DISPARITY IN MATERNAL HEALTH
Mortality and Morbidity among African American Women in Maternal Health
Health disparity is not a new phenomenon in the United States. Literature on the subject as well as concerted attempts to address the challenge and achieve health equality in the country have been on the rise. Many authors have documented numerous types of disparities in health by race, gender, geographic locations, and socioeconomic status, among other aspects. For example, research shows that African American women have a four times higher likelihood of dying from pregnancy and childbirth-related complications compared to white women (Black Women’s Maternal Health, 2018). The problem is common across the country and has persisted over the years. Black women continue to suffer the effect of inadequate access to health care during their pregnancy and delivery. The purpose of this paper is to identify and investigate a health disparity among African American women in the United States. Although maternal health care in the country has improved in recent decades, African American women continue to experience a higher rate of maternal death during pregnancy and childbirth compared to white women.
Definition of Health Disparity
“Health disparities” and “health equity” are common terms in discussions relating to access to health care in the United States and globally. However, they are not universally defined, creating a high level of ambiguity in their use. The definition used for the current discussion is based on Healthy People 2020 proposal to address the uncertainty. Health disparity is the specific kind of health difference, which is closely related to “economic, social, or environmental disadvantage” (as cited by Braveman, 2014, p. 6). It is the difference in health and access to related services between various groups or populations. The problem arises across multiple dimensions, such as race, gender, socioeconomic status, age, disability status, location, and sexual orientation.
Maternal Health Disparity
Generally, women face challenges relating to their access to health care during pregnancy and childbirth because of various factors, such as race, socioeconomic status, and location. However, some groups are worse affected than others. According to Creanga, Bateman, Kuklina, and Callaghan (2014), maternal morbidity and mortality disproportionately affect racial/ethnic minority women, particularly African Americans. More black women are likely to experience inadequate pregnancy and childbirth health care compared to white women. They are more likely to die or have other complications with their health and the health outcomes of the babies, such as low birth weight. The problem should be explored further to create quality improvement interventions to address the disparity.
Determinants of Health
Various factors play a significant role in the health outcomes of individuals, including health disparity. World Health Organization (2010) discusses nine factors and their impact, including income and social class, physical environment, education, transportation, social support networks, health services, genetics, health services, and gender.
Income and Social Status
The factor focuses on the role of income and social class in access to health care. The gap between the rich and the poor in society creates a high level of health disparity. African American women are most likely to face inequality because they are among the poorest in the United States (Graham et al., 2016). Therefore, most likely, they cannot afford critical care during pregnancy and childbirth.
The factor includes access to clean air and water, healthy working environment, safe houses and roads, and safety in communities. African Americans are most likely to suffer adverse health outcomes associated with these factors because of their socioeconomic reality (Braveman & Gottlieb, 2014). Consequently, they suffer from a higher level of maternal health inequality compared to other racial groups, especially whites.
Employment and Working Conditions
Employed individuals tend to be healthier than the unemployed. Individuals with high control over their working conditions are even healthier. Black women are more likely to face inequality in this aspect (Graham et al., 2016). As a result, they experience health-related challenges, including poor maternal health.
The level of education determines health outcomes. People with low education level tend to have poor health, heightened stress, and low self-confidence (Braveman & Gottlieb, 2014). These issues affect their tendency to access health care, including maternal health regardless of availability.
Social Support Networks
The networks provide support to various members of the community. Families, friends, and society provide significant support that enhances health outcomes. The factor is critical among pregnant women, but is not always available for all, hence creating inequality (Braveman & Gottlieb, 2014). African American women are more likely than whites to experience inadequate support.
The factor includes customs and traditions, as well as beliefs within society. They can either support or hinder access to care during pregnancy and childbirth. Typically, African Americans have strong customs and beliefs that might delay their tendency to seek health care (Ehiri, 2014). Therefore, cultural beliefs might affect the quality of their maternal care.
Personal Behavior and Coping Skills
These aspects include proper diet, physical activity, drinking, smoking, and how people deal with stressors and challenges in their lives. Black women might differ from whites, concerning these behaviors and coping skills (Braveman & Gottlieb, 2014). For example, pregnant women might ignore the importance of proper diet, which would negatively affect their health outcomes.
Health disparity is closely linked to access and use of health services that treat and prevent illnesses. Some communities in the country, especially African Americans, experience poor access to health care services (Braveman & Gottlieb, 2014). The problem affects their health outcomes, especially among pregnant women.
Men and women experience different types of health challenges and illnesses at different ages. Women are affected by maternal health challenges, including pregnancy and childbirth (Ehiri, 2014). Their health is threatened by problems that affect their access to maternal health.
The Epidemiology Associated with the Problem
Although pregnancy and childbirth are risky processes for women across the country and globally, some women face a higher risk than others. The Centers for Disease Control and Prevention (CDC), the Division of Reproductive Health (DRH) conducts surveillance pregnancy-related mortality in fifty-two reporting areas (50 states in the US, New York City, and the District of Columbia). Epidemiological data indicate a high level of disparity in maternal mortality and morbidity in the fifty-two reporting areas and nationally. The maternal mortality rate in the United States in 2015 was 26.4 deaths per 100,000 live births (Black Women’s Maternal Health, 2018). African American women were four times more likely to suffer maternal mortality compared to white women. Even after controlling the socioeconomic status, the risk persisted at three to four times. The leading causes of death among black women were preeclampsia, eclampsia, and cardiovascular disease. The disparity shows the potential for essential factors that place these women at a higher risk of maternal morbidity and mortality compared to white women.
Cultural Considerations for the Problem
Besides systematic factors, important cultural or societal factors that influence the disparity in maternal mortality and morbidity in the United States are evident. Culture affects women’s access to information and decision-making, such as to access prenatal care and proper childbirth. For instance, women lack the decision-making power within the community, which hinders their access to adequate health care during their pregnancy and childbirth. Other cultures neglect issues affecting women even when they are most vulnerable due to pregnancy. As a result, they access care from fellow women, such as midwives who lack adequate resources and facilities to provide quality maternal care. Some cultural beliefs also keep pregnant women away from healthcare facilities. Hence, they support the preference for home births through midwives, which places their lives at risk (Ehiri, 2014). Lack of proper care is blamed for the highest percentage of maternal mortality and morbidity among African American women.
The Health Care Literacy Challenges with the Population Impacted
Health literacy is a new concept to many people in the United States and across the world. However, the idea has caught the attention of health care providers and policymakers with a significant impact on health care outcomes. However, not everyone in society accepts health literacy efforts because of various factors. Regardless of the importance of information among the affected community, less education, inadequate finances, and minority status have a negative impact on health literacy efforts. African American women are more likely to be affected by these factors than the whites. The members of this community have less access to information resources such as the Internet. Besides, their financial challenges hinder any effort to receive information from health care providers. In addition, health care providers might find it hard to gain the trust of members of the community because of their racial, socioeconomic, and educational differences (Johnson, 2014). African American women might not understand the need for information, especially since they are struggling with other demands in life. Communication barriers due to cultural differences also affect health literacy among African Americans.
Health Promotion Theory
A meaningful and successful intervention to the problem is necessary to improve the health outcomes of pregnant African American women. The response requires mechanisms to enhance information access and use among women through effective mass education. Dr. Nola Pender’s Health Promotion Model (HPM) can be useful in achieving the objective of promoting health literacy among the affected women (Garcia, 2016). The model is used in helping the target community to achieve a high level of well-being through behavior change promoted by health professionals. For instance, it is crucial to educate African American women about the need to manage their health throughout the pregnancy and to seek proper care during childbirth. The model encourages them to control their behavior, implement efforts to improve themselves and their environment, work with nurses and doctors to achieve positive health outcomes, and make a self-initiated change. Information sharing and education should be conducted over extended periods to sustain changes in the beliefs and behaviors of the affected individuals and communities.
The United States experiences various health disparities along multiple lines, including race/ethnicity, gender, socioeconomic status, sexual orientation, and age among other aspects. African American women experience one of the most common disparities during pregnancy and childbirth. These women face a three to four times higher risk of mortality and morbidity during maternal care. Various factors increase their vulnerability, including their income, education, culture, environment, and socioeconomic status, among others. Therefore, health care providers should implement behavior change campaigns within their communities to improve health literacy and tendency to visit health care providers during pregnancy and childbirth.