The COVID-19 crisis adds a new dimension to the maternal mortality crisis for New Yorkers. In New York City, Black women are eight times more likely to die of causes related to pregnancy and birth, compared to their White counterparts. The rate of Black women suffering from severe maternal morbidities, such as hemorrhage or preeclampsia, is even higher. However, this current crisis crystallizes the magnitude of how much we are failing mothers of color.
As a Black midwife, woman, mother, wife, and daughter, I cannot help but think about my fellow Black and Brown women who are pregnant during this crisis. Black and Brown people have a higher risk of comorbid conditions, such as diabetes and hypertension, but this is not because of their race or ethnicity. Rather, it is related to how people react to the color of their skin. Black and Brown people in the United States suffer from the generational effects of institutional racism that have altered their cellular reactions to life stressors such as pregnancy. This is a condition coined as “weathering” by Arline Geronimus, a professor at the University of Michigan. When a person is exposed day after day to harsh elements, they change, just as a wooden shingle becomes brittle after years of exposure.
Pregnancy is a natural stressor on the human body that most women and birthing people are designed to handle well. However, with the addition of weathering due to institutional racism and health care inequities, a common life stressor can turn into a death sentence.
New York City (the five boroughs) contains a rich mixture of religious, cultural, and socioeconomic groups residing in a small square-mile radius. While there appears to be a greater proportion of wealth and access in New York City, there is also a large number of poor, marginalized residents that lack access to healthcare, including reproductive healthcare. Consequently, birth options are not a privilege afforded to the majority of New Yorkers. So, while our healthcare administration focus on plans to limit the spread of COVID-19, many pregnant New Yorkers continue to flee the city to seek refuge in other areas that are thought to be less affected by the virus. Still others seek home or birth center births. These options are only afforded to an elite minority group, while the majority of New Yorkers are left to deal with the deleterious effects of COVID-19.
It has been six weeks since the first confirmed case of COVID-19 in New York State. Many pregnant and birthing people grow increasingly anxious. Many hospitals in and around New York are completely inundated with exponential numbers of infected patients. Labor and birth, mother/baby, and nursery units previously occupied by family members excited by the hope of new life are now filled with patients fighting to survive. There is a palpable sense of unrest within the birthing community.
Unfortunately, the communities most affected by COVID-19 are predominately Black and Brown. Recent reports demonstrate increased rates of fatality related to COVID-19 within the Black and Brown communities. Yet again, our most marginalized citizens are suffering. We are now witnessing a rise in the number of pregnant women infected with COVID-19. At this time, there has not been an official report citing an increase in maternal mortality, but it is likely that this will occur, with effects that could last for generations.
It is crucial that the birthing community – all disciplines who care for mothers and babies – comes together to critically examine the data as we emerge from the COVID-19 pandemic. What lessons can we learn to reverse the long-term health effects for people of color and move toward better health for all people?
At this time, we need to reflect on the health disparities that continue to plague the Black and Brown marginalized members of our country while aspiring for a brighter future.
This commentary represents my thoughts as an individual midwife.
Sascha is the President of the New York State Association of Licensed Midwives, co-chair of Governor Cuomo’s Task Force on Maternal Mortality and Racial Disparities, member of Governor Cuomo’s COVID-19 Maternity Task Force, and a Lecturer at Yale University School of Nursing.
