When I first assumed the role of president of The New York Academy of Medicine last September, I never imagined that one of the first public issues I’d address would be the fate of an old Central Park statue across the street from my office. But our ongoing opposition to the bronze of 19th century doctor J. Marion Sims is particularly relevant during Women’s History Month. He symbolizes the continuing inequity in health and health care for women of color – an issue our Academy is striving to fix.
Described by some historians as “The Father of Modern Gynecology,” Sims refined his treatment of vesicovaginal fistula through repeated experimentation on enslaved women, using no anesthesia or numbing procedures. Sadly, almost two centuries later, black women still bear the brunt of unusually high rates of complications and deaths in childbirth from a system that is failing to meet their needs. As protester chants against the statue drifted up to my office, I wished that energy could also be channeled into improving care for struggling women today.
Only blocks from the statue’s new home in Green-Wood Cemetery, where Sims is buried, is a hospital where unequal care for childbearing black women is starkly evident. Serving an overwhelmingly black patient population, SUNY Downstate Medical Center registered one of the highest rates of complications for hemorrhages in childbirth across three states, according to a two-year investigation by ProPublica, a non-profit newsgroup specializing in independent investigative journalism. The ProPublica study analyzed two years of hospital inpatient discharge data from New York, Illinois and Florida.
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“On average 34 percent of women who hemorrhage while giving birth in New York hospitals experience complications. At SUNY Downstate Medical Center, it is 62 percent,” noted the ProPublica report.
The investigation noted that the hospital disproportionately serves black mothers who are at a higher risk of harm – and they are dying at a rate more than triple that of white mothers from causes such as infections, birth-related embolisms and emergency hysterectomies.
In East Brooklyn, Brookdale Hospital Medical Center performed C-sections on 35 percent of first time mothers with low risk deliveries – an operation that places both mothers and babies at risk for complications. This rate compares to a federal recommended limit of 24 percent. Like SUNY Downstate, Brookdale disproportionately serves black women with high risk of complications.
These risks are borne out by reports by the New York City Department of Health and Mental Hygiene. “Black non-Latina women had the highest rate of severe maternal morbidity – three times that of White non-Latina women,” noted a four-year study released in 2016 by New York City health care researchers.
The causes for the disparity are complex, involving issues that are both medical and social. Many black women suffer from chronic health problems like hypertension, diabetes, heart disease, or obesity, which complicate pregnancy. Precarious housing, lower education levels and difficulties in accessing health care might aggravate these health problems.
More difficult to quantify is the effect of systemic racism on the health of black women. One study noted an increase in very low birthweight infants among women who experienced racial discrimination at work, during job searches, at school, obtaining medical care and getting service in stores and restaurants. The chronic stress of daily discrimination and anxiety over unfair treatment takes its physical toll on the health of the mother and the gestating child.
In an effort to tackle some of these problems, New York City officials in December convened a new committee to review deaths and childbirth complications, the Maternal Mortality and Morbidity Review Committee. Protocols were introduced for treatment of maternal hemorrhage, hypertension and venus thromboembolism. The health department also offered free doula services and prenatal care to aid and support pregnant women. Last month, Governor Cuomo proposed that the state establish a maternal mortality review board to investigate each maternal death in New York and make recommendations to reduce pregnancy related complications and reduce racial disparities.
But improving maternal mortality and morbidity among black women must involve a broad, multipronged approach, with investment in community-based interventions to address the social factors that contribute to inequities in health. To that end, The New York Academy of Medicine hosted a Maternal Mortality summit last month to spotlight ongoing efforts and recommendations for policy and practice changes. Attendees included an array of government officials, hospital associations, community organizations, health practitioners and other stakeholders. The program, available via webcast, included discussion of ways in which structural racism contributes to disparities in maternal mortality, and strategies to mitigate those harms.
At one point this past fall during protests over the Sims statue, it was suggested that sculptures be erected of the enslaved women he used for his research in place of Sims. It is an appealing idea, but let’s also use this moment in time to delve into ways to effect real change. Improving health care for black childbearing women is the best way to remember those voiceless enslaved women experimented on by Sims long ago.
Dr. Salerno is the President of The New York Academy of Medicine and former President and CEO of Susan G. Komen. She is a physician executive and one of the nation’s pre-eminent leaders in health and health care.