Abstract

Excerpted From: Ashley Pattain, Black Maternal Mortality Rate: Improving Outcomes for Black Mothers Using Legislation That Reverses the Effects of Structural Racism in Medicine, 45 Mitchell Hamline Law Journal of Public Policy and Practice 141 (Spring, 2024) (183 Footnotes) (Full Document)

Frentorish “Tori” Bowie was a three-time Olympic medalist who once earned the title of world's fastest woman. On May 2, 2023, Bowie's body was found by sheriff's deputies in Orange County, Florida. All the accolades she received in her short life and all the barriers she broke did not stop her from becoming another heartbreaking statistic. In 2021, the maternal mortality rate for non-Hispanic Black women was 2.6 times the rate for non-Hispanic white women in the United States. Bowie was pregnant at the time of her death. Orange County Medical Examiner Chantel Njiwaji wrote in her autopsy report that Bowie died from natural causes, citing complications potentially stemming from respiratory distress and eclampsia. Eclampsia is a disorder that can occur during pregnancy that is related to high blood pressure. There was evidence that Bowie was undergoing labor when she died. Bowie's autopsy “repeatedly described her body and organs as being in normal condition.” The story of Bowie's untimely death is reminiscent of the complicated birth stories of so many other Black mothers.

Serena Williams was the unofficial queen of tennis. She holds seventy-three career singles titles, twenty-three doubles titles, and two mixed doubles titles. Her accomplishments don't end on the court. She also created Serena Ventures, a venture capital firm focused on investing in companies that embrace diverse leadership and opportunity. Despite being a world-renowned athlete and business owner, Williams experienced postnatal birth complications in 2017 with the birth of her first child. Williams experienced an episode in the hospital where medical professionals did not act on her concerns that she was experiencing a pulmonary embolism. A pulmonary embolism “is a blood clot from your leg that travels to your lung and stays there.” It can cause issues with blood flow and oxygen levels in your lungs. Without quick treatment, a pulmonary embolism can cause heart or lung damage and even death. A computed tomography (CT) scan later showed several small blood clots in her lungs, which confirmed Williams' suspicions. Fortunately, in Williams' case, she was able to advocate for herself despite initial resistance from her nurse. Her advocacy resulted in her receiving proper care, avoiding what could have been a devastating situation. If world-renowned public figures have issues being heard in health care settings, it begs the question of what happens when the patient is not a public figure.

Kira Johnson was an expectant mother of one who was admitted to Cedars-Sinai Medical Center to have a cesarean section to deliver her second son. Shortly after her delivery, Johnson started to experience complications from the surgery. Despite her husband communicating his concerns to her health care providers, twelve hours after delivering her son she was dead. Despite being healthy with access to medical care, no pre-existing conditions, and family there to advocate for her, she still fell prey to an unresponsive medical team. These stories share a common theme: Black women going unheard by their health care providers. Unfortunately, for one of these women, going unheard resulted in her death. These women's stories reminded me of my son's birth story. An event that ended in so much joy with my son's arrival, began as a journey filled with so much pain. Pain caused because I felt unheard by medical staff. I left the ordeal traumatized and never wanting to go through the birthing process again. It was only later in life that I learned that my experience was the same experience of so many other Black mothers. However, in some cases, those mothers did not get to go home.

The World Health Organization defines maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” For Black women twenty-five and older, pregnancy-related mortality is about four times higher than it is for white women of similar ages. In the twenty-first century, living in a nation that spends more on health care than any other country, this statistic requires one to wonder why the U.S. health care system is failing Black mothers at this rate. According to Kira Johnson's husband, Charles Johnson IV, “[t]here's no doubt in my mind that my wife would be here today ... if she was a Caucasian woman.” Mr. Johnson's belief that the racist bias his wife experienced kept her from going home is supported by statistics. Despite the increase of other positive factors, such as socioeconomic status and education level, the maternal mortality rate does not increase for Black mothers.

Parenthood is an experience everyone should have access to without worrying about an increased likelihood of mortality. The racist policies this country was built on have contributed to the maternal mortality crisis in the U.S. This paper will: (1) discuss racism, its roots in medicine, and the impact racism has on the American medical system; (2) discuss how racism contributes to the high Black maternal mortality rates; (3) discuss how the government previously used legislation to address systemic issues; (4) discuss current legislation that seeks to improve the maternal mortality rate; and (5) explore methods of implementing current proposed legislation using available resources that would improve the maternal mortality rate for Black mothers.

[. . .]

Improving the maternal mortality rate for Black women needs to happen and with proposed legislation already in place it is possible. With an improved maternal mortality rate in the most vulnerable population, there will be a ripple effect throughout maternal health care and improve the rate for all women. With one of the highest maternal mortality rates among the developed countries, this is a statistic the U.S. needs to improve. Not only is it a necessity but the United States has the resources to make it happen. The U.S. has a long history of using law and policy to improve the lives of vulnerable citizens. The health care space has seen a lot of this in recent years with the passing of the ACA. When an industry is producing outcomes that continuously negatively affect people, greater regulation can help improve those outcomes. With this issue, we have seen that one of the biggest contributing factors is race and how the treatment of Black mothers is negatively affected by the implicit bias of health care professionals. In a country where race has and is still used to divide people it is also presenting issues in the care that women are receiving. With bills already proposed and resources that have been used in this work for decades, it is time we utilize both of these things to fix a problem that we are capable of addressing.

The thought of having a baby and bringing new life into the world is filled with so many positive feelings. Feelings like joy, wonder, and promise. In addition to positive feelings, there are also ones of trepidation and uncertainty surrounding how you will manage parenthood. For Black mothers there is also the very real concern of whether they will be able to have a safe pregnancy, where they can access the necessary care to carry a healthy baby to term and then safely deliver that child. Everyone deserves to be heard when it comes to their medical concerns, and everyone deserves to not have their message be muffled or dismissed due to a health care provider's bias. Steps have been taken to promote the positive outcomes that having open conversations about race and our implicit bias can impact the decisions we make in our professional lives, but further support is needed to channel this awareness into systemic change. Becoming a parent is one of the biggest changes that a person goes through in their life; Black mothers should not have to worry about whether they will get to go home with their child. Racism is a problem that will not be solved overnight, but it is also not something we can ignore just because of the magnitude of the problem. A problem like this requires calculated steps to solve but guaranteeing that more children will be raised by their mothers is a worthy goal.

The author recognizes that not all people who give birth identify as women or mothers. This identifier was used throughout this paper as it was in line with the language used in many of the statistics given and the legislation drafted surrounding this topic.

Juris Doctor Candidate, Mitchell Hamline School of Law, May 2025.