Maternal Mortality
By Faith Avery (Written March 24, 2019)
As a black woman that aspires to have a family, it is scary to think that I may die during childbirth. It’s even more terrifying to think that, for the rest of my life, I will have to deal with doctors that don’t believe that I feel physical pain. Though my fear is only prospective, there are many mothers all across the country that have and are living with this fear. I am reminded of women like Kira Johnson, who experienced complications and died less than 24 hours after giving birth to her son (Jones). I am also reminded of women like Shalon Irving, who died three weeks after giving birth to her newborn daughter (Martin). Even sadder is that both of these women received higher education and had more than enough access to exceptional health care and they still fell victim to maternal mortality. Unfortunately, their deaths are a marker of maternal mortality, or “deaths due to complications from pregnancy or childbirth” (UNICEF).
Maternal mortality is an issue of vertical toleration, which requires that the minority succumb to the will of the authority, otherwise known as the permission conception (Forst). Horizontal toleration follows the respect conception, which requires that both the authority and minority not only accept the wills of each other but enact mutual respect and abide by norms that each party can accept (Forst). Using vertical and horizontal toleration to analyze the problems with maternal mortality in Texas, we can see that it stems from problems of governmental regulation (vertical) and cultural attitudes (horizontal). Vertical problems cause marginalization at the horizontal level, which then reinforces the problems at the vertical level because no effective solutions can be reached. I argue that taking an intersectional approach to understanding maternal mortality will help resolve some of these issues. While we also need better government regulation for health care, promoting an intersectional approach in discussions about the U.S. health care system will help make changes at the cultural level. In turn, this will help promote better policies.
“Dangerous Deliveries”, an article from the Texas Tribune, will help assess the issues of maternal mortality and access to health care in the state of Texas. Though there is much debate surrounding the accuracy of maternal mortality rates in Texas (because of varied data collecting methods), the most recent numbers show that “per 100,000 births between 2012 and 2015: the average maternal mortality rates were 24.3 deaths” (Evans). The maternal mortality rates reflect the state of the health care system in Texas. In the United States, 10.6 million women are uninsured and in Texas, 22% of women are uninsured (KFF). These uninsured Texas women were negatively impacted by legislators’ decision to not expand the Affordable Care Act and cut 73.6 million dollars that would be contributed to family planning (Evans). These acts on behalf of state legislation are a prime example of vertical toleration. Because they are in control of how much is spent on health care and how many people can be served a year, they directly impact the citizens of Texas who don’t have as large of an impact on legislation. As a result of reduced government funding for health care, six in ten Texans (men and women) skip out on or postpone health care (KFF). This heavily impacts their daily existence, as those living in high mentally and emotionally stressful circumstances (such as homelessness, food insecurity, or unemployment) are now dealing with potential physical stress because they do not have access to resources to take care of themselves if needed. The lack of access to resources is a result of both vertical and horizontal toleration, which will be further discussed in the paper.
Maternal mortality rates in Texas are not only a result of government regulation but of attitudes surrounding women and their health. As previously stated, 24.3 per 100,000 fall victim to maternal mortality. However, these numbers vary greatly depending on the race/ethnicity of the women. The Texas Tribune cites from the Department of State Health Services that per 100,000 live births, the maternal death rates are 19.2 for Hispanic women, 27.6 for white women, and 42.6 for black women. Though a large part of these rates is a result of government regulation and access to resources, cultural attitudes also play a role in how the government and general society views women and their health. Whether they’ve been speaking about politics or health, historically, black women have been silenced by women and men alike. This silencing is a result of our patriarchal society’s desire to undermine women as well as our nation’s plague of racism and anti-blackness. James Marion Sims, the esteemed “Father of Modern Gynecology”, played a major role in cultivating the attitudes that negatively affect black women and their experiences with medical practices. Sims operated numerous times on black female slaves without using anesthesia because he believed that “black people [don’t] experience pain like white people [do]” (Holland). These attitudes have persisted to the present as a 2016 study shows that black patients are less likely to receive pain management from doctors because of the beliefs they cannot afford it or because they don’t recognize the patients’ pain at all (PNAS). The stereotype that black women do not feel pain contributes to the cultural attitude of marginalization. They are treated as though their lives are insignificant and burdensome and therefore they do not have the often life-saving treatment that they deserve in hospital rooms. This marginalization at the horizontal level is carried into the vertical level. As black women are being removed from society through maternal death, their voices and experiences are being removed in the very spaces that push for policy change to better the health of women. Considering this, it is imperative that when having conversations about women’s health, intersectionality is always a factor. Kimberle Crenshaw’s concept of intersectionality, the overlap of social categorizations such as race, class, gender, etc, is crucial for understanding the plight of black women in society (YW Boston). Utilizing the concept of intersectionality is important because it provides clarity when trying to understand how history impacts people, how circumstances shape perspective, and how we should be more specific when coming up with solutions to problems.
Cultural attitudes surrounding women’s health not only include race but class as well. As briefly mentioned, part of the reason that maternal death rates are so high in the state of Texas is because of lack of access to resources or having inadequate resources. Access to resources is not just being insured by the government to receive health care, but having enough income to be able to take care of yourself and your children. Four in one Texans (men and women) reported having problems paying medical bills and six in ten Texans reported that they postponed or forewent medical care (KFF). The challenge to pay medical bills shows the problem with access to monetary resources. A majority of these Texans were also uninsured. This then becomes both a class and an access issue. The citizens struggle to pay their bills and receive medical care because of their limited income. This income is a direct reflection of their class status, and their job position ties back to access to an adequate education. If said Texan lived in a district where their elementary, middle, or high school did not receive a lot of funding, they were then less likely to receive better teaching and less likely to apply to or attend college. Because they don’t have a degree in higher education, they are then forced to get a low paying job which lowers their class on the totem pole of wealth. Despite their income status, every Texan (and every world citizen for that matter) deserves access to good medical care and liveable wages. However, these things can only truly be accomplished at the vertical level. When policymakers begin to listen to the needs of their citizens and gather up enough empathy and compassion to create change, our citizens will be able to properly and comfortably abide in society. Though there needs to be direct changes in vertical changes in the way that we treat citizens, there also needs to be change horizontally. We, as citizens first need to recognize the intersect of race and class and then use our privileges to help those in need, whether with our finances or education. This then allows for more access to resources for those in need and it prevents further marginalization of people of color and those that are impoverished.
If we don’t prioritize the health and well being of all women, we risk vertical intolerance; putting the needs of one group of women over another or neglecting a certain group. Though sometimes it may be necessary to prioritize one group, in this case, it is imperative to prioritize all. This is not only for the sake of research and accumulating data but for the betterment of our society. The desire for equality is one of the most important cultural attitudes and yet, it is not seen enough in our society as a result of our history with disenfranchising already marginalized groups. Equality looks like accessible and affordable health care and women being able to grow a family without fear that they won’t be able to raise it.
When we examine maternal mortality through the lens of toleration, we can see that it is the result of vertical intolerance because of the lack of government regulation and horizontal intolerance because of the cultural attitude of marginalization. It is important to acknowledge that said policies and cultural issues are a result of historical-cultural attitudes that pour into our modern health system. In order to lessen the rates of maternal mortality, we should listen to the woes of women and make health care accessible to women of all races and backgrounds. This means having an understanding that the factors of race and class intersect for a multitude of women and we should work to make improvements in both of these realms.
Works Cited
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https://plato.stanford.edu/entries/toleration/ Accessed 26 March 2019.
Evans, Marissa. “Dangerous Deliveries: Is Texas doing enough to stop moms from dying?”.
Texas Tribune, 2018.
https://apps.texastribune.org/dangerous-deliveries/?_ga=2.216582037.2089548622.1553562233-143139886.1552581231 Accessed 25 March 2019.
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https://www.history.com/news/the-father-of-modern-gynecology-performed-shocking-experiments-on-slaves Accessed 26 March 2019.
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http://www.episcopalhealth.org/files/8415/3116/6234/9216_-_Texans_Experiences_with_Health_Care_Affordability_and_Access.pdf Accessed 25 March 2019.
Martin, Nina. “Black Mothers Keep Dying After Giving Birth. Shalon Irving’s Story
Explains Why”. NPR, 2017.
https://www.npr.org/2017/12/07/568948782/black-mothers-keep-dying-after-giving-birth-shalon-irvings-story-explains-why Accessed 15 March 2019.
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“Maternal Deaths” Image.
