The blog of the Urban Institute
July 30, 2020

Three Ways COVID-19 is Further Jeopardizing Black Maternal Health

On July 2, Sha-Asia Washington, a 26-year-old expectant mother, was admitted to the Woodhull Medical Center in Brooklyn, New York, for a routine test. Washington had abnormally high blood pressure, so, for fear of preeclampsia, medical staff gave her medication to induce labor.

Shortly after the induction, her labor took a turn for the worse. Washington was rushed to the operating room for an emergency C-section. But the complications worsened, and after 45 minutes of CPR, she was pronounced dead. Washington’s tragic death provides an unsettling reminder of the maternal mortality crisis in the United States. Black women have a maternal mortality rate approximately three times higher than white women.

The US health care system has been failing pregnant Black women, and the COVID-19 pandemic is exacerbating existing shortcomings. Below, we’ve described three specific ways COVID-19 may be putting pregnant Black women at increased risk. In this post, Black and white refer to non-Hispanic people. We also use the words “woman/women,” but we recognize this does not include all people who can give birth.

1) Telehealth and limits placed on in-person prenatal care can hinder early detection of health risks

Many doctors have shifted to providing routine prenatal care visits via telemedicine and scheduling fewer prenatal visits to limit the number of patients in the office at one time. Although recent research has shown telemedicine does not pose additional health risks for visits that do not require ultrasounds, lab work, or cervical checks, limited in-person access prevents opportunities for additional health screening. Given that Black women face greater birth complications such as preterm birth, low birth weight, preeclampsia, and maternal death, alterations to the frequency of prenatal care visits (PDF) can hinder early detection and adequate intervention of high-risk factors.

Some medical offices are requiring that patients attend their prenatal visits alone, removing the opportunity for loved ones to participate in health advocacy and provide social support. Without loved ones in the room, Black women are less likely to advocate for themselves and less likely to be taken seriously when they do. Black women often face racial bias when seeking medical care, which, combined with the constant stressors associated with self-advocacy, may contribute to weathering, or poor health outcomes that arise from enduring constant racism and discrimination.

2) Limited support during labor and separation of mother and child can put them at risk

Social support during delivery has been found to improve the birthing process and physical health outcomes of Black women. The World Health Organization recommends pregnant women have a companion of choice present, regardless of suspected or confirmed COVID-19 infection. But most facilities are only allowing a single support person in the delivery room, whereas mothers could have up to three people before the pandemic. For Black women at greater risk for adverse birth outcomes, weighing the expertise of one potential support person against the sentimental relationship of another can be particularly stressful.

Doulas can address racial disparities in maternal and newborn health by advocating for a mother’s desired birth plan and communicating complicated medical information. Black women with doula support have experienced better birth outcomes and rate their birth experiences as more desirable, but some facilities are not allowing doulas to attend deliveries during the pandemic. Not having a doula’s support in the delivery room to buffer scary, and potentially negative, interactions could yield life-threatening outcomes for mothers and their newborns.   

The Centers for Disease Control and Prevention and the American Academy of Pediatrics also advise facilities to consider temporarily separating newborns from a mother with confirmed or suspected COVID-19, a practice that can result in statistical discrimination against Black mothers. Structural racism and systemic factors have created health inequities for Black families and have led to disproportionately higher COVID-19 infection rates among Black people. As a result, Black mothers exhibiting COVID-19 symptoms in circumstances where they cannot be tested may be more likely to be separated from their newborns.

Separation intervenes with recommended skin-to-skin contact, which assists the newborn in adjusting to life outside the womb, bonding with the parent, and breastfeeding initiation. Separation can be detrimental to mental health and may cause greater panic for Black mothers, given the disproportionate rate of removing Black children from their families. If they are separated, Black mothers may be suspicious of when they will reunite with their newborns.

3) Social isolation and economic anxiety can disproportionately harm Black mothers after delivery

For women in the postpartum period, the pandemic has created a tenuous mental health environment. One in seven women experience postpartum depression, with Black women being at greater risk for postpartum depressive symptoms and more likely to receive suboptimal depression care. COVID-19 has exacerbated feelings of isolation, with lack of physical connection and long periods at home because of social distancing guidelines contributing to the struggle some new moms confront. Many households are facing financial uncertainties because of the pandemic, in addition to general anxieties around the pandemic itself.

Although teletherapy can help mothers work through these feelings, diagnosis and outreach may be difficult. And Black women who experience racism during medical interactions throughout their pregnancy and birth may be reluctant to seek assistance. There has been a substantial increase in reported instances of maternal depression during the COVID-19 pandemic, with Black women likely faring worse.

To support Black maternal health, listen to and believe women’s concerns

To ensure the health of Black mothers and their newborns, policymakers should consider changes to lessen the burden on Black women, including expanding Medicaid coverage for postpartum moms, increasing insurance coverage for doula services, and training more Black female doctors. But in general, the solution is less complex (PDF): when Black women express their medical concerns, listen to them, believe them and help them receive the best quality care. It is a matter of life and death.

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As an organization, the Urban Institute does not take positions on issues. Experts are independent and empowered to share their evidence-based views and recommendations shaped by research.