Pregnancy Risks High Among Blacks

When white American women of the ‘80s become pregnant, most do not worry that they will not survive childbirth. For most women, this particular fear belonged to their grandmothers’ generation.

For black American women the risk is very much in the present. According to a new University of Michigan study, black women die in childbirth at three times the rate of white women and at a rate as high as that in some Third World countries. A woman in Costa Rica in Central America has half as much chance that she will die giving birth as a black woman in a major American city, Chicago.

The high rate of black infant mortality has been widely reported, but there has been little public notice of an alarmingly high incidence of black women dying in childbirth, according to Kristine A. Siefert, professor of social work at the University of Michigan, who collaborated on the research with Louise Doss-Martin, regional public health social work consultant with the U.S. Public Health Service.

Disparity Between Whites and Blacks

The most recent statistics show that in 1983 the national maternal mortality rate was 8 per 100,000 live births. For white women the rate was 5.9; for black women 18.3. In Chicago and Detroit where the researchers focused, the rates were much higher. In Chicago, from 1979 to 1984, 22.3 mothers died for every 100,000 births. The rate for white women was 13.3, for black women 31.8. In Detroit, the rate was 10.7 among white women and 28.1 among blacks. Maternal mortality is defined as death of a woman while pregnant or within 42 days of the termination of a pregnancy from any cause related to or aggravated by the pregnancy or its management.

The tragedy is that most of these deaths are the result of poverty and discrimination and could have been prevented, according to Siefert. Almost all studies indicate that two-thirds to three-fourths of obstetric maternal deaths are preventable, Siefert said. “If you look at aggregate statistics for the entire population, we’re doing all right, but if you look at the figures for the oppressed or discriminated-against groups in our society, the figures are shocking.”

Many of the deaths Siefert and Martin looked into were caused by hypertension, hemorrhage, infection and other problems that need not be fatal if properly diagnosed and treated. In Chicago, 12% of the maternal deaths between 1979 and 1984 were caused by ectopic pregnancies--a pregnancy in which the fetus begins to grow in the Fallopian tube rather than in the uterus and which is detectable by careful prenatal examinations. All of the women who died with ectopic pregnancies were black.

Situation Called ‘Absolutely Obscene’

Although death in childbirth is not common for any group of women--much less common than infant mortality--Siefert considers every maternal death important in terms of public health. “It is absolutely obscene that a country as rich as ours should have statistics like this,” she said. The Public Health Service has set a goal to reduce deaths in childbirth to fewer than five per 100,000 live births for every county and racial and ethnic group in the country by 1990. “We simply are not going to make it,” Siefert said.

For all women, health education and counseling, pregnancy testing, early identification and treatment of high-risk patients, nutritional assistance, labor and delivery service, postpartum care and an array of social services should be a national responsibility, Siefert recommended. In addition, the social, economic and social conditions that affect overall health of women--not just reproductive health--need to be addressed.

There is “nothing mysterious” about how to solve the problem of maternal deaths, Siefert said. “We need to provide universal high-quality medical care without regard for ability to pay. . . . The figures show that poverty, discrimination and lack of opportunity profoundly affect health.”