Tamara King was 28 weeks pregnant when a blinding headache took hold. By the time she got to the hospital, her blood pressure was high enough to set off the monitor’s alarm.
“It was like, ding-ding-ding! This person might die!” King said.
After three weeks’ hospitalization in Columbia, S.C., King had an emergency C-section when the baby’s heart rate flat-lined. Her daughter was born at 31 ½ weeks weighing less than 2 ½ pounds.
It was a harrowing brush with a baffling problem: the high risk of dying as an expectant mother in America, a danger that is especially acute for black women like King. The nation’s maternal health crisis has captured increasing attention in the media, in the medical community and in Congress.
Now it has hit the 2020 presidential campaign, with multiple Democrats touting plans to expand healthcare access and address the racism that leads to disparate treatment of white and black patients.
There are humanitarian reasons for the surging interest in a long-standing problem. But there are also political considerations. Black women are a vital Democratic voting bloc, especially in South Carolina, an early presidential primary state that ranks among the 10 worst in the nation for deaths among pregnant women.
“Motherhood, children, life and death — that resonates with everybody,” said Kellye McKenzie, a Charleston, S.C.-based public health consultant. “Frankly, it’d be irresponsible and probably political suicide not to talk about it.”
Democratic Sen. Cory Booker of New Jersey put forth a measure last year to expand Medicaid coverage for pregnant women. Two other presidential hopefuls, Sens. Kamala Harris of California and Kirsten Gillibrand of New York, signed on as co-sponsors.
In another bill, Harris proposed providing federal dollars to train medical providers about how racial prejudice affects care. Recent research indicates that it does: One 2015 study surveyed a group of white medical students about physiological differences between white and black people. About half held factually inaccurate beliefs, such as black people having thicker skin, which swayed treatment decisions.
“At the heart of it, it really is about implicit bias in the medical health profession,” Harris said.
Booker similarly has emphasized race, saying that maternal health “is an issue of access, but it’s also about correcting for the racial disparities that we see baked within significant systems of our country.”
The number of pregnancy-related deaths in the United States has steadily risen in the last 30 years, according to the Centers for Disease Control and Prevention, making the country an outlier among industrialized nations. About 700 women die per year as a result of pregnancy or delivery complications, and more than 50,000 suffer severe short- or long-term impacts to their health. Experts aren’t sure why.
For black women, the statistics are grimmer. According to the CDC, the death rate among white women was around 12 per 100,000 live births between 2011 and 2014, and it was 40 per 100,000 births for black women.
“This should be seen as unacceptable,” said Stacey D. Stewart, president of March of Dimes, which has made maternal health a priority issue.
As the deaths have climbed, so too has public attention. NPR-ProPublica and USA Today released major reports on maternal deaths in the last two years. Celebrities such as tennis superstar Serena Williams and pop sensation Beyonce went public with tales of their own grievous pregnancy complications. In December, President Trump signed a federal law that will help states better compile data on maternal deaths. On Tuesday, two congressional Democrats launched a “Black Maternal Health Caucus.”
Naida Rutherford, 38, was 28 weeks pregnant when she started bleeding. Her placenta was separating from the walls of her uterus, endangering her life and her baby’s.
In the frenzy of the emergency room in Charleston, she said, no one asked her a single question about her background, and she was spoken to only in Spanish. Days into her hospital stay, Rutherford, a black woman who describes her appearance as “ethnically ambiguous,” learned the hospital incorrectly assumed she did not speak English, had no prenatal care or health insurance, and was unmarried.
“It was such a humbling experience,” said Rutherford, who was then earning a six-figure salary selling medical equipment.
Her son was born healthy, but the experience nine years ago reinforces what Rutherford, now a nurse practitioner, knows from working in the state’s rural counties: There was plenty of reason for minorities in South Carolina to be distrustful of the medical establishment.
Look at the state Capitol, she said, located blocks from a philanthropic consignment store she owns in Columbia. The grounds feature a bronze bust of J. Marion Sims, a 19th century physician known as the father of modern gynecology. He earned that moniker in part by pioneering surgical techniques on enslaved black women, rarely with anesthesia.
“So when you have that kind of mentality and that kind of culture in the state you’re in — and I know from firsthand experience — if a black person asks a lot of questions, they are literally labeled as a problem,” Rutherford said.
The Palmetto State has a swirl of other factors to contend with: a high poverty rate, the state’s decision not to expand Medicaid under the Affordable Care Act, a large swath of rural counties where hospitals and OB-GYN practices have been closing. It has plowed more energy in recent years into improving its birth outcomes. Hospitals, doctors and advocates meet regularly to share best practices on dealing with pregnancy complications. In one rural county, a public-private partnership has begun paying for doula services.
The maternal mortality rate here hovers around 26 deaths for every 100,000 births, outpacing national figures; for black women, it jumps to 56 deaths per 100,000, according to the United Health Foundation, a nonprofit that tracks national health metrics.
Poverty and limited access to care offer only partial explanations.
“An educated, wealthy African American woman in Charleston still has about double the risk of death,” said Scott Sullivan, director of the maternal fetal medicine division at the Medical University of South Carolina. “Is it racism? Is it stress? Are there other factors that we’re missing?”
Talk of prejudice in medicine runs the risk of sparking a backlash from practitioners. Rozalynn Goodwin, a lobbyist with the South Carolina Hospital Assn., said when her organization first raised racial disparities, the response was palpably uncomfortable.
“There’d be creases in the seat,” she said, mimicking someone visibly stiffening.
Now, the focus is on data, which undeniably show black women suffering worse outcomes. That, paired with a subtle shift in vocabulary to talk about “equity” instead of disparities, helped make the topic less fraught, Goodwin said.
South Carolina occupies an outsize importance in the Democratic presidential race — the fourth nominating contest and the first with a large black electorate, starkly contrasting with the Iowa, New Hampshire and Nevada electorates that precede it.
Championing maternal health could be a potent selling point for women like King and Rutherford, who said they want a presidential contender who demonstrates real awareness of what minority women are up against.
“I want to know that the candidate actually is aware of the statistics and the issues,” Rutherford said.
King’s daughter Madison is now a healthy toddler. But the 41-year-old community relations manager for a public library still grapples with the care she received — the doctors who talked over her and rolled their eyes when she asked questions.
“I always wonder,” she said. “If I was white with my same background, nothing changes except the color of my skin — would I have been treated differently?”