In a recent candid interview with Vogue, Serena Williams, one of the world’s most elite athletes, shared the circumstances of the birth of her daughter, as well as the multiple complications she experienced after birth.
After birthing her daughter via an emergency Cesarean section, Williams developed a pulmonary embolism, or PE, a potentially life-threatening blood clot in the lungs. (A PE in 2011 sidelined Williams for nearly a year.) She identified her own symptoms and asked for the care she knew she needed, but her nurse thought her pain medicine was making her confused. In fact, Williams was right.
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In the days after, coughing fits from the PE made her Cesarean section wound re-open and, during surgery to address that, doctors found internal bleeding from the blood thinners used to treat the blood clots. She required an additional procedure to prevent more clots from traveling to her lungs, for a total of three major procedures in the first week after birth, a precious time of bonding with her daughter.
As an OB/GYN and a black woman, I know first-hand that black women experience pregnancy and postpartum complications at an alarming rate. Williams’s experience—as well as the recent death of activist Erica Garner due to apparent complications that began after her son’s birth—put a familiar face on the deplorable state of maternal health for black women in the United States.
The US has the worst maternal death rate among economically developed countries, as reported by ProPublica in 2017, and is one of few countries where the maternal death rate has increased over time. While it is not surprising that black women fare worse, the degree to which the outcomes between races differ is alarming: Black women are three to four times more likely to die during pregnancy and childbirth as white women.
These frightening numbers and stories only underscore what I already know. While activist, birthing, and some medical communities have been vocal about the worsening rates of maternal complications and deaths for years, the renewed interest in the Affordable Care Act due to threats of repeal have led to a wider discussion of these issues.
With this more public discussion—especially with the inclusion of personal stories from black women and their families—I have seen how quickly some public figures are to fall back on assumptions about individual risk and economics to explain the striking disparities in maternal health. Some of the risk factors for poor pregnancy and birth outcomes, like high blood pressure, obesity, and poverty are more common in the black community; but these alone do not explain the disproportionate risk black women face in pregnancy, nor do they help us understand why this difference exists.
More recent research has validated the open secret that many in the black community have lived with for decades—the stress of daily experiences of racism worsens the health of black people. The medical community has been slow to acknowledge or understand the role stress and racism plays in maternal health, but also slow to recognize the racism reinforced in medicine.
Despite the privilege of being a physician, I have seen and experienced how both institutional and interpersonal racism can have detrimental health effects on patients. A close friend who is a well-educated black woman developed a life-threatening infection during her pregnancy which required an emergency delivery. She was first brushed off by her physician as “being dramatic.”
Like Williams, she was a patient with economic means and excellent access to care, but bias impacted how her concerns were seen and treated. This is one of the reasons it is paramount that medical providers recognize, acknowledge, and correct personal biases. One way to do this is to listen to and trust the concerns of black patients.
A common theme in many personal stories about pregnancy and birth complications, including Williams’s, is medical providers’ inattention to symptoms and silencing of concerns. As Williams recounted, despite having symptoms suggesting a pulmonary embolism—a condition which she has a history of—a less diagnostic test was initially performed against Williams’s concerns.
This illustrates two issues women face in pregnancy and postpartum. First, the symptoms of women and people of color are often taken less seriously by medical providers, which can lead to the undertreatment of pain and worsened disease due to missed opportunity for early diagnosis. Additionally, because most pregnant women are young and healthy, providers sometimes underestimate the risk of complications, also leading to worse outcomes.
Many activists and writers have described the experiences of black women as the proverbial canary in the coal mine—a sign that something catastrophic is happening. This is seen in myriad issues from politics to state-sponsored violence. Maternal health is having its canary in the coal mine moment: We are in a public health crisis, and black women are bearing the brunt of decades of the systemic neglect of black and female bodies.
I applaud Serena Williams for using her platform to share her experience and bring attention to this issue, but we can’t forget that, less than two weeks into 2018, there are undoubtedly multiple nameless, faceless, black women who have similar experiences or worse. Who will tell their stories?
If we are to turn the tide on this crisis, complex solutions, and resources will be needed. But first medical providers must listen and learn from our patients, be reflective on the ways in which we are complicit in the racism in healthcare and improve our behaviors, and use our privilege to amplify the voices of black women. Now is the time. Black women are trying to save themselves. It’s time for the medical community to act.
Sanithia L. Williams, MD, is an OB/GYN in California and a fellow with Physicians for Reproductive Health.
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