Introduction
African American women are more likely to die or have difficulties during childbirth compared to white women. African American women face different severe health outcomes in the US while giving birth, such as prenatal mortalities. Established wellness and social and cultural framework elements affect the occurrences in many instances. Women of color encounter difficulty in receiving proper healthcare, and multiple other prejudiced areas affect this demographic’s well-being.
The goal of this research is to recognize factors that may lead to racial differences in pregnancy-related mortality. The research paper aims at identifying the pregnancy-related complications that were affecting Black women based on the Patricia Hill Collins critical race theory. The researcher looked at distinctions in symptom severity, chronic conditions, and treatment invoice between 608 (304 African-American and 304 white) sick people for one of three perinatal mortality illnesses. Such illnesses include pregnancy-related pulmonary disease, peripartum infection, and bleeding from health facilities selected randomly from a countywide area. In the research paper, African-American women tended to have higher levels of high blood pressure, lower hemoglobin intensities before internal bleeding, more antenatal hospitalizations, and a higher proportion of overweight. The theory suggests that these issues are a result of systematic racism in all areas rather than a concern only affecting the healthcare domain.
Review of the Literature
Since the beginning of the twentieth century, the rate of child mortality or serious complications during pregnancy among Black women in the US has become much higher than among white females. The numbers are terrifying: “according to the CDC, black mothers in the US die at three to four times the rate of white mothers, one of the widest of all racial disparities in women’s health” (Martin & Montagne, 2017, p. 2). They also experience higher rates of cesarean delivery and pregnancy-related morbidity and mortality (Misra, Slaughter-Acey, Giurgescu, Sealy-Jefferson, & Nowak, 2017; Tangel, White, Nachamie, & Pick, 2019). Various researchers study this phenomenon and its causes, and the existing literature may provide valuable insights related to this topic.
To begin with, some researchers try to explain the factors that contribute to this severe issue. For example, as stated by Owens and Fett (2019), “the legacies of slavery today are seen in structural racism that has resulted in disproportionate maternal and infant death among African Americans” (p. 1342). The same idea is noticed by Prather et al. (2018). The researchers indicate that the negative effects of slavery and various experiences of racism, namely, discriminatory healthcare practices, undermine the reproductive and sexual health of Black females.
Further, there are many obstacles that prevent African American women from receiving proper prenatal care. These barriers include unintended pregnancy, insurance, negative attitudes towards prenatal care, transportation, and overall life stress (Mazul, Ward, & Ngui, 2017). In order to improve the situation, specific changes and interventions need to be introduced in the nearest future (Chambers, Erausquin, Tanner, Nichols, & Brown-Jeffy, 2018). For example, proper and effective ethical principles for perinatal care aimed at reducing preventable causes have to be identified (Scott, Britton, & McLemore, 2019). Further, preconception care is also important, and “several nonpharmacologic strategies exist to reduce negative pregnancy outcomes for Black women, including innovative nursing and public health programs” (Scott, Britton, & McLemore, 2019, p. 111). Therefore, it is possible to determine the causes of higher rates of pregnancy-related complications among African American women and find proper solutions.
Theory Definition
Racial minorities have been historically oppressed and discriminated against for generations. However, one may argue that the outcomes of the civil rights movement have stopped the systemic oppression and have changed society once and for all. While the law ensures political and social equality on paper, in practice, the disparities are present and still affecting the African American community on multiple levels. One example is the pregnancy-related complications that primarily affect black women. It is certain that discrimination and inequality are not as simple as targeting a particular population in a way that would be too obvious and easy to combat. For example, medical students are not taught to attend to patients in a different manner based on the color of their skin. However, since black females are more likely to encounter pregnancy-related complications, there is certainly a deeply-rooted issue that leads to such unfortunate outcomes. This is why it is essential to propose a theory that would partially answer the question of why such disparities still occur and whether implementing certain measures can mitigate the problem.
The proposed theory was developed by Patricia Hill Collins. The author has suggested that systemic racist is interconnected, and since all the domains which are affected are linked, the traces can be found by looking at the broader picture. For example, Collins points out that black females earn more than $21,500 less than white women in a year (2015). Thus, the inequality here refers to income. However, income affects multiple different areas such as healthcare, nutrition, education, and other essential factors. Instead of linking problematic pregnancies prevalent for black women to something abstract, one may argue that the health issues may be interconnected with the low income. As Patricia Hill Collins’ critical race theory portrays, the racism that is present in multiple areas of life is interconnected, which is why it is hard to address since a systemic approach is needed.
Based on the theory, racism is much more complex, and the outcomes of discrimination in one field lead to negative implications in other fields. Collins’ critical race theory illustrates the matrix of domination rather than a particular field that does not allow black women to be equal to white ones. Thus, persistent intersectionality is referred to as a continuous overlap of inequalities present in multiple areas of life at the same time. For example, since the political arena is not represented by enough black women, the legislation does not address certain issues related to racial injustice. Thus, the problems that exist in the black communities continue to create difficulties. Another example would be the lack of opportunities for receiving education. As long as fewer African American children can access top colleges and universities, the chance of having a high-paying job and a higher income decreases. Thus, lower financial potency leads to inadequate access to healthcare and other essential human needs, which is why medical challenges occur more often. These are examples of intersectionality and how one aspect may impact the entire system.
Collins’ theory can be applied to every field, and healthcare is one of them. Problematic pregnancies are closely related to the access to treatment and medical preventative measures that depend on one’s income. In the US, the system which does not imply generalized healthcare creates a dispersity in the level of services each individual can have. González (2021) mentions how the white population takes advantage of such a societal structure since more resources are available and no significant focus is centered around fixing the distance between races which is portrayed through inequality in opportunities. Moreover, Bakimchandra, Oinam, and Kajal (2020) specifically refer to the lack of medical assistance that has been observed while researching healthcare for black women. There are multiple reasons why such adverse outcomes occur. The first one, as mentioned earlier, is the low income and a lack of medical insurance that would create a much more favorable situation. However, the same researchers mention a lack of consultations. This may also illustrate a sense of isolation and the lack of representation through more black doctors, which may have been an ameliorating factor. Thus, a black female would perhaps be more comfortable being in an environment where no discrimination and injustice can occur. However, there is no simple way to deal with the problem based on the proposed theory. A complex, systematic approach is needed to minimize difficulties in pregnancies for African American women.
The theory suggested by Collins refers to a hierarchy that affects the whole society instead of singular unities or institutions. Based on the premise, the financial, political, societal, and cultural inequalities are all a part of greater systemic oppression. Thus, to address one seemingly small area, such as pregnancy issues in black women, it is essential to confront each domain in particular. As a result, to minimize the health problems for future mothers, it is crucial to provide women with adequate healthcare. In order for someone to have access to good healthcare, one must have a good job. Acquiring a high-paying job involves education at an excellent university. Graduating from such an institution begins with the opportunity to be admitted and so on. The whole system of factors creates an environment in which medical-related inequalities are not a portrayal of racism itself but rather its outcome.
Theory Application
In order to understand the roots of the problem, which is pregnancy issues for black females, applying the theory mentioned earlier can be helpful. Several examples can be provided for the inequality to be evidence from a theoretical standpoint. According to researchers, black women are more prone to having such health problems as heart disease, high blood pressure, and metabolic issues (Barghikar, Khosravi & Sadeghi, 2017). These are preventable diseases, and often, these conditions are exacerbated by certain factors that have to do with one’s lifestyle. However, the lifestyle does not necessarily correlate with an individual’s personal choice but rather with certain circumstances. As referred to prior, African American females have a statistically lower income compared to white women. Thus, it could be the case that the conditions illustrate the inability to maintain a healthy lifestyle. Healthy foods, gym memberships, and other aspects of healthy choices can be unattainable when one’s main priority is feeding a family and taking care of bills. Such options are impossible to make due to their inaccessibility from a financial standpoint. Based on the critical race theory suggested by Collins, the issues related to heart problems, blood pressure, and metabolism are a part of a more significant challenge. Low income and a lack of opportunities lead to the occurrence of preventable diseases that would otherwise be prevented with the necessary resources. Moreover, such health issues may affect pregnancy, and if black women are prone to having these health problems, it is certain that more pregnancies are also affected by them.
There are other health problems that primarily affect black females compared to white women. For example, researchers concluded that endometriosis is a disease that black women are more prone to having (Barochiner, Martínez & Aparicio, 2021). Endometriosis has to be confronted early on to minimize the possible adverse outcomes during pregnancy. However, since it causes more challenges to African American females, they are less likely to go to the doctor and fix the issue, which can then have adverse effects. The same issue occurs with bacterial vaginosis, which can be addressed if individuals receive the necessary treatment (Verstraelen & Swidsinski, 2019). However, in reality, as mentioned prior, black women do not have the same access to high-quality healthcare as white females do. Thus, the theory can be applied from the perspective of inequality in opportunities. Since this particular demographic is prone to having complications in pregnancies due to this disease, it may be the case that the actual challenge that needs to be confronted is inadequate healthcare availability. This is linked to the lack of opportunities to receive the same level of education and reach higher-paid jobs that correlate with better health insurance.
It is certain that one of the issues that also leads to problems during pregnancies is stress. Black women experience anxiety due to multiple reasons. Some possible reasons are systemic inequality, poverty, and other societal challenges that create an environment many may deem unsafe. Thus, African American women are prone to having miscarriages even before knowing they are caring. Researchers also mention other medical conditions such as infectious diseases, chronic difficulties, and other health concerns that can be either preventable or taken under control if the necessary measures are applied (Westby, Erlandsen, Nilsen, Visted, & Thimm, 2021). However, no medical data refers to the overall health condition of black women in a way that such diseases would primarily affect one particular race. Thus, the theory suggests that instead of looking for a scientific basis that does not exist, it is essential to address the concern from a societal viewpoint. Black females would be a healthier population and would have fewer problematic pregnancies if they had access to the same resources as white women. However, given the current situation, the lack of medical access and lower incomes create an environment in which there are such disparities.
Moreover, there is evidence that the issues that occur during pregnancies are not related to the child baring itself but rather the health condition of the mother. Researchers mention that the challenges are often reoccurring symptoms of chronic diseases already present in the body (Vanstone, Fergus, Ladhani, & Warner, 2021). The theory can be applied through the same explanation: black women have less access to resources that would include healthcare and options for a healthy lifestyle. Collins’ theory even explains why research rarely refers to the African American population when it comes to health issues. According to researchers, there is little known data on the causes of mortality or health problems in black infants (Maruyama, 2020). Thus, the critical race theory illustrates the environment in which the black population is not being considered or being left out from such conversations that could improve the situation.
For a more evident appliance of the proposed theory, it can be helpful to consider the history of the African American community. Since most areas of life were affected by segregation, there were different institutions and specialists that would only provide services for black pregnant women. Thus, the choice of receiving the best possible care was diminished through the obligation to choose from particular individuals only working with this demographic (Borradale, 2017). However, the critical race theory applies to both the past and current situations. While the inequalities in the field of healthcare are not a result of particular racist legislation or guidelines that would specifically negatively affect black individuals, the society itself remains dispersed.
The theory developed by Patricia Hill Collins can certainly be applied to multiple different areas. These include politics, education, representation in the media, police brutality, and other essential factors that illustrate discrimination. However, healthcare is a domain that has to be the most unbiased since people’s lives directly depend on it. Problems during pregnancy are not only dangerous for the infant but also for the mother. The more challenges occur, the more the black community will suffer from health complications and high rates of mortality. Collins’ critical race theory suggests looking for a possible answer by addressing inequalities on all other levels since they are interconnected. The financial situation, societal overview, cultural differences, and lack of opportunities are to be addressed in order for black pregnant women to be able to receive the same care as white females. Since Collins refers to intersectionality as the core of systematic racism, it is vital to consider the circumstances as an outcome rather than as the illustration of inequality in a singular field. Thus, the theory can be applied when the concern refers to pregnant black women and the health issues that correlate with these particular circumstances, which are statistically more prevalent than in other races.
Conclusion
The prevalence of pregnancy-related issues in black women suggests the disparities that affect the healthcare system. However, since no scientific reasons for such statistical differences to occur exist, the problem can be explained through the appliance of the critical race theory. Collins refers to the intersectionality that links multiple areas together. While racism affects various domains, the interconnected system creates even more visible disparities. Instead of considering the problematic pregnancies as an illustration of inequality, the whole structure is to be confronted. The issues that pregnant African American females face during pregnancies can be explained through the lack of resources. Thus, the inability to access the same healthcare, jobs, or education in some instances ultimately affects black women in terms of challenging pregnancies. The healthcare system is not singular, and other linked areas need to be addressed to diminish the problem. If this demographic had access to jobs offering adequate health insurance, education that would open opportunities for such jobs to be acquired, and other resources, the rate of miscarriages and pregnancy-related complications would be lower. Thus, based on Collins’ theory, the whole society has to change for beneficial changes to occur.
While there is no specific legislation that would mention discrimination based on race, the higher number of black females experiencing pregnancy-related complications is an illustration of one of the outcomes of the systemic issue. The socioeconomic background results in the inability to adopt healthy life choices and access high-level healthcare services. Furthermore, the theory explains the phenomenon as a small side effect of the racist system that creates an environment in which people have different opportunities because of the color of their skin. The only solution to the problem of pregnancy issues affecting the black community is confronting inequalities on all levels.
References
Bakimchandra, O., Oinam, J., & Kajal, R. (2020). A geospatial approach to assess health coverage and scaling-up of healthcare facilities. Current Science, 118(5), 728.
Barghikar, M., Khosravi, A., & Sadeghi, M. (2017). Which components of metabolic syndrome have a greater effect on mortality, CVA and myocardial infarction, Hyperglycemia, high blood pressure or both? Advanced Biomedical Research, 6(1), 121.
Barochiner, J., Martínez, R., & Aparicio, L. (2021). Novel indices of home blood pressure variability and hypertension-mediated organ damage in treated hypertensive patients. High Blood Pressure & Cardiovascular Prevention.
Borradale, H. (2017). Strategies to support women who have had an epidural in labor. Women and Birth, 30, 45.
Chambers, B. D., Erausquin, J. T., Tanner, A. E., Nichols, T. R., & Brown-Jeffy, S. (2018). Testing the association between traditional and novel indicators of county-level structural racism and birth outcomes among Black and White women. Journal of Racial and Ethnic Health Disparities, 5(5), 966-977.
Collins, P. (2015). Science, critical race theory and colour-blindness. The British Journal of Sociology, 66(1), 46-52.
González, M. (2021). Sovereignty within feminist international relations theory. El Outsider, 6, 8.
Martin, N., & Montagne, R. (2017). Nothing protects black women from dying in pregnancy and childbirth [PDF document]. Web.
Maruyama, T. (2020). A woman with primary ovarian insufficiency had two live births resulting from intrauterine inseminations during 10 years of ovarian follicle monitoring. Journal of Obstetrics and Gynecology Research, 46(10), 2159-2163.
Mazul, M. C., Ward, T. C. S., & Ngui, E. M. (2017). Anatomy of good prenatal care: Perspectives of low income African-American women on barriers and facilitators to prenatal care. Journal of Racial and Ethnic Health Disparities, 4(1), 79-86.
Misra, D. P., Slaughter-Acey, J., Giurgescu, C., Sealy-Jefferson, S., & Nowak, A. (2017). Why do Black women experience higher rates of preterm birth? Current Epidemiology Reports, 4(2), 83-97.
Owens, D. C., & Fett, S. M. (2019). Black maternal and infant health: Historical legacies of slavery. American Journal of Public Health, 109(10), 1342-1345.
Prather, C., Fuller, T. R., Jeffries, W. L., Marshall, K. J., Howell, A. V., Belyue-Umole, A., & King, W. (2018). Racism, African American women, and their sexual and reproductive health: A Review of historical and contemporary evidence and implications for health equity. Health Equity, 2(1), 249-259.
Scott, K. A., Britton, L., & McLemore, M. R. (2019). The ethics of perinatal care for black women: Dismantling the structural racism in “mother blame” narratives. The Journal of Perinatal & Neonatal Nursing, 33(2), 108-115.
Tangel, V., White, R. S., Nachamie, A. S., & Pick, J. S. (2019). Racial and ethnic disparities in maternal outcomes and the disadvantage of peripartum black women: A multistate analysis, 2007–2014. American Journal of Perinatology, 36(08), 835-848.
Vanstone, R., Fergus, K., Ladhani, N., & Warner, E. (2021). Reproductive concerns and fear of cancer recurrence: A qualitative study of women’s experiences of the perinatal period after cancer. BMC Pregnancy and Childbirth, 21(1).
Verstraelen, H., & Swidsinski, A. (2019). The biofilm in bacterial vaginosis. Current Opinion in Infectious Diseases, 32(1), 38-42.
Westby, C., Erlandsen, A., Nilsen, S., Visted, E., & Thimm, J. (2021). Depression, anxiety, PTSD, and OCD after stillbirth: A systematic review. BMC Pregnancy and Childbirth, 21(1).