As a Black woman, Kyla Armstrong-Romero had to fight for adequate medical care at every step of her pregnancy. After being diagnosed at 23 weeks with preeclampsia, a serious pregnancy complication characterized by high blood pressure, she was in and out of the hospital until she gave birth to her twin boys a month early on July 18, 2020.
“When I got to the post delivery side, I was having some really bad pain,” Armstrong-Romero, president of the Aurora Public Schools Board of Education, said during a Black Maternal Health webinar on April 12. “The nurse, when I told her I wasn’t prepared to go and (that) I was still concerned about my blood pressure overall, she told me I was exaggerating and that my blood pressure would naturally go down.”
Approximately 700 people die every year in the United States as a result of pregnancy-related complications — a rate much higher than in other developed countries around the world. Black mothers die at a rate that’s three times greater than white women, according to a 2019 report from the Centers for Disease Control and Prevention.
The long-standing racial disparities are due to an array of interconnected factors, including barriers to high quality medical care before and after childbirth, gaps in insurance coverage, disproportionate prevalence of chronic illnesses, racial bias in the health care system and delayed diagnosis of complications by medical professionals, according to the CDC.
For Dr. Jandel Allen-Davis, president and CEO of Craig Hospital in Denver, one of the biggest and least studied factors that contributes to poor maternal health outcomes for Black mothers is the chronic trauma and stress of being a person of color in America.
“We’re beginning to understand some of the physiologic impacts, some of the connections, but we haven’t done nearly enough work on that,” Allen-Davis said during the Black Maternal Health webinar hosted by the organizations Colorado Black Women for Political Action and the reproductive-rights group Cobalt.
Increased focus on health disparities at state and federal level
The topic is getting more political attention this year with a slew of bills being introduced in Congress and Colorado’s state Legislature that aim to chip away at the long-standing disparities. The effort in Congress includes the Black Maternal Health Momnibus Act, which is a package of 12 bills that aims to address various health disparities and factors that contribute to disproportionate maternal mortality for Black people.
The Biden-Harris administration announced on April 13 a handful of actions they are taking to address the maternal health crisis, including increased federal funding for implicit bias training for health care providers; extending Medicaid coverage from 60 days to up to 12 months postpartum; and additional funding for obstetrics care in rural communities.
“Quality, equitable health care is a right, not a privilege,” a White House press release announcing the actions said. “The actions announced today are initial steps in the critical work this Administration will do to address our maternal mortality crisis, close disparities in maternal care and outcomes for all birthing people, and address the systemic racism that has allowed these inequities to exist.”
In Colorado, state Rep. Leslie Herod, a Denver Democrat, and Sen. Janet Buckner, an Aurora Democrat, have introduced two bills that aim to address different aspects of maternal health.
The first bill, Senate Bill 21-193, aims to provide protection and safety for pregnant people in the perinatal period, including for people who are incarcerated. The second bill, Senate Bill 21-194, seeks to minimize the barriers for health-care providers such as birth doulas or midwives to be reimbursed for their professional services. The bill also directs the state’s Department of Public Health and Environment to study perinatal health and propose recommendations for improving maternal health outcomes.
“We need to do so much more in this area,” said Herod, who is chair of the Black Democratic Legislative Caucus of Colorado and the House Appropriations committee. “Our numbers are quite frankly just abysmal no matter which race you’re looking at.”
A few months after Armstrong-Romero was discharged from the hospital, she contacted her doctor to check if the heavy vaginal bleeding she was still experiencing was normal. They told her to come in for an ultrasound later in the day.
When she arrived, the nurse practitioner told her that she would have to wait another day to see a doctor despite having difficulty walking because she was so dizzy. When she was finally seen, the doctor told her she needed to go into emergency surgery to remove excess scar tissue from having a C-section.
“It’s traumatizing and I’m hoping that something changes that puts our health more at the forefront because it shouldn’t matter who you are or what you do to receive good care,” Armstrong-Romero said, who is pregnant again and is due in August.
Allen-Davis said Armstrong-Romero’s story is unfortunately not unique and makes her embarrassed for the health care system and more determined to facilitate change.
“We know that the social determinants are playing a significant role and as I said, it’s overwhelmingly preventable across all races,” she said, adding that there are crucial intervention points to improve outcomes before, during and after someone gives birth.
“Access is important, but it’s not just access to care. It needs to be high quality prenatal care that’s delivered in a culturally proficient fashion,” she added.
Allen-Davis would like to see dedicated funding for research that could lead to improved health care for Black mothers.
“We need to understand the linkages between these chronic conditions and the maternal outcomes,” she said. “This research needs to be funded and then beyond that, we’ve got to translate it into practice in a very explicit, intentional and ongoing way that’s tied to outcomes and metrics that we have clearly identified.”