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Improving Black Maternal Health

May 2, 2022

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Community Conversation: Nkechinyere Amadi, MD, OB/GYN and Ophelia M. Byers, DNP, RN

Did you know Black women in New Jersey are seven times more likely to die from a pregnancy-related complication than white women? That’s just one of many statistics that demonstrates the challenge facing New Jersey and the nation to improve maternal health for Black women.

Nkechinyere Amadi, MD, OB/GYN at Atlantic Medical Group, and Ophelia M. Byers, DNP, RN, Chief Nursing Officer at Overlook Medical Center, joined a Community Conversation on April 11, 2022, to examine the various causes of this crisis and share potentially life-saving information.

In what ways and to what extent is the health of Black mothers at risk? 

There are stark differences in health outcomes for Black mothers across the country, Dr. Amadi explained. The United States is one of the worst performing developed countries for maternal health and New Jersey is among the lowest performing states. Dr. Byers emphasized the need to improve black maternal health: “It is a huge disparity, and we need to close that gap.”

How has the state begun to raise awareness of Black maternal health?

Tammy Murphy, the First Lady of New Jersey, founded the Nurture New Jersey initiative to bring these disparities to the forefront of conversation and to find proactive ways to address them. April is National Minority Health Month, and this year Black Maternal Health Week runs from April 11 to April 17.

How long have these serious health care disparities existed? 

Both Dr. Amadi and Dr. Byers said that Black women have experienced these disparities in maternal health for a long time and attention to the issues is long overdue.

Dr. Byers added, “Our Black health care professionals, our physicians, our nurses, nurse midwives, our scholars, we've known for decades that there's been a health disparity overall, and certainly, when it comes to obstetrical care, it is great to see that people are listening more, that our political leaders are listening, that the health care community is listening more, but we've lost a lot of women and babies in the process.”

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What are the root causes of these health care disparities?

Dr. Amadi said there is a complex array of factors that cause inequality in the care of Black mothers and babies. Among them are lack of access to care, especially prenatal care, and other social determinants of health, including poverty. Dr. Amadi elaborated on the importance of accessible health care, especially in the first trimester:

“It's having a provider in your community that you can go see in a timely fashion. If it takes you two months to get in to see a doctor and you're pregnant, that's a problem because you've missed a big portion of the first trimester. Getting educated, making sure that your weight is appropriate, that you're getting your prenatals or looking at anatomy scans of the fetus … impacts the overall quality of your pregnancy.”

What are social determinants of health?

Social determinants of health are defined by the World Health Organization as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

Dr. Byers provided examples, including housing, access to nutritious, high-quality foods and transportation. She emphasized the importance of recognizing racism and classism as structural causes of disparities in the social determinants of health. “They're embedded in the reality of Black people's experiences here in this country, and really are the foundational piece to the disparities of health.”

What should an expectant mother do to advocate for her health?

Dr. Amadi said it is important that you speak up and be vocal, ask questions about your health and bring awareness to what’s happening to your body. She acknowledged that many Black women often feel ignored by their physician, but they should continue to self-advocate, even if it means being confrontational.

“Oftentimes I think as Black women and Black patients, we're told that we're aggressive or combative, and people are simply asking questions. So, don't worry about that. Be combative. Be aggressive and get your questions answered.”

She added that if you believe that your concerns are being dismissed, and something is not right with your body or the way you feel, reach out to another physician, and seek other sources of information.

What other sources of health care information exist for women to explore?

The Centers for Disease Control and Prevention (CDC) has an online resource called Hear Her Concerns that provides questions that women should ask their health care providers. Dr. Byers mentioned, another online resource that is focused on Black maternal health.

She said it is important for women to ask the right questions of their obstetrician and to empower others in their immediate circle – their birth partner, their mother, their family – to be armed with information to advocate on your behalf. Dr. Byers suggested adding the patient advocate or patient relations representative in the medical center to your list of contacts.

The most important thing is to know that you have a right to high-quality health care. You have a right to escalate concerns if you have them, and your health care team… (has a) responsibility to give you the best possible obstetrical care.”

Ophelia M. Byers, DNP, RN, Chief Nursing Officer at Overlook Medical Center

Why is it important to have a relationship with a primary care physician and an OB/GYN?

Dr. Amadi said it is important to have a physician you know and trust, someone you have built and fostered a relationship with and who knows your health history. Your well-being extends from routine checkups to conversations about family planning and any health concerns associated with pregnancy. As with any relationship, communication is key. Dr. Amadi said if you have questions about your care, don't be shy or reluctant to speak up. If you don’t feel that you are being heard, find a physician who will listen to and acknowledge your concerns. Find an OB/GYN >

What role does nutrition play in the health of an expectant mother and her unborn child?

Nutrition plays a significant role in the mother and baby’s health during pregnancy.

“There's another life growing inside that needs additional calories and high-quality nutrients,” said Dr. Byers.

Access to affordable, high-quality food is essential and there are community organizations and resources to help support women’s nutritional health. Dr. Amadi added that one of the conditions that must be managed during pregnancy is gestational diabetes. Women are adjusting to new eating habits and may experience rapid weight gain. A nutritionist can help curate a healthy diet for your pregnancy and postpartum experience.

How can health care providers better serve the needs of Black women?

Cultural competence enables health care providers to deliver effective, quality care to a diverse population. However, Dr. Byers shared an example of a nursing textbook that included a section that attempted to address cultural competency, but was, in fact, deeply biased and filled with inaccuracies about Black women. Health care providers need accurate information, training, and education so they are aware of structural racism, classism and prejudices.

“We are to listen to our patients. We are to listen to Black women, and to respond in the same way that we would with anyone else. Equity is our responsibility. It's not a nice-to-have, it's a need-to-have, and it's incredibly important.”

How does economic status impact the delivery of health care to Black Women?

“Black women who are professionals, who have private insurance, are no less subject to racism and the ills that come along with poor Black maternal care” said Dr. Byers.

Even Black physicians need to be aware of biases and the ways structural racism impacts the delivery of care. Dr. Amadi elaborated, “We also need to check our own biases and just really come and approach patients as humans and individuals and listen to what is being asked of us in this situation.”

Dr. Amadi reiterated the importance of speaking up and self-advocating if you feel something is not right with your health or the delivery of care.

Graphic of a black mom carrying her baby in a wrap.

Read More About Improving Black Maternal Health Outcomes

As we work to bring the challenges of black maternal health into greater focus, Christina Johnson MD, PhD and Judy Banks, MD, discuss listening to stories of several women - African American health care workers who experienced negative outcomes related to their pregnancies.