Close up photo of nurse using stethoscope for prenatal check

Blue Cross Pledges to Reduce Racial Disparities in Maternal Health

Shalon Irving was excited to become a mother. As an epidemiologist with the U.S. Centers for Disease Control and Prevention and a lieutenant commander with the U.S. Public Health Service Commissioned Corps, Irving was a highly educated and motivated woman.

She found out she was pregnant while deployed with the Corps in Puerto Rico, working on a Zika mission. She knew her pregnancy was high risk, as she had been diagnosed previously with a genetic condition that increased her chances of having blood clots.

Despite doing everything right – taking her medication, going to every prenatal appointment and drafting an extensive birth plan, Irving died weeks after giving birth to her daughter, Soleil, in 2017.

In the weeks after her caesarean section, Irving experienced high blood pressure, bladder issues, weight gain and headaches – and went back and forth to the medical clinic for help. She collapsed just five hours after her last visit and died a week later.

Irving was one of hundreds of Black women who die within a year of having a child in the U.S. Her mother, Wanda Irving, has shared her story publicly so that another family doesn’t have to undergo the same heartbreak of a newborn child losing its mother.

“We hear the stories that make the headlines, but we don’t hear of the many incidents that don’t make the news,” said Dr. Patricia Ferguson, physician consultant with Senior Health Services, Emergent Holdings. “These tragedies are happening over and over. The saddest part is that a significant number are preventable, and change the trajectory of the lives of these families forever.”

Blue Cross commitment

The Blue Cross Blue Shield Association is working with its affiliate companies across the country – including Blue Cross Blue Shield of Michigan – to reduce racial disparities in maternal health by 50% in five years. The Blue Cross Blue Shield Association has compiled a new report, “Racial Disparities in Maternal Health,” that examines trends and risk factors between white, Black and Hispanic communities in hospital births covered by Blue Cross and Blue Shield commercial insurance from 2018 to 2020.

“The emphasis on racial disparities is key because, when normalized for all social determinants of health, the only factor that remains attributable as a root cause of the disparity is unconscious bias. Unconscious bias, explicit bias, micro aggression, or any form of disparate practice at the point of contact which impacts health care delivery must be acknowledged, recognized and addressed as severely as the unfortunate consequences outlined in this report,” Ferguson said.

Here are some key findings from the report:

  • Women in majority Black communities have a 63% higher rate of severe maternal morbidity – unexpected outcomes from labor and delivery that impact a woman’s health, including death – than women in majority white communities.
  • Women in majority Hispanic communities have a 32% higher rate of severe maternal morbidity than women in majority white communities.
  • Compared to white mothers, Black and Hispanic mothers are at least 100% more likely to experience adult respiratory distress syndrome, sepsis and ventilation in their first year after having a baby.
  • Black and Hispanic mothers are also more likely than white mothers to experience eclampsia, shock, acute heart failure and acute renal failure.

Unconscious bias

Black mothers have existing chronic conditions that put them at a higher risk for complications after having a baby at a rate that’s twice that of white mothers, including:

  • Anemia
  • Hypertension
  • High body mass index
  • Preeclampsia

However, these risk factors are well documented. Ferguson said many of the causes of death for newly postpartum women of color are preventable, but often providers may not be asking the right questions because they make assumptions about an individual based on their own biases.

Unconscious, or implicit, biases are automatic associations we make, influenced by our own reservoir of memories, experiences, exposures and more. Everyone has them. But, in the field of medicine, unconscious biases can have significant impacts on patient care. This is why it’s important to address the root cause.

A patient’s characteristics – including the clothes they wear, weight, sex and sexuality, knowledge of their own health, socioeconomic status, behavioral health condition, first language, insurance status, skin color and age – can trigger unconscious bias that can influence the thinking of health care providers, and the kind of care delivered. Acknowledging bias is often the first step to addressing its role in how we make decisions.

Blue Cross is committed to working to reduce these disparities for mothers of all races, and to prevent dangerous and tragic outcomes.

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Photo credit: Getty Images

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