Every February, American Heart Month stands to underscore the significance of cardiovascular health. Cardiovascular disease is particularly common in the United States, leading the cause of death in general, and across various demographics. Unfortunately, there exists a disproportionate burden among specific populations—specific burdens that not only parallel, but also may speak to, a concomitant crisis in the United States. Black women and birthing people in particular, face disproportionately high rates of cardiovascular disease and heart-related complications, a disparity that extends to the maternal health landscape.
In a nation facing a worsening maternal health crisis, with a heightened burden among Black birthing people, the intersection between cardiovascular disease, structural racism and inequity, and maternal mortality not only demands urgent attention, but calls for evaluation and analysis. Furthermore, a full-scope assessment of maternal mortality necessitates a shift from dialogue that addresses healthcare disparities in siloes, to a national conversation that acknowledges maternal mortality’s interconnectedness with a constellation of conditions.
Black Maternal Mortality and Cardiovascular Complications
In order to understand where Black maternal mortality fits within the overarching picture, we must first investigate the full scope of cardiovascular health and accompanying stratification in the United States. According to the American Heart Association, not only do Black women hold the highest prevalence of high blood pressure, but they also face dismal rates of blood pressure control. Only 25% of Black women have their blood pressure under control (with the use of lifestyle modifications and/or medications), which means the remainder face an increased risk of cardiovascular complications—many of which can lead to mortality.
Among these complications are those which ultimately emerge within the United States’ maternal health landscape. According to various studies, cardiovascular disease stands as the single largest cause of indirect maternal mortality, accounting for over a third of maternal deaths. When we couple this disheartening statistic with the fact of Black women and birthing people dying of pregnancy and childbirth-related complications at three times the rate of their non-Black counterparts at baseline, a catastrophic picture comes into view. Evidently, the inequities underpinning the disparities within cardiovascular disease extend to those of maternal mortality.
The Missing Link: Implicit Bias and Widening Maternal Healthcare Gaps
As seen within the maternal health landscape in and of itself, multiple actors convene to form a noxious cocktail of conditions that manifest within the medical establishment. Not only do Black women and birthing people experience heightened risk of cardiovascular disease and complications, but they present to medical settings where implicit biases diminish the quality of care.
Black women often deal with delayed diagnoses, inadequate pain management, and the dismissal of symptoms when presenting for routine care—trends that undoubtedly extend to their reproductive health experiences. What this means is that not only are pregnant Black women and birthing people likely to present with pre-existing conditions that make maternal mortality and morbidity more likely, but they are also bereft of opportunities for early intervention in heart-related complications through the pregnancy and postpartum period.
New Direction and Paradigm
The convergences we continue to observe in the United States should lead us to embrace a new paradigm—one that considers the establishment of overall health as indispensable in the fight against maternal mortality for Black women and birthing people. The deep-rooted inequities, low quality of care, and medical bias that place Black women at higher risk for cardiovascular complications ultimately renders them vulnerable to maternal mortality and morbidity before conception.
What this means is that addressing longstanding disparities in maternal mortality calls for comprehensive solutions—solutions that honor the preventability of conditions such as heart disease, and refrains from treating maternal mortality and morbidity as inevitable occurrences. Confronting maternal health disparities head-on means transcending the sphere of birthing and reproduction to build a future where every mother, regardless of race, holds an equal chance of achieving a healthy pregnancy, childbirth, and life beyond the delivery room.
