Celebrating Juneteenth: The Importance of Equity in Childbirth

Juneteenth marks the day when enslaved African Americans in Galveston, Texas, were told by Union soldiers they were officially free. Even though President Abraham Lincoln signed the Emancipation Proclamation on January 1, 1863, it took more than two years for enslaved people to be considered citizens.

The Legacy of Juneteenth

Juneteenth has symbolized emancipation (freedom from slavery) for all Black Americans since June 19, 1865. In 2021, it became the newest federal holiday. It’s a day to celebrate independence and progress. But it’s also a time to recognize the struggles of being a Black person in the United States.

This includes areas like criminal justice and health care — and especially childbirth. The country has changed a lot since the Civil War, but inequality continues to affect the lives of many Black mothers and their children.

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

– Martin Luther King Jr.

Inequality and Birth Injuries

Birth injuries include any form of harm that comes to an infant as they are born. These injuries can damage a baby’s brain and/or body.

One of the most common results of birth injuries is cerebral palsy. Sadly, this group of movement disorders has been found to happen more often in Black newborns than in newborns of other races.

According to a 2012 study that looked into rates of cerebral palsy for Black and white newborns:

“Black children in the United States appear to have a higher prevalence of cerebral palsy overall than white children.”

– Epidemiology journal

The study showed that for every 1,000 Black newborns, roughly four were diagnosed with cerebral palsy. According to the study’s authors, this may be because of race-based risk factors, access to interventions (actions to improve or protect health), and under-identification of cerebral palsy due to below-standard care.

Giving Birth as a Black Mother

Black women are more likely to have certain birth risk factors contributing to infant mortality. These risk factors can have long-term consequences for children’s physical and cognitive health.

Preterm birth (birth before 37 weeks gestation) and low birthweight (defined as a baby born less than 5.5 pounds) are leading causes of infant mortality.

Here are some detailed examples of maternal and infant inequality among Black Americans:

• Congenital disabilities: Once known as birth defects, congenital disabilities are the second leading cause of infant mortality in African Americans.
• Infant mortality: In the United States, Black newborns die at three times the rate of white newborns.
• Maternal mortality: Black mothers are three times as likely to die during pregnancy or from birth-related injuries than white mothers.
• Stillbirth: The rate of stillbirth (intrauterine fetal demise) is two times higher for non-Hispanic Black women than for non-Hispanic white women.
• Sudden infant death syndrome: Non-Hispanic Black/African American infants had twice the sudden infant death syndrome (SIDS) mortality rate as non-Hispanic whites in 2018.

Experts say the latest data shows little progress in closing racial gaps in birth outcomes. This is especially troubling as the nation faces threats to maternal health care.

Improving Health Equity for the Most Vulnerable

Many factors contribute to childbirth disparities among Black mothers, such as differences in quality health care, underlying chronic conditions, structural racism, and implicit bias.

In addition, Black women living in poorly funded urban communities lack access to healthy food and safe drinking water and suffer from unsafe living conditions with high crime rates. Such areas have long histories of limited access to quality education and well-paying jobs.

Historically, segregation has led to poorer hospitals with substandard care and higher rates of life-threatening complications.

Because of the living conditions in some urban areas, Black women are more likely to be uninsured or under-insured. They may also suffer from chronic health conditions such as obesity, diabetes, and hypertension. These are all risk factors for birth injuries and other complications during pregnancy and delivery.

Gaps in culturally competent care also play a role. In a recent study of hospital births in Florida, there were significant improvements in mortality for Black newborns who were cared for by Black physicians after delivery. Data shows can be beneficial when children are cared for by doctors of the same race or ethnicity.

“It’s important to illustrate what’s happening and make the public aware because it can encourage the health establishment to take on this crisis much more seriously.”

– Dr. Ana Langer, Harvard T. H. Chan School of Public Health

Healing the Wounds of Inequality and Childbirth Trauma

Emancipation is not the same as equality. Working together is the only way to help heal the wounds of birth trauma linked with health care inequality.

Here are some things pregnant women and their families can do to reduce risk factors for Black mothers:

• Maintain both health and social support systems before, during, and after pregnancy.
• Get help if something doesn’t feel right.
• Talk to a health care provider if anything is concerning.
• Watch and seek immediate care for any of the urgent maternal warning signs:
  • Severe headache
  • Extreme swelling of hands or face
  • Trouble breathing
  • Heavy vaginal bleeding or discharge
  • Overwhelming tiredness
• Document and share pregnancy history during each doctor’s visit for up to a year after delivery.

Gaps in prenatal and maternal care have impacted minority communities for generations. This Juneteenth — and every day — we recognize how critical it is to stand up for the rights of Black mothers and children everywhere and advocate for birth equity.