Her requests for help were rejected, she said, and she was repeatedly sent home from the hospital. Doctors and nurses told her she was having normal contractions, she said, even as her abdominal pain worsened and she started vomiting bile. Angelica said she wasn’t taken seriously until a searing pain shot through her body and her baby’s heart rate plummeted.
She rushed to the operating room for an emergency C-section, months before her due date, and nearly died of an undiagnosed case of sepsis.
Her experience is a reflection of the medical racism, bias, and inattentive care black Americans endure. According to the Centers for Disease Control and Prevention, black women have the highest maternal mortality rate in the United States: 69.9 per 100,000 live births in 2021, nearly three times the rate of white women.
Black babies are more likely to die, as well as much more likely to be born prematurely, paving the way for health problems that can haunt them throughout their lives.
“Race plays a huge role, especially in the South, in terms of how you’re treated,” Angelica said, and the consequences are catastrophic. “People are dying.”
To be black anywhere in America is to experience more chronic conditions such as asthma, diabetes, high blood pressure, Alzheimer’s disease and, most recently, COVID-19. Black Americans have less access to adequate medical care; their life expectancy is shorter.
From birth to death, regardless of wealth or social status, they are much more likely to get sick and die from common ailments.
Black Americans’ health problems have long been attributed to genetics or behavior, when in reality a range of conditions associated with racism – including restrictions on where people can live and historic lack of access to care – play a major role.
Discrimination and bias in hospital settings have been disastrous.
The nation’s health disparities have had a tragic impact: Over the past two decades, higher death rates among black Americans resulted in an additional 1.6 million deaths compared to white Americans. That higher death rate resulted in a cumulative loss of more than 80 million years of life from people dying young and billions of dollars in health care and missed opportunities.
A year-long Associated Press project found that the health challenges faced by black Americans often begin before they take their first breath.
The AP conducted dozens of interviews with doctors, medical professionals, lawyers, historians and researchers who detailed how a history of racism that began during America’s founding years led to the inequalities we see today.
It wasn’t until after her baby was born that Angelica, 34, learned she was near death.
“I was on a ventilator,” she said. “I coded.”
She woke up three days later unable to speak due to a respirator in her mouth. She remembers gesturing wildly to her mother and asking where her son, Malik, was.
He was fine. But Angelica felt that so much had been taken from her. She never experienced those first moments of joy when her newborn baby was placed on her chest. She didn’t even know what her son looked like.
Maternal sepsis is a leading cause of maternal death in America. Black women are twice as likely to develop severe maternal sepsis compared to their white counterparts. Common symptoms include fever or pain in the area of infection. Sepsis can develop quickly, so a timely response is crucial.
Early-stage sepsis can reflect common pregnancy symptoms, so it can be difficult to diagnose. Due to a lack of training, some healthcare providers do not know what to look out for. But slow or missed diagnoses are also the result of bias, structural racism in medicine and inattentive care that leads to patients, especially black women, not being heard.
“The way structural racism can play into this particular disease is not being taken seriously,” said Dr. Laura Riley, chief of obstetrics and gynecology at Weill Cornell Medicine and New York-Presbyterian Hospital. “We know that delay in diagnosis leads to these really bad outcomes.”
For decades, frustrated birth advocates and medical professionals have tried to sound the alarm about the ways medicine has failed black women. Historians trace that abuse to racist medical practices endured by black people during and after slavery.
To fully understand the crises of maternal and infant mortality for black women and infants, the nation must first consider the dark history of how gynecology began, said Deirdre Cooper Owens, a historian and author.
“The history of this particular branch of medicine … it begins on a slave ranch in Alabama,” Owens said. “The advancement of obstetrics and gynecology had such an intimate relationship with slavery and was literally built on the wounds of black women.”
Reproductive surgeries that were experimental at the time, such as cesarean sections, were often performed on enslaved black women.
Doctors such as the once acclaimed J. Marion Sims, an Alabama physician many call the “father of gynecology,” performed torturous surgical experiments on enslaved black women without anesthesia in the 1840s.
And long after the abolition of slavery, hospitals performed unnecessary hysterectomies on black women, and eugenics programs sterilized them.
Health care segregation also played a major role in the racial health gap that still persists.
Until Congress passed the Civil Rights Act of 1964, black families were usually excluded from well-funded white hospitals and often received limited, poor, or inhumane medical treatment. Black-led clinics and doctors worked to fill the gaps, but even after the new protections, hospitals once reserved for black families were underfunded and black women did not regularly receive the same support available to white women.
That history of abuse and neglect led to a deep-seated distrust of healthcare facilities among communities of color.
“We have to recognize that it’s not about a few racist people or a few bad actors,” said Rana A. Hogarth, an associate professor of history at the University of Illinois, Urbana-Champaign. “People need to stop thinking about things like slavery and racism as just these features that happened and are part of the outline of history, and maybe think of them more as foundational and institutions that have stood by us every step of the way.”
Some health care providers still hold false beliefs about biological differences between black and white people, such as black people having “less sensitive nerve endings, thicker skin, and stronger bones.” Those beliefs have led medical providers to now rate Black patients’ pain lower and recommend less relief.
The differences are there regardless of education or income level. Black women with a college degree or higher have a pregnancy-related death rate more than five times that of white women. Notably, the pregnancy-related death rate for black women with a college degree is 1.6. times higher than that of white women with less than a high school diploma.
Attempts to address the problem
There is some evidence that the suffering of black mothers and their babies is acknowledged, however late.
In 2019, U.S. Representative Lauren Underwood, a Democrat from Illinois, and Representative Alma Adams, a Democrat from North Carolina, launched the Black Maternal Health Caucus. It is now one of the largest bipartisan congressional caucuses. The caucus introduced the Black Maternal Health Momnibus Act in 2019 and again in 2021, proposing sweeping changes that would increase funding and strengthen oversight. The main parts of the legislation have been passed, but the bill itself has yet to be approved.
President Joe Biden’s fiscal year 2024 budget includes $471 million in funding to reduce maternal mortality and morbidity, expand maternal health initiatives in rural communities, and implicit bias training and other initiatives. It also requires states to provide ongoing Medicaid coverage for 12 months after childbirth to close health insurance gaps. It also includes $1.9 billion in funding for women’s and children’s health programs.
U.S. Secretary of Health and Human Services Xavier Becerra told The Associated Press that more needs to be done at all levels of government to eradicate racism and prejudice within the health care system.
“We know that if we give mother and baby access to care for a year, we are likely to not only have good health outcomes, but also a promising future for mother and baby,” he said.
More from this series
This story is part of an AP series exploring the health disparities black Americans experience throughout their lives.
Birth — Why do so many black women die during pregnancy? One reason: doctors don’t take them seriously
Youth — Black children are more likely to develop asthma. Much depends on where they live
Teenage years— Black kids face racism before they even start school. It leads to a major mental health crisis
maturity — High blood pressure plagues many black Americans. Combined with COVID, it is catastrophic
Elsewhere – A lifetime of racism makes Alzheimer’s disease more common in black Americans