Celebrating Black History Month: Supporting Black Birthing Individuals and Strengthening the Black Community Through Focused Systemic Change
Recent findings from the CDC’s National Vital Statistics show that maternal deaths are declining for every racial category collected (limited to white, Black, Asian, and Hispanic), except Black birthing individuals. This month, we reflect on the history of Black birthing families in the United States, with a call to action to overturn these devastating outcomes through policy and systemic change in Pierce County.
Maternal deaths in the United States declined from 817 in 2022 to 669 in 2023. While this is a positive trend, we must focus to the Black community, whose mortality rate remains the highest nationwide. In 2023, Black birthing parents died at 3.5 times the rate of white individuals, averaging 50.3 per 100,000 among all age groups. The remaining three racial categories saw a decline with white individuals at a statistically significant fall from 19 to 14.5 across all ages, Asian from 13.2 to 10.7, and Hispanic from 16.9 to 12.4. Age disparities remain high, and in the Black community, birthing individuals die at a rate of 132.9 per 100,000 births compared to 56.6 in the White community, and 35.8 for the Hispanic population (Asian unknown).
As mentioned in last month’s blog, Indigenous and Black birthing individuals face the highest disparities and mortality rates in Washington State. In order to move towards equitable outcomes for all birthing individuals, regardless of racial identity, we must first understand the historical root causes driving these disparities. Dr. Aisha Nnoli’s article, “Historical Primer on Obstetrics and Gynecology Health Inequities in America: A Narrative Review of Four Events,” identifies four key events leading to systemic inequities in the United States: the invention of race as a social construct, enslavement in the Americas, the legal doctrine of partus sequitur ventrem, and the American eugenics movement. Collectively, these four events fostered mistrust, institutional bias, and chronic stress in the Black community, contributing to negative birth outcomes such as preterm birth, low birthweight, and hypertensive disorders during pregnancy. In Pierce County, these inequities are no secret to the birthing community and we attribute these to the concerning rates of hypertension countywide.
Now that we know the data, where do we go from here?
Many of us who work with young children and families are familiar with the data presented above, and have dedicated our work to overturning these numbers. The Family Connects Leadership Council, currently comprised of state and local leaders, is committed to collaborative policy and systems-change efforts, fusing both our local community voices and state and national policy recommendations.
One of these efforts is the implementation of the The Blue Band Initiative, and will launch on February 24, 2025 through our subcontracted community-based organizations as a response to rising rates of hypertension in Pierce County. By having patients wear a blue wristband during and after pregnancy, health providers are alerted to potential complications. Family Connects nurses will provide education to families during their visit, provide a blue band and blood pressure cuff if they don’t have one, and bridge the gap between community and providers.
Why are we focusing on hypertension as a systems-change effort?
Family Connects is a part of The Pierce County Early Childhood Network, and is committed to rapidly responding to emerging needs in Pierce County. As a race-forward organization, we prioritize supporting the Black community through community collaboration and systems-change efforts. Hypertension disproportionately impacts Black birthing individuals, leading to death at 6 times the rate of white women. As mentioned earlier, this is driven by historically racist practices in the United States.
Preeclampsia, resulting from pregnancy-related hypertension, is a life-threatening complication characterized by high blood pressure, persistent headaches, swelling, and can lead to seizures and death. These risks are more prevalent in the Black community, where health-related stereotypes about Black Americans can lead to delays in seeking medical care or cause Black individuals to not be taken seriously when presenting their symptoms to healthcare providers. Our nurses hope to change that by bridging the gap between the community and providers to help raise awareness, ensure proper monitoring, and advocate for better care.
Policy and Systems-Change Efforts
The Family Connects Leadership Council is dedicated to policy and systems-change, informed by State and national recommendations and the voices of the Black community, acknowledging that BIPOC voices have long been marginalized by bias and structural racism in healthcare.
The first recommendations to highlight come from a study that interviews ten Black women in the birthing community. These culturally-focused pathways emphasize five key recommendations in the publishing of: “Pathways to Equitable and Antiracist Maternal Mental Health Care: Insights from Black Women Stakeholders.”
These include:
Investing in Black Woman-Led Community-Based Organizations
Valuing, Honoring, and Investing in Community and Traditional Healing Practices
Promoting Integrated Care and Shared Decision Making
Educating and Training Practitioners
Investing in the Black Women Mental Health Workforce
The systemic-change suggestions below address Black maternal and infant mortality from a policy perspective. These can be referenced in the report, “Eliminating Racial Disparities in Maternal and Infant Mortality: A Comprehensive Policy Blueprint.” These include:
Improve access to critical services
Improve the quality of care provided to pregnant women
Address maternal and infant mental health
Enhance supports for families before and after birth
Improve data collection and oversight
Finally, in alignment with these policy recommendations, The Policy Center for Maternal Mental Health, advises five suggestions in their Black Maternal Health Issue Brief to specifically address Black maternal mental health, an inequity fueled by chronic stress rooted in racism:
Increase the number of Black and BIPOC mental health and community health professionals.
Increase the number of Black and BIPOC obstetric professionals
Support embedding CHWs/PSSs (Community Health Workers and Peer Support Specialists) in clinical settings with protocols, incentives, and clear billing coding.
Test for proficiency in recognizing and addressing personal bias, cultural competence, and maternal mental health.
Mandate insurers/health plans report provider demographics and conduct network adequacy assessments based on the population served.
Support research and adoption of community-based organizations (CBO) Interventions.
As we reflect on the historical impact of racism on Black maternal health, we are also committed to honoring and uplifting Black birthing families. Our focus is to celebrate Black families by dedicating our efforts to amplifying Black voices and driving actionable policy and systems change to improve birth outcomes. While Family Connects is not a targeted intervention, a recent study, “Impact of a Universal Perinatal Home-Visiting Program on Reduction in Race Disparities in Maternal and Child Health”, found that Family Connects reduced disparities in 7 of 12 categories, demonstrating significant improvements in maternal and child health for Black, white, and Hispanic communities. We pledge to center Black voices in our work and aim to build equitable systems of care founded on mutual trust and collaboration.
