The maternal mortality rate increased 89% nationally between 2018 and 2021.
Kansas looks to be an increasingly dangerous place to give birth, especially for women of color.
The U.S. Centers for Disease Control and Prevention found that maternal deaths per 100,000 live births within a month and a half of giving birth nearly doubled nationwide between 2018 and 2021. A disproportionate number of Black mothers made up most of those deaths.
While year-by-year data for Kansas over that span isn’t available, another figure from the CDC showed the Sunflower State trailing closely behind the nationwide average from 2018-2021. Another study running from 1999 to 2019 ranked Kansas among the highest in the nation for increases in maternal mortality among Native American mothers, with an increase of more than 162%.
What are the causes?
Sharla Smith, a health services and systems researcher at University of Kansas Medical Center in Wichita, said racial inequities fuel the disparities.
“It’s not the individual physician, but it’s the system,” Smith said. “And there’s a lot of things within the system that are not friendly to certain populations.”
For instance, she said the decision in Kansas to not expand Medicaid disproportionately affects women of color. Some women who wouldn’t qualify for Medicaid can get the coverage for a pregnancy. But they can wait as long as 45 days after applying before Medicaid covers them.
That, in turn, can lead to complications for expectant mothers by delaying the diagnosis and treatment of conditions that pose difficulties during and after their pregnancies, she said.
“If you don’t have health care before you’re pregnant, you’re not receiving women-wellness visits,” Smith said. That means “there’s less known about the health of your body before you become pregnant.”
Research from the U.S. Department of Health and Human Services showed a marked drop from 2008 to 2021 for all demographic groups in deaths in hospitals related to giving birth. Most deaths, instead, happened in the days, weeks and months after delivery.
Heart disease and stroke remain the most common causes of those deaths. But mental health plays an increasing role in the rising rates in Kansas, Smith said. She attributed that partly to “weathering,” a process in which the body ages faster than normal in response to psychological stress.
She said research shows that societal stresses from racism, on top of the universal stresses of the COVID-19 pandemic, have played a key role in weathering for women of color. The CDC’s 2018-2021 study found the uptick has been especially noticeable among younger Black and Hispanic mothers nationwide.
Black mothers under the age of 25 saw the highest increase in mortality rate across all demographic groups. Hispanic mothers 25-39 years old also showed a significant uptick.
Sapphire Garcia-Lies, executive director of the Wichita-based Kansas Birth Justice Society, said declining mental health among Kansas mothers stems from rising rates of labor induction, where medications are used to speed up the birthing process.
One of the drugs is Pitocin, a synthetic opiate that can trigger contractions of the uterus without the high. It can sometimes exacerbate postpartum depression.
“That is a magic time for parents and babies, because that’s the point that bonds them,” Garcia-Lies said. “They’re being robbed of that experience.”
Racism and poverty
Dr. Philip Newlin, a pediatrician and medical director of women’s and children’s services for Ascension Via Christi’s Wichita hospitals, said a range of factors including age, education, living environment, health care access, community and the compounding effects of racism matter for a mother’s health.
“A lot of times, these markers of health care disparities may have an ethnic or racial marker,” he said. “But sometimes, poverty is a common thread underneath.”
Yet Smith, the KU researcher, said race can overwhelm the effects of income. One 2022 study of California from the National Bureau of Economic Research showed that the wealthiest Black women face a roughly 50% greater risk than the least wealthy white women.
Sometimes, Smith said, discrimination can arise when doctors don’t listen to concerns voiced by women of color.
“Women know their body,” she said. “But when they tell their physician something is happening, (doctors) turn a deaf ear to it.”
Garcia-Lies experienced that firsthand when her second daughter died in 2013 following a pattern of concerning behavior shortly after she gave birth. When she brought her concerns to her doctor, she was brushed off.
“It was discriminatory care because I was a young brown mom with a (Medicaid) card,” Garcia-Lies said. “We’re primed to think that doctors don’t make mistakes and that they’re infallible, but living through that taught me that we have to be our own advocates.”
Soon after her daughter’s death, Garcia-Lies began pursuing the work that would eventually coalesce into the Wichita Birth Justice Society, later expanding to a statewide scope as the Kansas Birth Justice Society.
New solutions to old problems
Garcia-Lies has pushed for more training and employment of doulas to coach women through a pregnancy. She also calls for the wider use of midwives for women of color.
The practice, which was once especially popular among women of color, dropped off after the 1921 passage of the Sheppard-Towner Act, which was intended to reduce maternal mortality by professionalizing health care.
“And we see at that same time that those midwives who are majority Black and brown, who had served folks in their communities and provided community-based care, were not able to pass this legacy to the next generation,” she said.
Garcia-Lies said taking birth out of a typical hospital setting can help people of color, who often feel underrepresented in health care, to feel more at ease during a pregnancy through a process developed over hundreds of years to be attuned to specific cultures.
Yet a reliance on midwives means handing over care to people who can find themselves unequipped to handle many medical complications and higher-risk pregnancies. Garcia-Lies said teaming midwives with physician care can help.
She noted better health outcomes in other developed countries, such as the United Kingdom, where midwives attend all planned births. And she said wider use of midwives could help mothers in rural Kansas where dissolving health care access threatens mothers across all demographics.
Meanwhile, Smith said other things can be done to curb maternal mortality. She called for increasing access to affordable housing and education and overhauling property and food taxes, all of which she said contribute to a wealth gap and disproportionately affect many people of color.
Garcia-Lies said change starts at a community level and stressed the importance of accepting uncomfortable truths.
“I think all of us in this society should take responsibility for this issue … it’s hard to even think about, but all of us play a part in perpetuating these systems,” she said. “We can vote and we can become engaged in these systems…It takes a lot to make the leap from ‘I’m just surviving’ to ‘I am working to change systems,’ but that’s the work we’re engaged in doing.”
Resources for pregnant women
Several resources are available for expecting mothers for care, information on the risks of birthing, options for birthing and benefits for new and expecting mothers.
- The Wichita Baby Company: Offers postpartum and infant care for mothers and their children in the Wichita area, including overnight care from doulas and other specialists.
- Evidence Based Birth: Provides data sheets and information for expecting mothers to bring to their health care providers to help make an informed decision on birthing specific to their needs.
- KanCare Fact Sheet: Overview of Medicaid eligibility criteria for pregnant women and where to apply.
- Supplemental Nutrition Program for Women, Infants and Children (WIC): Provides food, nutrition education and health care referrals for low-income pregnant and postpartum mothers, as well as their children up to 5 years old.
- Reproaction Fake Clinic Database: Searchable database on facilities across the country posing as pregnancy clinics that operate under an anti-abortion agenda, often providing misleading information to expecting mothers.
- VBAC Facts: Source of information for expecting mothers who have previously had a C-section and want to explore having a vaginal birth.
This article was republished here with the permission of: The Wichita Beacon