Introduction

Black women experience the highest rates of maternal mortality in the United States, approximately 2.5 times greater than the overall national rate (CDC, 2020). This pattern holds true in Florida, where Black women disproportionately suffer pregnancy-related death at nearly twice the overall rate in the state (FDOH, 2021). The majority of pregnancy-related deaths are preventable. The most common contributing factors are systems of care, providers, and patients (Building U.S. Capacity to Review and Prevent Maternal Deaths, 2018). Systems of care factors include inadequate policies and procedures, and lack of communication and care coordination between providers. Provider factors include missed diagnoses, ineffective treatments, and inadequate provider communication with patients. Patient factors include unfamiliarity with warning signs, obesity, and substance use.

Social contributing factors include housing inequalities, exposure to environmental stressors, healthcare access, and healthcare quality. These factors have been shown to contribute to increased rates of chronic disease and other risk factors, which combine to contribute to greater levels of pregnancy-related death for Black women (CDC, 2020). The social determinants of health also include racial bias and discrimination. A study presented seven domains in which Black women are impacted by these social factors, including negative stereotypes, inequitable law enforcement, housing discrimination, systemic barriers to education and employment, lack of access to community resources, and inadequate medical care (Chambers et al., 2021). Collectively, these social inequalities place a greater burden on Black women in terms of navigating the healthcare system, which can compromise their maternal health.

This publication is intended to support Black women in navigating the healthcare system before, during, and after pregnancy. The strategies presented are not substitutes for addressing the root causes of maternal health disparities for Black women. Rather, they highlight potentially beneficial ways to cultivate a greater level of agency and self-determination in the face of these day-to-day realities facing Black women. Finally, the suggestions in this publication are only the beginning of ways to support Black women’s thriving before, during, and after pregnancy.

Strategies and Resources for Black Women

This section presents suggestions and resources available to Black women, to supplement practices they already have in place to promote their health before, during, and after pregnancy. These strategies include embracing holistic approaches to health, establishing proactive and open communication with healthcare providers, and recruiting family members, friends, and professionals to provide support and advocacy.

Embrace well-being

Often, health is discussed solely in physical terms such as temperature, body weight, or blood pressure. However, scientific research increasingly indicates interconnections among mental, emotional, and physical health and wellness. A national report found that 63% of pregnancy-related deaths overall were due to preventable causes associated with hypertension and cardiovascular complications (Building U.S. Capacity to Review and Prevent Maternal Deaths, 2018). Physical and psychological stress, diet, smoking, exercise, and genetic and other factors influence these conditions. Therefore, forming healthy habits to cope with stress supports an overall approach to health and well-being and reduces the likelihood of preventable complications. Common elements of wellness include ones that are:

Spiritual: Finding purpose, value, and meaning in life

Emotional: Being able to understand, manage, and respect your feelings

Intellectual: Finding creative ways to improve your knowledge and skills

Physical: Keeping your body healthy through nutritious food and exercise

Financial: Managing resources to live within your means

Social: Developing and maintaining positive social relationships

Environmental: Cultivating a vibrant indoor and outdoor environment

Additional Resources

• “A Practical Guide to Healthy Living”: https://edis.ifas.ufl.edu/publication/FY1498
• “Mindfulness: An Introduction”: https://edis.ifas.ufl.edu/publication/FY1381

Additionally, taking a proactive approach to seeking medical care early in pregnancy can help to avoid preventable complications. Delaying or missing prenatal visits presents an additional risk factor for the mother and child.

Communicate with healthcare providers

Taking an active approach to forming a healthy working relationship with healthcare providers is a powerful way to make sure that your voice is heard. Remember to include any questions and concerns that come up during pregnancy and postpartum.

Research providers: Before scheduling your first appointment, invest some time in researching the providers in your area. Search online and ask friends, family, and neighbors for recommendations of excellent providers. There are also directories online, such as https://blackdoctorsusa.com/, where you can search for Black doctors.

Ask questions: Before your first appointment, be prepared with a list of all your questions. Let your provider know that you would like to take notes or audio record the appointment so that you can review it later and look up any new terms. Research any health conditions that emerge using trustworthy sources such as UF Health (https://ufhealth.org/encyclopedia) or the Mayo Clinic (https://www.mayoclinic.org/patient-care-and-health-information). Keep track of your symptoms to discuss at your next appointment.

Discuss racial disparities: It may be helpful to bring up the data on racial disparities in maternal mortality with your provider. Sharing your concerns based on current trends will allow your provider to discuss additional steps you can take to ensure a healthy pregnancy and postpartum care. This may also open a broader discussion of important common warning signs (see https://www.cdc.gov/hearher/maternal-warning-signs/index.html). Framing your concerns with the data and national trends may help to prevent a defensive response on the part of the provider. If, however, this interaction does not result in a positive discussion, consider meeting with different providers (see the “Research providers” section above and the “Engage social support” section below).

Following these steps will help to establish an open and trusting relationship with your provider, which is critical for a successful birthing experience. Remember to trust yourself throughout the process. Seek a second opinion if you ever feel that you are not being heard and your needs are not being addressed.

Additional Resources

“How Black Women Can Advocate for Their Own Health”: https://www.thelily.com/experts-tips-for-how-black-women-can-advocate-for-their-own-health/

“Top Five Questions for Your Healthcare Provider to Ensure Collaborative Care”: https://www.pampersprofessional.com/sfsites/c/resource/PDF_DrTerri_QuestionsForProviderCollaborativeCarePampersProfessional

“Anti-Racist Prenatal and Postnatal Care Preferences”: https://loomhq.com/protect-black-birth

“Maternal Health Equity”: https://www.pampersprofessional.com/s/black-maternal-health-resources

“Working Together to Reduce Black Maternal Mortality”: https://www.cdc.gov/healthequity/features/maternal-mortality/index.html

Heal in Her Hue: https://healthinherhue.com/

Engage social support

There is a proverb that “it takes a village to raise a child.” In that same spirit, seek trusted family members, friends, and professionals to help you and to support your maternal health. This could be your partner, mother, sister, a friend who has also navigated the healthcare system during pregnancy, or anyone you trust to have your best interests at heart and advocate for your well-being.

Another option is engaging with holistic health professionals, such as midwives and doulas. These holistic healthcare professionals are valuable resources to consider. They can help to provide comfort as well as insight related to the medical practices and processes of your primary healthcare provider. There are also several organizations devoted to positive health outcomes for Black mothers, including the Black Mamas Matter Alliance, Sista Midwife Productions, and the National Birth Equity Collaborative. Finally, you may have the opportunity to engage with researchers to study and improve the collective outcomes of Black mothers through community-engaged research projects.

Additional Resources

National Black Doulas Association®: https://www.blackdoulas.org/

Sista Midwife Directory: https://www.sistamidwifedirectory.com/

Black Mamas Matter Alliance: https://blackmamasmatter.org/

Every Mother Counts: https://everymothercounts.org/unitedstates/

National Birth Equity Collaborative: https://birthequity.org/

Sista Midwife Productions: https://www.sistamidwife.com/

Summary

This article presents key resources and suggestions for Black women to support and protect their overall health and wellness, and to improve their healthcare experience during and after pregnancy. These include adopting a holistic approach to healthcare, proactively communicating with healthcare providers, and taking full advantage of the support of social networks and community resources.

While the fundamental work of addressing disparities in maternal health continues at a structural level, through policy and practices to improve the social determinants of health and systems of care, the strategies in this publication are meant to serve as a starting point to support Black mothers to holistically meet their healthcare needs.

References

Building U.S. Capacity to Review and Prevent Maternal Deaths. (2018). Report from Nine Maternal Mortality Review Committees. https://www.cdcfoundation.org/sites/default/files/files/ReportfromNineMMRCs.pdf

Centers for Disease Control and Prevention (CDC). (2020). Pregnancy Mortality Surveillance System. Retrieved September 23, 2021. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm

Chambers, B. D., Arega, H. A., Arabia, S. E., Taylor, B., Barron, R. G., Gates, B., Scruggs-Leach, L., Scott, K. A., & McLemore, M. R. (2021). Black Women’s Perspectives on Structural Racism across the Reproductive Lifespan: A Conceptual Framework for Measurement Development. Maternal and Child Health Journal, 25(3), 402–413. https://doi.org/10.1007/s10995-020-03074-3

Florida Department of Health (FDOH). (2021). 2020 Physician Workforce Annual Report. https://www.floridahealth.gov/provider-and-partner-resources/community-health-workers/HealthResourcesandAccess/physician-workforce-development-and-recruitment/2020DOHPhysicianWorkforceAnnualReport-FINAL3.pdf