Analysis Health Systems

Segregation Increases Black Women’s Risks for Severe Birth-Related Injuries

Rita Henley Jensen

Hospitals with predominately Black patients “appear to provide lower quality of care,” a recent report found.

The disturbingly high rates of deaths and severe injuries during pregnancy and childbirth facing New York City Black women may, in part, be a legacy of the segregation of the city’s patient population, a recent report has indicated. The report is among a spate of new research highlighting long-established health disparities between Black and white women giving birth in the United States.

The studies come at a time when the rates of maternal deaths and mortality continue to rise nationally, but are decreasing globally.

New York City has about two million Black residents, the largest of any U.S. city. At the same time, Black women in the city are 12 times as often as white women to die due to pregnancy and childbirth. Nationally, Black women die three to four times as often as white women, a ratio that has remained static since 1915.

Published in the August edition of the American Journal of Obstetrics and Gynecology, the report found that Black women giving birth in New York City are more likely to deliver at higher risk hospitals than are white women. The report did not name the high-risk hospitals due to restrictions required by the New York State Department of Health in order for researchers to gain access to its data gathered from the city’s birth certificates and hospital discharge records.

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Dr. Elizabeth A. Howell, a professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai in the city and the lead author of the report, said in an interview with Rewire that the quality of care in hospitals predominantly caring for Black women might explain as much as 47 percent of the disparity of maternity “near misses” between Black and white patients. “Near misses” are when patients who’ve just given birth receive life-threatening diagnoses or undergo life-saving procedures during their hospital stay.

The city’s Black women giving birth experience near misses three times as often as white women, according to Howell’s report.

The New York City Department of Health report on maternal morbidity, which is based on similar information as Howell’s report, found Black women experienced a rate of near misses of 386.9 per 100,000 deliveries, or more than a third of all near misses in the city. The highest rates of near misses are experienced by women living in the city’s neighborhoods with high percentages of residents with African heritage.

For example, in Brownsville, which is a neighborhood in eastern Brooklyn, residents giving birth experienced a rate of 497.4 near misses while neighboring Williamsburg-Greenpoint residents experienced a near miss rate of 122.5. Brownsville, predominately Black, has the highest poverty and crime rates in the city. Williamsburg, on the other hand, has a large Hasidic Jewish population and Greenpoint is known for its high number of residents of Polish ancestry; both are close-knit enclaves with lower poverty and crime rates than Brownsville.

The New York City Department of Health report offers significant data on the frequency of maternal morbidity, but it largely avoids the issue of the quality of hospital care.

A health department spokesperson, Carolina Rodriquez, wrote in an email to Rewire that the report “is a critical starting point in addressing the stark racial and ethnic disparities revealed in the data. Our strategy is to target interventions that improve women’s overall health in the neighborhoods with the highest rates of chronic disease, which is linked to poor pregnancy outcomes.”

The city is developing three wellness centers in renamed and remodeled District Public Health Offices that will include a “Women’s Health Suite,” for families to receive physical and mental wellness services, health education, peer interaction, and referrals for social supports. The first three are expected to open next year: one each in Manhattan, Brooklyn, and the Bronx, but not in Williamsburg-Greenpoint or Brownsville.

Dr. Howell and her colleagues issued a different report in January examining the link between hospital care and the high maternal morbidity rates for Black women nationwide. That research also indicated that Black women receive separate and unequal maternity care. Hospitals with predominately Black patients “appear to provide lower quality of care,” a recent report found.

For that report, Howell said her team determined “nearly 75 percent of all Black births in a concentrated set of hospitals, hospitals with a disproportionately high percentage of Black patients. These hospitals also had high rates of severe maternal morbidity.” In New York City, 27 percent of Black births occurred in public hospitals while 96 percent of white births occurred in private hospitals.

Howell and colleagues ranked hospitals by the proportion of Black deliveries into high, medium, and low “black-serving hospitals.” For example, in 279 hospitals with the highest proportion of Black deliveries, up to 99 percent of the patients were Black, with the median at 59 percent. Of those hospitals, 181 were in the South, 21 were in the Midwest, 39 were in the Northeast, and few were reported as being in the West. Medium “black-serving hospitals” had percentages of Black patients as high as 48 percent.

The Black patients in hospitals that Dr. Howell identified as “high black-serving” experienced severe complications after accounting for patient case mix—at a rate as high as 20.5 per 1,000 births; at the 1,006 medium “black-serving hospitals” Black women experienced severe complications at a rate of 19 per 1,000 births. Black women giving birth at hospitals called “low black-serving” hospitals were treated for severe maternal morbidity at the rate of 16.9 per 1,000 deliveries.

In contrast, the 4,102 “low-black serving” hospitals had a median of 2 percent of Black patients.

“White women in high black-serving hospitals and medium black-serving hospitals had similar rates of severe maternal morbidity as African-American women,” Dr. Howell added, highlighting the fact that it is the site of care putting pregnant people at risk of life-threatening conditions.

The data also indicated that the costs of 69 percent of African-American births were covered by Medicaid, while 36 percent of the births to white women were.

Dr. Howell was asked if she was aware of Medicaid taking any leadership role in raising the quality of maternal care its patients received.

“No,” she said.

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