The Problem
Heart disease is the leading cause of pregnancy-related death. “Heart disease” is a broad term encompassing high blood pressure, arrythmia or atypical heartbeat, stroke, pulmonary embolism, and all other heart- and vascular-related complications.
Heart disease can exist prior to pregnancy or be triggered by pregnancy. The body, especially the heart and vascular system, has to work harder during pregnancy. Pre-existing conditions like diabetes and tobacco use increase the risk of developing heart disease during pregnancy.
This problem is getting worse, as the US maternal mortality rate climbs and the maternal mortality gap between Black and white women and birthing people continues to widen.
Racial Inequity and Heart Disease
Black and Indigenous women and birthing people are more likely to suffer injury, disability, or death due to pregnancy-related heart disease than any other group. Why? Racism and the social determinants of health.
Inequity in the built and social environments lead to disparities in the burden of heart disease. This looks like less access to healthy, affordable foods; less access to safe places to exercise, including lack of opportunities for walking and time spent outdoors; greater exposure to harmful chemicals in the air and water; exposure to harmful indoor contaminants as a result of racist housing policies and housing segregation; and less access to healthcare. Racism is a stressor that puts an inordinate amount of strain on Black women and birthing people both physically and mentally, which subsequently increases the risk of co-morbid conditions like perinatal mood and anxiety disorder and substance use disorder and thus makes managing heart disease more challenging.
When Black women and birthing people are able to access healthcare, that care is often inadequate or even harmful due to racist beliefs held by providers and staff, in addition to racist and non-trauma-informed policies enacted by the healthcare system as a whole. This manifests before, during, and after pregnancy.
One high-profile example of this dismissal of Black women by the healthcare system is the 2017 near-death experience of tennis superstar Serena Williams when she was in the hospital after giving birth. Knowing that she was prone to embolisms, she knew the symptoms to watch for. However, even after reporting excruciating pain and difficulty breathing, she was dismissed by her nurse and doctor before they finally scanned her lungs and found a life-threatening clot, just like she told them. We know that this attitude amongst medical staff towards Black birthing people is not an isolated incident; rather, it is one of the drivers of the Black maternal mortality crisis.
What can we do?
While the statistics might be overwhelming and the crisis grave, there are things you can do to support Black families:
- Advocate for comprehensive, proactive systems change to reduce the root causes of health inequity.
- Educate providers and hold them accountable for listening to and believing their patients.
- Provide culturally competent education on heart disease warning signs for pregnant women and birthing people. For pregnant people who want to monitor their own blood pressure between provider visits, blood pressure kits are available to check out from St. Louis County Library for three weeks at a time.
- Insist that healthcare systems and independent providers enact anti-racist, trauma-informed policies.
- Join the movement to advocate for reimbursement for doulas and midwives. If you live in Missouri, you can start by calling or emailing your state representative and urge them to vote yes on HB 2632 and HB 1446.
- Get involved with Generate Health to learn more about Black infant and maternal health.
