa Rica, Cuba, Panama, Suriname, Trinidad and Tobago, the United States and Uruguay. The countries were selected based on the percentage of Afrodescendent women in their population, the availability of national data and data disaggregated by ethnicity, race or skin colour, and the comparability of indicators.
The term Afrodescendent refers to “descendants of the African victims of the Trans-Atlantic and Mediterranean Sea slave trade. The group includes those of the Sub-Sahara slave trade,” according to a UN definition. The report uses the term to refer to Black and mixed race (Black and another race) populations identified as being of African descent.
Siannie Palmer Miller, an obstetrics and gynecology nurse working in eastern Costa Rica, who also spoke to reporters on Wednesday, said sometimes women don’t seek the attention they need because they don’t trust the system or feel that they are worthy of care.
According to the report, causes for Black maternal deaths in the Americas include a lack of quality health data disaggregated by race and gender, as well as policies and programs that overlook specific health-related vulnerabilities. It also identified structural racism and sexism in health service delivery and medical education as hindrances to maternal, sexual and reproductive health care.
Literature on Afrodescendent women’s health in the Americas frequently references social determinants as the primary cause of health inequities, the report said. But social determinants cannot explain most of the maternal mortality and sexual and reproductive health inequalities in its analysis because they happen across education levels, income and geography.
Patricia Da Silva, who co-ordinated the research and is UNFPA’s programme adviser for its Initiative for People of African Descent, said that one issue the team found is that even when health services are available, often they are not of the quality that’s required.
Women of African descent are not being respected in the medical system and it’s not because they are poor or uneducated, she told The Globe. “It’s really just racism.”
“We should assume that we will survive, that we will have happy positive births and experiences – that should be the goal. Instead, we’re still thinking, ‘Oh my gosh, I have to give birth. Will my older child that is home become an orphan because I might not survive this experience?’”
The UN agency called for increased and improved quality data disaggregation by race and gender, along with equity-centered primary health care, and policies and programs developed in partnership with civil society and female Black community leaders. It also recommended adopting an approach to maternal health that addresses racism and sexism, eliminating racism in medical education and increasing the presence of medical staff of African descent.
“What’s behind these deaths across the region is indeed a systemic and the historic pattern of racism and abuse in the health sector across the Americas,” Dr. Kanem said, calling it “a human-rights crisis that is often ignored or overlooked by decision makers.”
But she believes the future can change for Afrodescendent women and girls.
“It begins when we recognize and respect the invisible women who are still dying and we prevent deaths that are happening in plain sight.”
Janice Dickson