Pt.2: Social Determinants of Black Maternal Mortality

Is there one answer to why the maternal mortality rates in the U.S. and especially Georgia so high? Is there something we are missing? Is it policy? Is it pre-existing health conditions? 

WHY DOES THIS MATTER?

African American mothers in Georgia have a 66% mortality rate, compared to White mothers who are at 43.2% and Hispanic mothers who are at 18.1%.[1] The numbers are alarming. To put it in perspective, African American mothers are three to four time more likely to die from pregnancy or childbirth than white mothers! Unfortunately, the numbers don’t lie, and they are not improving. Many preexisting conditions such as heart disease, diabetes, high blood pressure increases the likelihood of pregnancy complications, they also have contributed to the rise in maternal deaths. Through my research, I have learned that preexisting health concerns are not the only contributing to the rise of maternal deaths in Georgia, especially among black women.

WHAT ARE SOCIAL DETERMINANTS AND HOW DO THEY RELATE?

Social determinants of health include the conditions in which we are born, work, learn, live, play, and age. Social determinants have the ability to impact health outcomes and overall well-being. The figure below [2] shows how race, psychosocial influences, and medical co-morbidities may have a bidirectional effect, along with social determinants, on maternal outcomes.

“Conceptual framework for the relationship between race/ethnicity, individual and community-level social determinants of health, and maternal outcomes. These relationships occur against a backdrop of historical structural and institutional inequities. Bi-directional arrows demonstrate the complex interaction of different social determinants in determining the ultimate pregnancy outcome. Dashed arrows represent the uncertainty that still remains in our understanding of the mechanism through which prenatal care utilization interacts with this relationship.”[2]

“Conceptual framework for the relationship between race/ethnicity, individual and community-level social determinants of health, and maternal outcomes. These relationships occur against a backdrop of historical structural and institutional inequities. Bi-directional arrows demonstrate the complex interaction of different social determinants in determining the ultimate pregnancy outcome. Dashed arrows represent the uncertainty that still remains in our understanding of the mechanism through which prenatal care utilization interacts with this relationship.”[2]

Going forward, I believe that WE have to recognize the multifaceted collaboration of social determinants in the lives of pregnant women of minority status, and specifically Black women. This alone has the potential to an invoke understanding of disparities in maternal outcomes across the board. Community-based research has shown that bundling prenatal care with other services, such as doula support, specifically aimed to reduce known inequalities in social determinants has been shown to improve outcomes. In the future, long-term, prospective research will be needed to continue to explore the relationship between these factors and maternal outcomes. It is imperative that we continue on the path to recognizing the problem, talk about and bring attention to the problem, and ACT on a community-level to help solve the problem!

About the Author: Brooke Blocker is a Senior Human Development and Family Science major at the University of Georgia. She is interning with BIRTHFIT Atlanta as part of her study program requirements. Brooke is planning to attend Nursing school with the hopes of working in women’s health.

Sources

https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/maternal_mortality/state/GA

Gadson, A., Akpovi, E., & Mehta, P. K. (2017). Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome. Seminars in Perinatology, (5), 308. https://doi.org/10.1053/j.semperi.2017.04.008

Kozhimannil, K.B., Vogelsang, C.A., Hardeman, R.R., & Prasad, S. (2016). Disrupting the pathways of social determinants of health: Doula support during pregnancy and childbirth. Journal of the American Board of Family Medicine, 29(3), 308-317. https://doi-org.proxy-remote.galib.uga.edu/10.3122/jabfm.2016.03.150300