It’s an American crisis that was long ignored at the government’s highest levels: Black women in the U.S. are roughly three times more likely to die giving birth than white women. Now, breaking new ground for a vice president, Kamala Harris is calling for sweeping action to curb racial inequities in pregnancy and childbirth.
“With every day that goes by and every woman who dies, the need for action grows more urgent,” Harris told STAT in an emailed interview.
Harris emphasized that health care is profoundly affected by implicit bias. The vice president spoke about the need to address that bias, the broader Black maternal health crisis in America, and how the Covid-19 pandemic has exacerbated racial inequities in health care. Harris’s advocacy for the issue is notable because no president or vice president has so focused on this as so urgent a matter facing the country. She said “it is my responsibility’’ as vice president “to stand up for everyone, and especially those who have been historically left out or left behind.’’
As a senator, Harris pushed for legislative changes to improve maternal health care for Black women. She was the lead sponsor in the Senate for the Black Maternal Health Momnibus Act, a package of 12 bills that would diversify the perinatal workforce, fund community-based maternal health organizations, and invest in social factors that can influence maternal health, such as access to transportation and nutritious food.
Harris did not respond to several of STAT’s questions, including whether she herself has experienced racial bias while seeking health care, or about what steps the administration might take to address the pain experienced by Black mothers and the mothers of Black children whose loved ones have died at the hands of police violence.
At a Black Maternal Health Week roundtable last Tuesday, though, Harris addressed the recent police killing of Daunte Wright, saying that “folks will keep dying if we don’t fully address racial injustice and inequities in our society from implicit bias to broken systems.”
In the email to STAT this week, Harris touched on Black maternal health issues ranging from implicit bias training for doctors to extending Medicaid coverage for the postpartum period. The interview was lightly edited for length and clarity:
I’ve listened to and spoken with Black mothers, including those in my own family, about pregnancy and childbirth, and so many of them feel they were being racially profiled by their doctors or nurses. Often they feel that as Black women they are viewed as being “strong” and as a result have their pain overlooked. Even worse, when they assert their health concerns, they can be dismissed by medical staff as being dramatic or disrespectful and then given even less attention and care. Do you have examples of how these issues have touched you or your family personally?
Black women deserve to be heard — and treated with dignity and respect — throughout pregnancy, childbirth, and the postpartum period. And when they aren’t, whether or not they’re a member of my family, it affects me. It affects all of us, our communities, and our country.
I’ve heard so many stories over the years — in letters to my office, in casual conversations, in roundtables in San Francisco, Calif., in 2020 and at the White House on Tuesday. At the White House, Erica McAfee spoke of nearly dying after her son was born, following two lost pregnancies. Heather Wilson said she alerted her health care providers of underlying conditions, only to be ignored. And Donna Trim-Stewart is still trying to get answers as to why her daughter died after giving birth.
It’s devastating — all the more so because 60% of these deaths are preventable. That’s why President Joe Biden issued a proclamation, the first of its kind, about this crisis.
Why has there not been more progress addressing racial bias in medicine? If you had to cite one major obstacle, what would it be?
Let me cite two major obstacles: systemic disparities and implicit bias.
When I served in the United States Senate, I introduced multiple pieces of legislation to address both obstacles —from investing in the social determinants that affect health outcomes to putting in place implicit bias training for health care providers. Our Administration’s budget, recently released, builds on this work. It will include $200 million to reduce maternal mortality and morbidity across the country — dedicating $30 million to implement my Maternal CARE Act and provide implicit bias training for health care providers across the country.
At the roundtable, Dr. Elizabeth A. Howell, who is Chair of the Department of Obstetrics & Gynecology at Perelman School of Medicine at the University of Pennsylvania, said, “We have to realize that we all have biases. We have to acknowledge them, take a moment, then change our behavior.”
If you are a health care provider and you are reading this, please consider getting trained or asking your employer for a training.
How, specifically, has the need for the Black Maternal Health Momnibus Act become more urgent since last year when you first introduced it in the Senate?
With every day that goes by and every woman who dies, the need for action grows more urgent.
Our Administration is taking action, advancing initiatives like implicit bias trainings, which will help ensure Black women are heard; state pregnancy medical home programs, which will improve the quality of perinatal care for those on Medicaid, and Maternal Mortality Review Committees, which would provide crucial data on the deaths of mothers who die within a year of pregnancy.
Additionally, knowing that Black women are more likely than white women to lose their health insurance at some point during their pregnancy, through the American Rescue Plan, we have lowered health insurance premiums for millions of families.
Now that the coronavirus has put racial disparities in health care front and center, do you think America is ready to acknowledge that racism is systemic in the medical field and that some doctors and health care professionals are racist?
The virus has accentuated and accelerated the fissures and flaws in all of our systems — and our health care system is not immune. Two in three Black Americans knows someone who has been hospitalized or died from Covid-19. Black Americans are less likely to have been vaccinated than white Americans. And Black women are still dying at alarming rates from pregnancy-related causes.
Our administration is speaking truth about what causes these disparities. President Joe Biden issued executive orders on implementing a whole-of-government approach to addressing racism and gender equity. We are investing in social determinants that we know influence maternal health, such as housing, transportation, and nutrition. All the work we do is interconnected — and will help ensure that race is no longer a factor in determining health outcomes.
How much more clout do you have on this issue as vice president than as a senator, and how will you leverage that clout?
This issue has been important to me for a long time, and it will remain a priority for me as Vice President. I will keep working to get more providers trained, to increase investments in what we know impacts health outcomes, and to raise awareness. For instance, I spoke last week about uterine fibroids, another issue that I’ve worked on that plagues Black women and can lead to maternal mortality.
Here’s the bottom line: I took an oath to defend the Constitution and protect the American people. As Vice President, it is my responsibility to stand up for everyone, and especially those who have been historically left out or left behind. And that’s why Black maternal health will continue to be a priority for me and our Administration.
If Congress does not act, are there specific things the administration could do on its own, to address Black maternal mortality?
In addition to the work I’ve already mentioned, through the American Rescue Plan, states that have yet to expand Medicaid can now access increased funds if they do so. States also have the chance to extend Medicaid coverage for a full year for women who are postpartum. Right now, nearly half of American births are paid for by Medicaid. So, this will help a lot of women.
As Erica McAfee told me, we’ve also got to replace “silence with storytelling.” So, we will also keep lifting up these stories — so that Black women everywhere know they are not alone. In this White House, I promise you that Black women will always be heard.