We Must Acknowledge that Systemic Problems Require Systemic Solutions
By Meika Tylese Neblett, MD, MS and Suzanne Spernal, DNP, APN-BC, RNC-OB
For many Black women in the United States, the prospect of childbirth comes with fear. As an emergency room physician and the head of women’s services at New Jersey’s largest academic health care system, we have seen this fear up close and personal. Black patients are all too aware that for them, pregnancy-related complications can pose a high risk to their health and possibly their child’s.
Despite the resources at our disposal, our country has higher maternal death rates than any other wealthy nation. In 2021, the number of maternal deaths rose a staggering 40%. The statistics reflect an especially stark reality for Black women. According to the Centers for Disease Control and Prevention, Black women are 2.6 times more likely to die from a pregnancy-related cause than white women. In our home state of New Jersey, that figure is more than doubled with Black mothers dying at nearly seven times the rate of white mothers, making maternal morbidity and mortality a true public health crisis.
At the root of these persistent and increasing health inequities is systemic racism, which creates and perpetuates gaps in care that largely impact Black people. These disparities are well documented—from academic research to lived experiences that are increasingly coming to light as Black women, including prominent celebrities, share their life-threatening childbirth experiences. So, when it comes to Black maternal health, we must acknowledge that systemic problems require systemic solutions and now is the time for us as a country to address this crisis.
At RWJBarnabas Health, we have set about doing just that and have reinforced our commitment to improving the health and well-being of Black women throughout pregnancy, delivery and the postpartum period. Our physicians and health care professionals deliver over 25,000 infants annually, representing a quarter of all hospital births in the state. That statistic creates both an opportunity and responsibility to prioritize maternal health equity. Through clinical training and community partnerships—along with our commitment to antiracism and DEI—we have developed a road map to ensure safe, equitable care for Black mothers.
As any doctor knows, you cannot treat a problem without first diagnosing it. Therefore, any effort to build Black maternal health equity must address structural biases and include strategies to hold ourselves accountable. Studies have shown that, when navigating the health care system, Black people often experience obstacles due to deeply rooted biases—both implicit and explicit. These biases influence a person’s perceptions, judgment, behavior and decision-making, and ultimately impact the type of care patients receive. For a Black pregnant woman, these issues can start from the time of scheduling a prenatal appointment right down to delivery and the postpartum period—based on what the doctor, nurse and other staff may believe about her.
When you consider other proven data, including the fact that providers are more apt to spend less time with Black patients, ignore their symptoms and complaints, and lose contact with them during the critical postpartum period, you begin to understand the interwoven ways in which the U.S. health care system fails Black mothers and puts them at risk of death.
Reflection and education are crucial parts of changing that narrative and promoting better health outcomes. Within Dr. Neblett’s hospital, Community Medical Center, and other RWJBarnabas Health facilities, we have set about identifying the ways in which inequity can manifest in various settings, including clinical interactions. We have prioritized training our clinicians and caregivers about racism, bias and discriminatory practices, equipping them with the personal and systemic knowledge to remove those barriers and better care for their patients.
Further, within the objective of providing patient-centered maternal care, it is important to ensure that clinical interventions and services incorporate the cultural norms observed by each patient. For us, this not only means that all our doctors, nurses and other staff receive the proper training, but it also goes beyond our hospital walls to include collaboration with local community organizations to reach women and their families in our region.
A comprehensive approach to providing high-quality care to all women must also acknowledge women’s lived experiences and involve them as experts in their care. Among these might include, as we have done within facilities in our system, the offering of trusted, knowledgeable nurse-midwives as a holistic option to pregnancy health and childbirth. Safe and anonymous maternal mental health programs that support women during the reproductive cycle, and family planning services that help women manage and achieve their reproductive goals are key to a full continuum of care. Our system also participates in TeamBirth NJ, an evidence-based, national model for better provider and patient communication that is designed to enhance women’s birthing experiences and improve outcomes.
We know changes to make our nation a better and safer birthing place for Black women will not happen overnight. We must all commit to engage in the critical work to eliminating health inequities while building practical solutions and services to improve health. Together, we can turn the tide for the better.
Meika Tylese Neblett, MD, MS, serves as Chief Medical, Quality and Academic Officer at Community Medical Center, an RWJBarnabas Health facility. Suzanne Spernal, DNP, APN-BC, RNC-OB, serves as Senior Vice President of Women’s Services at RWJBarnabas Health.