A new study released by the Centers for Disease Control and Prevention (CDC) has found that Hispanic and non-Hispanic Black pregnant women appear to be disproportionately affected by COVID-19 during pregnancy. This finding is but one more example of how systemic health and social inequities are putting Black and Hispanic pregnant women ― and minority populations in general ― at risk for adverse health outcomes.
The Morbidity and Mortality Weekly Report, released on June 26, 2020, found that among 8,207 pregnant women with laboratory-confirmed cases of COVID-19, 46 percent were Hispanic, 22 percent were Black, and 23 percent were white. These proportions are lopsided when compared with data on the reported race/ethnicity of women who gave birth in 2019: 24 percent were Hispanic, 15 percent were Black, and 51 percent were white.
The study, which is the first major report published on the impact of COVID-19 on pregnancy, also found that pregnant women with the virus are at increased risk for intensive care unit admission and receipt of mechanical ventilation, when compared with non-pregnant women with the virus. However, they do not appear to be at increased risk for death.
While the study helps to fill a void of information on the effect of COVID-19 during pregnancy, there is still much that remains unknown. Although currently the American College of Obstetricians and Gynecologists states that it is not likely that COVID-19 is passed to a fetus during pregnancy, there is emerging research indicating that in utero transmission is indeed possible. However, it is unclear what this means in terms of consequences for the pregnancy or the newborn.
Also, it is unknown how the increased use of telemedicine will impact moms-to-be and their babies. It also remains to be seen whether medical conditions that would normally be diagnosed and treated during prenatal care will go undiagnosed and untreated to the detriment of women and their babies due to women not seeking medical care for fear of catching the virus.
The study comes amidst a growing public outcry, backed by medical research, over minorities in the U.S. being disproportionately hard hit by COVID-19. In Philadelphia, for example, a study of pregnant women, published by Science Immunology on July 29, 2020, found that the rate of COVID-19 exposure among Black and Hispanic women is five times higher than among white and Asian women. Researchers tested 1,293 women who gave birth between April and June at two Philadelphia hospitals for SARS-CoV-2 antibodies to estimate rates of exposure to the virus. They found that overall 6.2 percent of the women possessed the antibodies. Of women with the antibodies, 9.7 percent were Black, 10.4 percent were Hispanic/Latina, 2.0 percent were white/non-Hispanic, and 0.9 percent were Asian.
Data published by the CDC on August 18, 2020, also show racial/ethnic chasms in COVID-19 cases, hospitalizations and deaths. According to the CDC, compared with white people, Black people have 2.6 times more cases; 4.7 times more hospitalizations; and 2.1 times more deaths. Also compared with white people, Hispanic or Latino people have 2.8 times more cases; 4.6 times more hospitalizations; and 1.1 times more deaths. Similarly, American Indian or Alaska Native people have 2.8 times more cases; 5.3 times more hospitalizations; and 1.4 times more deaths.
Indeed, in Pennsylvania, a recent report by the Commonwealth Fund underscores the deep divide between minority and non-minority populations in matters of health. The report, which examined deaths in the state in 2016 and 2017, found that Black patients are more than twice as likely to die prematurely of treatable health conditions, such as diabetes and heart disease, compared with their white counterparts.
If the discussion of racial/ethnic inequities in pregnancy health outcomes in the context of COVID-19 sounds familiar, it is because the underlying issue is déjà vu all over again.
Prior to COVID-19, concerns festered for years regarding racial/ethnic inequities in maternal and infant mortality. However, only recently has the issue received the public attention it deserves. According to the CDC, the maternal mortality rate for Black women in 2018 was more than 2.5 times higher than the maternal mortality rate of white women, and the infant mortality rate of babies born to Black women is more than 2.3 times higher than the infant mortality rate of babies born to white women. American Indian/Alaska Native women are more than twice as likely as white women to die as a result of pregnancy or its complications.
For more about how minority women are disproportionately dying from pregnancy-related causes CLICK HERE.
Carol Nelson Shepherd, a co-founding partner and medical malpractice and birth and neonatal injury attorney at Feldman Shepherd, said that multiple complex reasons contribute to racial/ethnic disparities in health outcomes. She cited lack of access to medical care, economics, underlying medical conditions, and implicit bias and structural racism in the healthcare system as some of the factors that put minority groups at increased risk for illness and death.
With respect to pregnant women, Shepherd said it has been her experience over more than 40 years of legal practice that poor pregnant women are at increased risk of receiving second-class medical care during pregnancy, labor, delivery and postpartum. In addition to putting women’s lives at risk, second-class medical care sometimes results in lifelong, severe cognitive, motor and developmental injuries to their children, Shepherd said.
The substandard care received by Black and Hispanic women is particularly disturbing when considered against the backdrop of the study, “Geographic Access to Obstetric Critical Care for Women of Reproductive Age by Race and Ethnicity,” published in August 2020, by the American Journal of Obstetrics & Gynecology. The study found that among women of reproductive age, 93.5 percent of Black women and 91.4 percent of Hispanic women lived within 50 miles of a facility capable of providing risk-appropriate obstetric critical care (OCC) services.
As to why minority pregnant women are faring worse during the pandemic than white pregnant women, the CDC has identified inequities in social determinants that put racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19. They include:
While the medical inequities experienced by Black and Hispanic pregnant women and their newborns are disheartening, the good news is that the publicity created by their heart-wrenching stories, including the stories of high-profile women such as Serena Williams and Beyoncé, has sparked lawmakers into action. The bad news is that the clock is ticking for bills that take aim at the problem to pass in both the Senate and House before lawmakers will need to start over again in 2021.
On July 22, 2020, U.S. Sens. Tim Kaine and Lisa Murkowski introduced the Mothers and Newborns Success Act, which aims to reduce racial inequities in maternal and infant mortality. The legislation is intended to tackle significant inequities by strengthening support for women during and after pregnancy, promoting maternal health research and data collection, and ensuring women are better matched with birthing facilities that meet their specific needs. The bill is presently before the Senate’s Committee on Health, Education, Labor, and Pensions, and no hearings have been held.
Less than five months earlier, on March 10, 2020, Sen. Kamala Harris, now candidate for Vice President, and U.S. Reps. Lauren Underwood and Alma Adams introduced the Black Maternal Health Momnibus Act of 2020, which is a package of nine bills intended to comprehensively address every aspect of the Black maternal health crisis in the U.S., including social determinants of health, diversity in the perinatal workforce, data collection, digital tools, maternal mental healthcare, payment models, continuity of health insurance coverage, and special needs of women veterans and incarcerated women. Again, the bills are tied up in committees of both chambers, and no hearings have been held.
In May 2019, Harris introduced the Maternal Care Access and Reducing Emergencies (Maternal CARE) Act, which, if passed, would pump $25 million into establishing implicit bias training within the medical profession. The bill, which is stalled in the Committee on Health, Education, Labor and Pensions, also would set aside $125 million to be used to identify moms with high-risk pregnancies and provide them with “the culturally competent care and resources they need.” An identical bill is stalled in the House Energy and Commerce Subcommittee on Health. Harris introduced a similar bill in 2018, which did not receive a vote.
Also, during the Democratic presidential primaries, many of the candidates made tackling racial disparities in maternal health a core component of their political platform as they sought the nomination. Joe Biden has pledged if elected president to adopt strategies used by California that halved the state’s maternal death rate to a three-year average of 7.0 deaths per 100,000 live births, as the U.S. maternal death rate worsened. Those steps included:
Thankfully, the fight to end the maternal health crisis for minority women in the U.S. is picking up momentum.
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