为什么黑人女性怀孕后存活率较低, and what's being done about it

身为黑人，在美国怀孕.S. was already a risky combination, and health experts now worry the pandemic is making things worse.

Before the pandemic, Black women were three times more likely than Hispanic women and 2.5 times more likely than white women to die from causes linked to pregnancy, according to the latest 疾病控制和预防中心 data from 2018. 这些数据表明，每100人,000 live births, 37 Black women died while pregnant or within six weeks of pregnancy compared to 12 Hispanic women and 15 white women.

Although data regarding the pandemic's impact on maternal mortality won't be available for some time, medical experts and health advocates are collecting anecdotes that highlight the intensifying crisis facing Black women.

"We haven't invested in the things that people need that protect them from harm when there isn't a pandemic, 所以当我们得到数据时，我们很有信心, it's going to show that the outcomes actually worsened because we don't have a social safety net," said Dr. Joia Adele Crear-Perry, 她是妇产科医生，也是全国生育公平合作组织的创始人和主席.

"We haven't made any substantive changes when it comes to listening to patients more, 确保他们的需求得到满足, 获得社区支持——我们知道这些实际上可以挽救生命," she said.

Her organization works to reduce Black infant and maternal deaths through research, 倡导种族平等和出生平等培训.

For nearly a year, 新冠肺炎疫情使当地医院不堪重负，资源紧张, depleted blood banks, 并将一些面对面的医疗访问转为视频通话. Early in the pandemic, some women were left without essential support when their companions were not allowed in birthing rooms because of pandemic restrictions.

但即使在COVID-19危机开始之前，黑人母亲 reported being dismissed by medical professionals when they expressed concerns during childbirth. 网球巨星塞雷娜·威廉姆斯说 Vogue in 2018 that she could have died after a C-section when she recognized she had a blood clot in her lungs but had trouble persuading hospital staff to take her concerns seriously.

这些种族差异背后的原因是多方面的. 缺乏获得保健的机会和保健质量差是其中的因素. But even college-educated Black women die at higher rates from pregnancy-related causes than white women who didn't finish high school, CDC data show.

多年来，美国医学界一直存在着隐性的种族偏见. Mary Rosser, director of Integrated Women's Health at Columbia University Irving Medical Center in New York City. "America has segregated people into neighborhoods where they don't have access to resources such as healthy food, green spaces, job opportunities, good housing and health care. 这是复合的压力所造成的 structural racism 也会影响黑人女性的健康."

对于所有背景的母亲来说, 心血管相关疾病是最常见的死亡原因, according to statistics 来自美国心脏协会. Federal data show such causes include cardiomyopathy, stroke and other cardiovascular conditions. 其他与怀孕有关的死亡是由于出血, 感染和高血压疾病，如先兆子痫.

"We're not biologically different; there's no Black gene or Black heart or Black kidneys," said Crear-Perry, 是黑人妈妈问题联盟顾问委员会的成员吗, a national network of more than two dozen maternal health initiatives and organizations led by Black women. "We've spent generations blaming Black people for their outcomes without really addressing the underlying root causes of racism, 阶级歧视和性别压迫. So, when people ask me what is the cause for Black maternal death, the answer is not race. It's racism."

联邦政府正在关注这个问题. Last December, the U.S. 卫生与公众服务部 outlined plans 资助为高危妇女服务的卫生保健提供者, 制定并公开报告孕产妇保健质量措施, 投资于孕产妇保健研究. 此外，疾病预防控制中心去年夏天推出了 Hear Her campaign 教育人们有关妊娠并发症的警告信号.

For Black women specifically, the Association of Black Cardiologists last June convened a task force of clinicians, 基于信仰的社区领袖, research organizations and the media to pinpoint disparities in care and propose solutions. The group published a position paper 刊登在美国心脏协会杂志《线上娱乐电子游戏网站》上. 就在同一周，三名国会议员 introduced legislation called the Black Maternal Health Momnibus Act of 2021 aimed at reducing ethnic and racial disparities.

"We know that if you have chronic stress and that stress is thrown at you on a constant everyday basis, 你的健康状况会很差," said Dr. 立场文件的主要作者雷切尔·邦德说.

通过与以信仰为基础的组织和企业合作, like beauty salons, 该工作组希望能够接触到女性，在她们聚集和公开交谈的地方, said Bond, 亚利桑那州尊严健康医疗集团的心脏病专家. The goal is to mitigate some of the mistrust that exists in the Black community toward health care providers and educate women about the risk factors for pregnancy complications and how to advocate for themselves more effectively.

"We wanted to highlight “坚强的黑人女性”现象 because it exists, it's real, 这是我们作为临床医生必须感同身受的事情," she said. “我们必须做更好的筛查工作, 特别是在压力极大的大流行期间. It may be a game changer in terms of helping to reduce these disparities that we're seeing."

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