“The risk factor is racism,” said Joia Crear-Perry, a gynecologist and founder of the National Birth Equity Collaborative, a nonprofit group dedicated to eliminating racial inequalities in birth outcomes and one of the report’s co-sponsors. “This report makes us clear again and again. If your pain is ignored, if your blood pressure is ignored, you die, and it’s happening across the Americas.”
There are more than 209 million people of African descent in the Americas, meaning it has the largest population descended from the African victims of the Transatlantic and Mediterranean slave trades. And while the report identifies a common root cause for the region’s growing maternal mortality crisis, it exhibits distinct manifestations that reflect each country’s history and culture.
According to the report by the UN Population Fund, the United Nations Sexual and Reproductive Health Agency, between 2016 and 2020, maternal deaths increased by 15 percent in Latin America and the Caribbean and by 17 percent in North America.
Maria J. Small, associate professor of obstetrics and gynecology at Duke University School of Medicine, who researches global racial and ethnic disparities in maternal health, said examining how racism drives differential maternal outcomes in countries with a tradition of slavery, is “conceptually one of them.” “The most important thing about this work,” which she was not involved in.
“Across America, the similar experiences of forced migration and many of the fundamental principles and behaviors that remain from those institutions still determine some of the outcomes in the present day,” she said. “I often think that it’s just a matter of historical circumstances that some people ended up in one country and not another.”
However, the nature of the data itself poses one of the challenges to fully understanding the magnitude of the problem, due to a lack of consistency and uniformity in the way countries in the Region report health outcomes based on race and gender.
Notably, the report says, only a third of nations in the hemisphere classify Afro-descendents as a population suffering from health limitations.
“We are seeing a failure by states to take the necessary action,” said Emilie Filmer-Wilson, human rights adviser to the UN Population Fund. “We want to make this problem visible, and the challenge is the data that makes the situation invisible.”
Of the countries that examine the data by race, 15- to 49-year-old Black women and adolescents in Suriname were 2.5 times more likely to die in childbirth or in the aftermath of childbirth between 2016 and 2017 peers. In Colombia, they were 1.6 times more likely than their peers to die in 2020, the report said. And in 2021 In Brazil, black women were 1.6 times more likely to die than white women.
One of the UN Sexual and Reproductive Health Agency’s goals is to achieve “zero avoidable maternal mortality” by 2030, but the report highlights that much work remains to be done on “a crisis that requires an immediate solution”.
“Broadly speaking, women of African descent in America still perform very poorly on many developmental indicators that you talk about in relation to health,” said Patricia Da Silva, program adviser to the UN Sexual and Reproductive Health Agency. “We talk about access to education, access to water and the wage gap. All of these factors directly impact a woman’s ability to access quality care.”
And yet, she said, the stereotypes Black women face in their day-to-day lives are often embodied in the rationale for why they face worse health outcomes: their bad choices or their bad genes.
People say racism is rare in Costa Rica, but Siannie Palmer said if someone yells at a white woman walking down the street, “they’ll say ‘señora’ or ‘señorita.'” But if they’re walking a black woman see, they will say “negra” which means “black”.
“She may be black, but she’s still a lady,” said Palmer, who has worked in Límon since 1999 as an obstetrics and gynecology nurse, which is similar to a board-certified midwife. Located on Costa Rica’s Atlantic coast, the province is home to much of the country’s black population.
This type of discrimination, whether conscious or unconscious, creates a barrier to medical care for many black people, who often delay seeing a doctor for fear of abuse, she said, even though Costa Rican law guarantees pregnant people access to medical care Care.
The way providers speak to patients of color is important, including where and how health information is solicited. “If you rush to talk to her, you’ll lose her,” Palmer said. “She’s not coming back.”
Of the eight countries reporting prenatal visits by race, Brazil, Costa Rica and Suriname were three that achieved equality between black women and their peers in 2018. A higher percentage of black women in Cuba had at least four health screenings compared to their peers.
“We often think of the US as a place where health information and resources are pushed to places with lesser resources, but that’s absolutely a paradigm that needs to be broken – and can be broken,” Small said. Instead, solutions can be found in other countries – and Small is cited as an example the report’s mention of maternity homes, which provide a more homelike, community-oriented environment for people about to give birth.
The report said that maternity homes in rural Cuba are sometimes used “as an alternative to the abuse” experienced by black women and girls in hospitals and clinics. “I never thought of her in that context,” Small said. “It’s something I’d like to see further explored.”
Just before the pandemic, Lenita Reason, a community organizer in the In the Boston area, she came across several pregnant Brazilian immigrants who were keen to return home give birth They told her that caring for a newborn in Brazil would be easier if their family network would help. Most of them “were fair-skinned,” she said, noting that their “experience would be very different from that of the dark-skinned people.”
She said Brazil has gotten better at talking about race issues, while in previous years “it’s been all about class, but the odds have always been better for people with lighter skin.” Then, as an example, Reason, executive director of the Brazilian Labor Center, a Boston-based nonprofit dedicated to defending and promoting labor and immigration rights, shared the story of her niece’s miscarriage.
Last year, the 20-year-old, who was four months pregnant and had no insurance, made a prenatal visit to a community clinic in Belo Horizonte, a city in southeastern Brazil, Reason said. Such clinics are publicly owned and treat a variety of conditions, but providers are not always optimally qualified to provide the care required. The doctor on duty that day, she said, was a dermatologist who couldn’t find the baby’s heartbeat and so ordered an ultrasound elsewhere.
It was supposed to be a month before Reason’s niece was seen – two hours away.
“By the time she was able to see the doctor, the baby was dead,” said Reason, who happened to be in Brazil when her niece was transferred to a maternity hospital almost six hours away. When she came to visit, Reason said, her niece was chatting with two other young women who also gave birth to stillborn children. Most of the women in the hospital, she said, are black.
According to the UN report, black women in Brazil were more likely than white women to be dissatisfied with the quality of their health services.
Maternal health is affected by an accumulation of life events that begin long before pregnancy and last for centuries. For this reason, it is a top indicator of a country’s health, reproductive health equity and human rights, experts said Tackling maternal mortality means understanding the impact that racism, housing and education policies, pollution and climate change have on expectant mothers.
“Our goal is not just for women to survive, but for them to thrive,” said Filmer-Wilson. “This aspect of thriving is often overlooked because we’re only looking at the mortality part.”