Why are black mothers and infants far more likely to die in U.S. from pregnancy-related causes?

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• Judy Woodruff:

  The United States has a problem with maternal mortality, and it's one that's been getting worse.

  The U.S. is one of only 13 countries where the death rate is worse now than it was 25 years ago, and among the worst of wealthiest countries in the world. Between 700 and 900 American women die each year from problems related to pregnancy, childbirth or complications up to a year later.

  There are as many as 50,000 cases annually where women face dangerous and even life-threatening situations.

  As part of our ongoing series Race Matters, Amna Nawaz looks at why it is dramatically worse among African-American women.

  It's the focus of this week's segment the Leading Edge.

• Amna Nawaz:

  And the statistics are stunning. Black infants are more than twice as likely to die than white infants, a racial disparity that is wider today than in 1850, 15 years before the end of slavery. And black women are three to four times as likely to die from pregnancy-related causes than white women.

  For a closer look at what's behind those numbers, we turn to Linda Villarosa. Her in-depth report on the subject ran in "The New York Times Magazine." And Monica Simpson, executive director of SisterSong, the country's largest organization dedicated to reproductive justice for women of color. In 2014, she testified before the United Nations Committee on the Elimination of Racial Discrimination.

  Linda and Monica, welcome to the "NewsHour."

  Linda, I would like to start with you.

  Help us understand these numbers. What is going on in America, in the lives of black women, in our medical communities that's causing this?

• Linda Villarosa:

  Well, what I found in my reporting were really two things, both related to race.

  The first was that simply the experience of living in America as a black woman does something to your body that causes low birth weight babies, that causes maternal mortality, that causes infant mortality.

  Second is that there is a kind of racism in the health care system, and most of it unconscious. It's a kind of bias that's existed for a long time that we have known about that is affecting the birth experiences of black women in America.

• Amna Nawaz:

  So, Monica, let me ask you now, because this conversation about the black-white disparity, it's long centered on things like wealth and education, right, the idea being that poorer, less-educated women are more likely to have negative outcomes.

  But then last year, we all heard the story of Serena Williams, right, who had her own very serious complications during her delivery, and she shared them very publicly. That turned the conversation on its head.

  Is that kind of experience more common than previously thought?

• Monica Simpson:

  Unfortunately, it's very common.

  And what is so critical about this, this issue, is that we just came out of Black Maternal Health Week, the Black Mamas Matter Alliance that got birthed from this important work that we did that we took to the U.N. We were actually picking up stories like this and hearing this across the board from so many black women across this country, that it didn't matter what their socioeconomic status was.

  It didn't matter, you know, what their education level was. Here we are looking at Serena Williams in particular, who is the world's best athlete. She definitely has support. She's definitely not dealing with, you know, economic issues.

  And she still was dealing with the fact that she almost lost her life after giving birth. This story is — we can see the thread, right, through her story and to so many women, black women across the country.

  Unfortunately, their outcomes were still just not — they were not to par.

• Amna Nawaz:

  Linda, I want to dig into something you mentioned about the other things happening in women's lives.

  In your report, you tell the story of a woman whose daughter is stillborn. Her medical story at least begins and ends with sort of the pregnancy and the delivery. But, in your report, you trace her story back much, much further.

  Tell me why that is important, why an understanding of that complete story is necessary to understanding why things end up the way they do.

• Linda Villarosa:

  I think what her story told was really a story of empathy, so you could really understand what women go through during pregnancy and childbirth.

  And her baby died and she almost died in 2016 from preeclampsia. And that is high blood pressure during pregnancy. And so when she ended up getting pregnant again a year later, she was terrified. And so she really needed a lot of support, because she was very much afraid of coming home empty-handed again.

  And I think telling that story really is a story of humanity. It's a story of resilience. And it allows people to really understand what is happening in the lives of black women today.

• Amna Nawaz:

  And you used a couple of phrases in your report I would love for you to explain, toxic stress and weathering. How do those work in the context of this conversation?

• Linda Villarosa:

  So, when you hear the word stress, you kind of think of, oh, I feel really stressed out, or I just need to kind of take a chill pill or relax.

  But, really, toxic stress is the result of aggressions that happen to you and insults that happen to you, and, in this case, race-related. It can be everything from, I feel that I'm treated differently, people think I'm less intelligent, to, I am being discriminated against by the police in housing and in my workplace.

  And those actually — it's been proven that those have a physical effect on the body, because every time you get stressed out in this way, and if it happens repeatedly, all of your systems fire up. And if your systems continually fire up, they break down.

  And weathering is the idea that you, your body — because of these repeated insults and this repeated firing up the system, the body ages prematurely. And so — and it's not on the outside. I mean, it could be, but it's on the inside.

  And that all comes to a head during what is essentially a stress test of a woman's body, and that is pregnancy and childbirth.

• Amna Nawaz:

  And, Linda, when you say that it's been proven, I want to be clear about this.

  Linda, in your report, you talk out the body of evidence, the statistical evidence, that traces back years and years. Tell me about that.

• Linda Villarosa:

  One thing that — well, how I learned about it, specifically in infant mortality, how I learned about the discrepancy between, that an educated black woman has a higher chance of her baby dying than a white woman with an eighth grade education, was in 1992, when one of my professors in grad school handed me a study that had this, this kind of data in it.

  And it was in "The New England Journal of Medicine." And I argued with him. And he said, "No, this is real."

  And I went back and talked to one of the women who was an author of that study, you know, several months ago. And she had collected 174 studies that were saying similar things, whether they were about race in the body — you know, the effect of race on the body, or the effect of race in health care.

  And I said, my gosh, you have 74 footnotes here — 174 footnotes. And she said: "You have to prove things. You can't just say, it's race. You have to prove it."

  So, this is a thing.

• Amna Nawaz:

  So, Monica, I want to ask you about this now.

  There is obviously the lived experience that contributes to this, and there is also, as you mentioned, what happens, or what we now know happens, by and large, to women of color, particularly black women, inside the health care system.

  You have testified about that racial disparity before the United Nations. What, if anything, is being done to address that so far?

• Monica Simpson:

  Absolutely.

  One, we have to address the fact that we have lack of Medicaid expansion in this country and the lack of access to health care. It's still huge. In the South, overwhelmingly, saw that we didn't see an expansion of Medicaid. So, thousands of people are still left without access to their basic health care.

  We also looked at the fact that, unfortunately, we're still dealing with abstinence-only education that doesn't give a comprehensive, you know, overview for folks for them to understand their bodies and what happens to their bodies, and to help people plan and think about what they want for their lives. That is also very critical to this.

  And then thinking about the fact that research is still needed, right? We still need to get accurate numbers and continue to feed these statistics and let people understand the fullness of this issue. And then that will help us think about how to move this in terms of policy and making sure that our elected officials understand that we need to have this handled, right, in our policies.

  And we need to move forward with proactive legislation that helps us get on the front end of this issue, to see some of these — to see these numbers decrease.

  And so from bringing those stories from on the ground, you know, the statistics are real, and so are the stories from so many folks who have experienced oppression, they have experienced discrimination within the system.

• Amna Nawaz:

  Linda, you mentioned the conversation over 25, 30 years ago. Now, today, what do you think is the next thing that needs to happen to alleviate that disparity?

• Linda Villarosa:

  I think that what we have to do is change the medical system.

  Something is deeply embedded, you know, a kind of — I don't want to say individual people are racist. Maybe that is part of it. But this is a — something that's embedded in the system. It's baked in.

  And we have to — starting at medical school and before, to start getting doctors to face and other medical providers to face unconscious bias that is affecting the care that women of color and everyone receives in the health care system.

  So, I think that's a very, very important first step.

• Amna Nawaz:

  Linda Villarosa, Monica Simpson, thanks for your time.

• Monica Simpson:

  Thank you so much.

• Linda Villarosa:

  Thank you.

• Amna Nawaz:

  Thanks.