A Hidden Crisis in America: Why the System Is Failing Black Mothers

MICHEL MARTIN: Thanks, Bianna. Professor Khiara Bridges, thanks so much for talking with us.

 

KHIARA BRIDGES: Well, thank you for having me.

 

MARTIN: So, by now, many people know that Black Americans in the United States are three times more likely than white Americans to die from pregnancy-related causes. Okay. But what’s so striking about your latest research and your latest book, it’s not just that this gap does not close with income or education, it actually widens. And I think that is just the kind of thing that just makes people’s heads spin. And so, the first thing I wanted to ask is, when you dug in on this particular issue, were you surprised?

 

BRIDGES: Absolutely. The statistic that you just mentioned is the engine behind this book. It was discovering that statistic that actually encouraged me, incited me, provoked me to engage in two years of research that culminated in “Expecting Inequity.” 

And it’s not only true for maternal deaths, but it’s also true for infant deaths. So the babies that Black people have when they are at the higher ends of the socioeconomic ladder, they more frequently die than the babies that poor Black people have.

So there was some, there was something there. And I think there’s a common misperception in the United States that having some degree of class privilege, right, having high income, having wealth, having a high-status job, that that protects you from racial disadvantage, that protects you from racism. And it’s true in a lot of respects. Class privilege is protective. However the fact that Black people are dying more frequently than their white counterparts when they are wealthier, it means that class privilege actually opens us up to a particular type of vulnerability. There’s a particular type of marginalization that happens when one has wealth and status and income. And so that is the engine behind this book. And I sought it to interrogate that a little more as well as discover what Black people were doing in light of that really unique and unexpected marginalization. 

 

MARTIN: You write, “The higher rates of black maternal deaths in the United States are not because black people disproportionately bear the burdens of poverty. Black people have higher rates of maternal deaths than white people across all income levels. Racial disparities and maternal mortality are not a problem of class. They are a problem of race, of racism to be precise.” But if it’s not poverty, if it’s not that, what are some of the things that are happening to Black people, Black patients, even in well-resourced settings that are leading to these outcomes?

 

BRIDGES: Some of the factors that are contributing to the higher rates of death and in severe injuries among pregnant folks even at the higher ends of the socioeconomic ladder, there is actually it’s many different contributors. The fact is that being a person of color in the United States, being a Black person in the United States, it’s stressful. And there’s reams of research at this point that demonstrates — it’s called weathering. There was a public health researcher — is a public health researcher, Arline Geronimus, who has devoted her life to investigating just how chronic stress weathers the body systems of people who are exposed to it. 

I’ve also talked about in the book epigenetics, and it’s, epigenetics is a very touchy subject to talk about, because it’s so easily misunderstood as genetics. No one is making the argument that Black people have some race specific genetic variation that causes us to die more frequently than our white counterparts. Instead, epigenetics refers to the expression of the genes, and the genes are expressed in particular ways according to their environment. And so, if you live in a hostile environment, your genes will be expressed in a way that is inconsistent or contrary to life and health. 

And I tell the story in the book, my mother, my maternal grandmother, was a maid in the Jim Crow South. She cleaned white people’s houses her entire life. She died prematurely. And I think it would be fantastical to believe that her genes were not expressed in a way that led to her premature death. Moreover, she passed that genetic expression down to my mother. I likely inherited that genetic expression from my mother. And so, even though I have all this privilege and all this, you know, elite status and la la la — I’m just two generations out of Jim Crow. And so it would be surprising if I have not inherited those expression of the genes that would compromise my health. And that might lead to the pregnancy complications that might end in death.

 

MARTIN: One of the data points you’ve cite in the book is that African immigrants who come from majority Black countries, within a generation or two, their birth outcomes deteriorate, whereas white immigrants who come from less affluent or less resourced countries in the United States, their birth outcomes improve.

 

BRIDGES: Right. Right.

 

MARTIN: So that, that is a really interesting sort of point right there. So what are some of the other factors?—

 

BRIDGES: Well, there’s also segregation, just good old fashioned residential segregation, which leads to healthcare segregation. And the fact that there are some hospitals that care for more people of color than other hospitals, which predominantly care for white people. And I think a lot of people believe that, Hey, if you have some status, you have some wealth, you can, as a Black person, you can move for Black people to live in integrated neighborhoods, because when a critical mass of Black people move into those neighborhoods, we experience white flight and the white families leave. The resources leave. The values decrease, property values decrease. And then we’re dealing with under-resourced communities relative to their white counterparts. And so the hospitals and healthcare systems that Black people are relying on for their healthcare just tend not to be as well-resourced as the hospitals and health systems that their white counterparts can frequent and or can go to in their neighborhoods.

 

MARTIN: But what about what happens in the exam room? I mean, you said that there are system issues, but there are also these individual interactions. Because I think it is fairly standard, at least, was until the current, you know, era to have sort of implicit bias training. Does your research indicate that there are still these one-on-one patient to medical provider interactions that contribute to more negative outcomes for Black patients?

 

BRIDGES: Yeah, I mean, so I don’t deny in my research that implicit bias is a factor towards the inferior healthcare that Black people receive from their providers. My problem with implicit bias as an explanation is that it has been a total explanation of all manner of racial in inequities and racial disparities. 

And that’s what medical schools and nursing schools have been doing. They’ve been trying to fix the problem of racial disparities in health and racial disparities in maternal mortality and morbidity by like ensuring that providers don’t have these implicit biases against their Black patients. Again, incredibly laudable. But there’s just so much more that we can do. And especially when you’re a person like me and you believe that structural contributors are what are doing the heavy lifting when it comes to killing Black people and shortening their lives and making them sick, then implicit bias just seems like a pat and easy fix. It seems like something where you can maintain the status quo while professing to like actually be doing something to solve this problem.

 

MARTIN: Tell us about Annette and about her experience, and what does Annette’s story tell us about the limits of class privilege, especially in these high stakes moments when something goes wrong.

 

BRIDGES: Right. Absolutely. So, you know, Annette, I actually began the book with her. She earned her law degree from, you know, an elite law school. She’s a civil rights attorney. She’s married and she was pregnant with her first child. She was healthy. And she started experiencing a rapid heartbeat through towards the tail end of her second trimester. And she would go to the emergency room whenever this happened. And the providers there would tell her, Nothing’s wrong. You know, it’s just stress. You’re, you know, you’re just stressed out, try to relax. She would report the symptoms to her midwives during her follow-up visits. They told her the same thing, Just try to relax. It’s stress. Your body does weird things when you’re pregnant. Also during her pregnancy, she would experience these, like, like on a scale of one to 10, how much pain are you in? She was like, It’s a 25, it’s a 50. Like, she would become incontinent, vomit, like the whole nine — delirium inducing pain. In fact, they told her that, you know, you should probably get a better bra that supports your breasts because you know this, it’s back pain.

 

MARTIN: Back pain.

 

BRIDGES: So, long story short, it turns out that her rapid heartbeat was caused from a pregnancy-induced heart condition that could have been lethal. They finally diagnosed it when she was in labor that she, because she was in the hospital, they did an EKG on her, discovered the heart condition. The delirium-inducing pain was actually caused from pancreatitis. They could have discovered the pancreatitis if, by a simple blood test would’ve revealed that she had elevated levels of her enzymes. No one bothered to do a workup of her to discover sort of the source of her symptoms. In fact, she might’ve died from the pancreatitis. She ended up having a emergency surgery to remove her pancreas.

So this is a clear example of, like, medical neglect. It’s a clear example of not paying attention to patients when they report their symptoms. And it did not matter at all that she was, had a JD from one of the top law schools in the United States. It didn’t matter at all that she was married her, you know, that her husband was there with her. It didn’t matter that none of — that she was well-spoken. None of these things mattered. They did not encourage her, her doctors to actually give her the quality of healthcare that she deserved.

 

MARTIN: You also point out that the U.S. is one of only a small number of countries where maternal mortality is actually increasing. 

 

BRIDGES: Right. Yes. 

 

MARTIN: And the only industrialized nation among that small group of countries. What, what if you had Black practitioners, though? Does that make a difference in these outcomes?

 

BRIDGES: So I talk about it in the book, about racially concordant care. That’s what the literature calls it. And there are studies that demonstrate that Black providers — or rather Black patients have better outcomes when they are cared for by Black providers, in some contexts. Now, infant mortality is one of those contexts. We have to wait and see whether maternal mortality, morbidity, is another context. In fact, there is data coming out of California demonstrating as much. So in, just, in discrete context Black providers can improve the outcomes of their Black patients. 

And for that reason, many of the Black patients that I talked to sought care from a Black provider. But it’s really important to understand that they knew that there were no guarantees. They knew that these Black providers were not like unicorns or like magical creatures. Instead, they were just playing in statistics and likelihood. Their sense was that they were more likely to avoid the implicit biases that compromise care if they were being cared for by a Black provider. They were more likely to have a provider who listened to them if they were cared for by a Black provider. And so these were the chances that many Black people were willing to take.

 

MARTIN: You compared care in public hospitals and elite private settings. And you found that in fact, even though the kind of actual logistics of getting care from one of these kind of busy public hospitals could be really draining, could be chaotic, could feel demeaning — you still found that some of the outcomes act were actually better. Can you just say more about that?

 

BRIDGES: Yeah, absolutely. So I think that we believe that well-resourced settings — the predominantly white settings — will improve our outcomes, as people of color. And of course, you know, white folks believe that as well. But there, there’s some data challenging that. 

It might seem like the hospital with all the bells and whistles and that has the green tea station and that has the, it smells like lemongrass and lavender. When you walk into the waiting room, it might seem like that is the place where you’re gonna get the best quality healthcare. But meanwhile, the hospital down the street that cares for low-income people, that cares for marginalized people, whose very reason for existence is to care for the regions marginalized, that space might actually be better for you. Because its entire orientation is anti-racist. Its entire orientation is to be conscious of racial disadvantage as well as all the other disadvantages. 

These are highly-regulated spaces. These are spaces where providers don’t have the discretion to not run a scan. Because of the Medicaid apparatus. Because Medicaid says you have to do X, Y, and Z in order to receive Medicaid reimbursement. And so the highly regulated aspects of the care that you might receive at the under-resourced place, as well as the fact that these places exist to care for the most marginalized, it might mean that you’re better off as a Black person going to these institutions that many others avoid like the plague.

 

MARTIN: So before we let you go, you know, there was a viral moment in Washington recently in which Representative Summer Lee, a Black Democratic congresswoman, confronted Health Secretary Robert F. Kennedy Jr. over the administration’s DEI cuts, among others. She argued that the cuts interfered with important research into lowering mortality rates for Black women. And she asked, how can we solve the Black maternal mortality crisis if we can’t say “Black?” So, you know, NIH grants canceled or disrupted, research grants all over the country in certain institutions, disrupted, canceled, terminated, et cetera, for a variety of reasons. What’s the, what’s an avenue of to address these issues that you raise, when the — I think the federal government is the primary funder of basic research. What can people do?

 

BRIDGES: Right? Yeah. I know I wrote — the last chapter in the book is the solutions chapter. I was writing it in January 2025, right when Trump assumed office for the second time, right when it became just obvious that he was more organized than he was the first time around. That these campaign promises about attacking everything that is important to me, that they weren’t just campaign promises. Instead they were gonna be a program of action for the next four years. 

So what can we do in light of the fact that we can’t even say race? Certainly can’t say Black? 

We can count, we can count the needless deaths that are going to happen. We can count the preventable deaths that are, will inevitably occur through our steady determination not to pay attention to race. And we can learn. We can learn from what happens when an administration, when a government, as powerful as the United States is, is hellbent on ignoring what is undeniably true to me, which is that racism persists and that is killing us. 

And so we can learn during these next, you know, three years, two and a half years and then we can do what we know needs to be done. (44:25) And that means making sure that Black patients can be cared for by Black providers. And what that’s gonna mean is that we need to increase the number of Black people and medical schools and nursing schools and midwifery schools. We need to start funding doulas. We need to tackle residential segregation. We need to get rid of healthcare segregation where there are some hospitals that just, that we know provide inferior care while other hospitals provide better care. We can learn in the next, you know, couple of years about what negligence and apathy and violence looks like. And then we can actually do something about it when we have an administration that cares.

 

MARTIN: Professor Khiara Bridges, thank you so much for talking with me.

 

BRIDGES: Thank you for having me.