Across the three years analyzed by the committee, Black women had a rate of 128.8 deaths per 100,000 births, 93% higher than the reported 91.6 deaths for white women. (Getty Images)
A key legislative panel heard testimony related to the state’s dismal maternal mortality rate Tuesday, exploring solutions it could propose as legislation in the 2023 session.
The latest Indiana Maternal Mortality Review Committee report found that 92 women died during pregnancy or up to a year postpartum, an increase from the previous year.
State Health Commissioner Kris Box reviewed the Maternal Mortality Committee’s report, briefing the interim committee on public health, behavioral health and human services on its contents. Between 2019 and 2020, pregnancy associated deaths increased from a ratio of 74.2 deaths per 100,000 births to 117.1, while pregnancy-related deaths rose from a ratio of 18.6 deaths per 100,000 births to 22.9.
For Black Hoosiers, the risk was even higher.
Across the three years analyzed by the committee, Black women had a ratio of 128.8 deaths per 100,000 births, 93% higher than the reported ratio of 91.6 deaths for white women.
The maternal mortality rate for Black women who graduated college is higher than that of a white woman who has not finished high school.
– Dr. Jasmine Johnson
Reflecting on the report and analyzing solutions, Dr. Jasmine Johnson, a Black mother and maternal-fetal medicine physician, noted the role of medical bias and discrimination in the racial discrepancy. In particular, the health system repeatedly failed Black women as their education and income levels increased – two factors that reduce risk for other women.
“For some patients, having increased education or having private insurance may put them in a kind of lower risk category for an adverse outcome,” Johnson said. “What we see with our data is that those same protections don’t necessarily translate to Black patients… the maternal mortality rate for Black women who graduated college is higher than that of a white woman who has not finished high school.”
Johnson noted that even Black pediatricians weren’t safe, as demonstrated by the preeclampsia death of Dr. Chaniece Wallace in Indianapolis in 2020.
“All of our patients come to us and say they are afraid to have a baby; they are afraid because they’re seeing that women are dying in the news and it’s especially apparent to the Black patients that they are at a higher risk of dying and it’s taking the joy of pregnancy away from people,” Johnson said.
Another researcher, Dr. Lauren Dungy-Poythress, noted that many social factors contribute to worse health outcomes for women, including the chronic stress of racism.
“The stress of being a Black woman in American society can take a physical toll during pregnancy and childbirth,” Dungy-Poythress said.
On top of that, Black women encounter racism while accessing healthcare. One study found that 33% of Black women said they had been discriminated against because of their race in the medical system and another 21% said they avoided going to the doctor because of said discrimination, Dungy-Poythress said.
“I have two daughters. When I was their age in my 20s I thought about getting married (and) having children. But I never once thought, ‘I shouldn’t have children because there’s a higher chance that I could die…. While the medical system watched and ignored me,’” Dugny-Poythress said. “Those are the concerns that young women have today.”
Johnson teaches at Indiana University, one of the largest medical schools in the country. She said that the state’s passage of the near-total abortion ban worried providers that healthcare access for pregnant Hoosiers would worsen as OBGYN students decided to practice elsewhere.
Though Black women accounted for a disproportionately high rate of deaths, overdoses accounted for the highest percentage of deaths, or 30.4%.
Box said part of the solution would not just be screening women and providing referrals to care, but ensuring they stay engaged with treatment without worrying that the government would penalize them by taking their children.
“A lot of women don’t seek care because they are afraid that we’re going to take their children away from them or that this child – because they admit to it – might be taken away,” Box said. “We have not taken that punitive approach in the state of Indiana for several years.”
Deaths increased across the board, Box said, regardless of category. Across the three-year period of study, overdoses accounted for 31.2% of deaths.
“It is heartbreaking to see those numbers (of deaths) increase and probably reflects some of the lack of care that was available with a lot of people closing offices or doing virtual visits and other things,” Box said.
Box noted that the report didn’t even include an analysis of women who nearly died during childbirth or in the postpartum period. The analysis of 2020 included just three deaths due to COVID-19, a number she expected to increase next year.
“In looking and discussing (this) with the CDC, every state saw this huge increase in maternal mortality,” Box said. “Unfortunately, we’re already seeing the numbers for ‘21 and they’re going to be elevated too.”
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