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Too many black women like Erica Garner are dying in America’s maternal mortality crisis

Garner may have been the victim of the stress of trauma and poor health care for black women.

Andrew Burton/Getty Images

“She was born at seven-and-a-half months, 4 pounds, 11 ounces, but she proved to be a giant,” said Esaw Snipes-Garner. She was speaking about her daughter, activist Erica Garner, who died December 30 after a heart attack. Garner went into cardiac arrest following an asthma attack a week earlier, and was later placed in a medically induced coma. She reportedly suffered extensive brain damage due to a lack of oxygen.

“She lived on her own terms,” Snipes-Garner said at her daughter’s Harlem, New York, funeral Monday evening. “And she died on her own terms.”

For those who knew Garner well or followed her activist work, her death has been difficult to process. That she died at 27 is a tragedy. That she became an activist to seek justice in the wake of her father Eric Garner’s death from an NYPD officer’s fatal chokehold is painful.

During her funeral, those who gathered in her memory said that Garner was one of many who gave their lives to the fight for racial justice, a person whose life and death stand as a reminder of both the resilience of those who lose loved ones to police violence and the long-term effects that trauma often has on black women.

“When her father died, she was the one going out there in Staten Island every Tuesday and Thursday,” Rev. Kevin McCall said. “She was the one to bring this to a national level.”

But as a young mother who gave birth in August to her second child, a boy named after her late father, Garner is among an alarming number of women in the US who die during pregnancy or within one year of childbirth.

The ongoing maternal mortality crisis disproportionately affects black women, who the Centers for Disease Control and Prevention notes are three to four times more likely than white women to die from complications related to pregnancy.

Why is this happening? The medical field is seeking answers, but one of the most obvious solutions is ensuring black women’s access to quality, unbiased medical care.

“The combination of institutionalized racism, chronic stress, and the physical stress of childbirth can be deadly, and some believe that this was the case for Garner, as it is for so many Black women in the United States,” Katie Mitchell wrote for Bustle. “And as we mourn [Garner’s] loss, we need to have a conversation about why maternal mortality disproportionately affects Black women in the US, and what can be done about it.”

The US has failed to deal with its high rates of maternal mortality on many fronts — particularly for women of color

The US has very high maternal mortality rates compared to the rest of the developed world. As Vox’s Julia Belluz has reported, maternal deaths have been on the rise in the US, increasing by 27 percent, to 24 deaths per 100,000 births, between 2000 and 2014. Belluz notes that this rate is more than three times the maternal death rate of the United Kingdom, and about eight times the rate of Netherlands, Norway, and Sweden.

In recent years, a growing number of maternal health-focused organizations and academics have dedicated more time and resources to better understand the crisis.

But there is still plenty that we don’t understand, particularly when it comes to the growing gap between the deaths of black mothers and their white peers.

Research has shown that a number of factors, including poor access to pre- and postnatal care, chronic stress, and the effects of racism, and inadequate medical treatment in the years preceding childbirth are all likely to play a role in a black woman’s likelihood to suffer life-threatening complications in the months that come before and after childbirth.

These issues might appear to suggest that the disparity between black women and white women dying from pregnancy-related causes is due to economic differences, but research has found that black women in higher economic brackets are still more likely than white women to die from pregnancy- and childbirth-related problems.

A recent story from ProPublica’s Annie Waldman illustrates why black women in cities like New York cannot simply educate or earn their way out of the crisis:

Even when accounting for risk factors like low educational attainment, obesity and neighborhood poverty level, the city’s black mothers still face significantly higher rates of harm, the agency found. Of note, black mothers who are college-educated fare worse than women of all other races who never finished high school. Obese women of all races do better than black women who are of normal weight. And black women in the wealthiest neighborhoods do worse than white, Hispanic and Asian mothers in the poorest ones.

The health department has even mapped where the most maternal harm occurs, dividing the city into community districts. The highest rates of complications are concentrated in a swath of land in Central Brooklyn, in an area largely untouched by the wave of gentrification that has swept other parts of the borough. Here, mothers face up to four times the complication rates of neighborhoods just a few subway stops away.

In all, black women are 243 percent more likely than white women to die from pregnancy- or childbirth-related causes, producing one of the largest racial disparities in women’s health, according to ProPublica.

The problem is further exacerbated by the American health care system’s history of disparate treatment of black women, whose health struggles have been systemically minimized or dismissed, funneling them into medical facilities that are less equipped to handle their pregnancies.

As journalists Nina Martin and Renee Montagne explained in a story on black maternal mortality in December, black women still report facing bias when receiving pregnancy-related care:

The feeling of being devalued and disrespected by medical providers was a constant theme. The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair. The Chicago-area businesswoman with a high-risk pregnancy who was so upset at her doctor’s attitude that she changed OB-GYNs in her seventh month, only to suffer a fatal postpartum stroke.

Over and over, black women told of medical providers who equated being African American with being poor, uneducated, noncompliant and unworthy. “Sometimes you just know in your bones when someone feels contempt for you based on your race,” said one Brooklyn woman who took to bringing her white husband or in-laws to every prenatal visit.

But if some of the problems have been identified, there are others that remain opaque. Much of our understanding of maternal deaths focuses on women who die from complications in the period preceding and immediately following childbirth, leaving those who die in the weeks and months after delivery, like Garner, less known.

Because of the structure of the US maternal care system, which ProPublica has noted is largely focused on the health of infants and less on their mothers, women predisposed to the conditions that make a pregnancy high-risk can fall through the cracks.

While limited and often inadequate health care access is certainly an issue, there have been disagreements about exactly how cuts to women’s health programs have affected the crisis in states like Texas, which has the highest rates of maternal mortality in the US.

It’s not really an urban versus rural issue either. ProPublica notes that in New York City, Erica Garner’s hometown, “black mothers are 12 times more likely to die than white mothers.”

Only one thing is certain: The crisis affects black women more than any other group.

“This is a national tragedy, [but] we aren’t doing the research that’s needed and could hold hospitals accountable nationwide,” Patrisse Khan-Cullors, a senior fellow studying maternal mortality with MomsRising and a co-founder of Black Lives Matter, told Vox.

While Garner’s death wasn’t officially deemed a result of her pregnancy, we know that her pregnancy exacerbated already present health issues. Snipes-Garner told the New York Times in December that her daughter’s first heart attack occurred shortly after giving birth to her second child in August. Doctors said the pregnancy strained Garner’s enlarged heart, a condition she was previously unaware of.

“What we’re seeing with Erica Garner is not just complications because of birth, but a larger conversation around her lack of access to health care,” Khan-Cullors said. “Black women don’t receive the health care we deserve from the moment we are born. And our mothers didn’t receive the health care they deserve. By the time that we get pregnant and go to have children, the [absence of] care that we should have received [has had an effect] and our bodies are aged beyond our years.”

When health disparities go beyond medical issues

According to researchers, obesity, diabetes, cesarean births, and delayed prenatal care are some of the risk factors that increase a woman’s chances of dying from pregnancy-related complications. Black women are particularly likely to deal with many of these issues.

That’s not to mention other problems that black women are statistically more likely to face in their daily lives, like poverty, limited or infrequent access to health care, harsher discipline in schools, and lower pay — all of which can contribute to high stress among black women.

Such stress can make a pregnancy deadly for expectant and new black mothers and their children. Black infants are more than twice as likely as white infants to die within the first year of life.

“It’s chronic stress that just happens all the time — there is never a period where there’s rest from it, it’s everywhere, it’s in the air, it’s just affecting everything,” Fleda Mask Jackson, an Atlanta researcher and member of the Black Mamas Matter Alliance, told ProPublica last year.

If chronic stress, largely driven by the daily effects of racism and discrimination, plays a role in killing black mothers, then particularly stressful incidents, like those brought on by the trauma of police violence, could be particularly aggravating.

Christen Smith, an associate professor of African and African diaspora studies and anthropology at the University of Texas at Austin, argues that the aftermath of police violence is particularly harmful to black women, who are forced to deal with lingering trauma that may very well be killing them slowly.

“When we think of police lethality, we typically consider the immediate body count: The people that die from bullets and baton blows. The death toll gives the impression that black men are the disproportionate victims of police killings. But these numbers do not reveal the slow death that black women experience,” Smith wrote in a recent op-ed about Garner’s death and the long-term effects of police violence on black women.

Garner’s case, Smith says, fits this pattern. In the years since Eric Garner’s death, Erica Garner became a prominent activist and outspoken critic of misconduct in policing.

A few months after her father’s death, she staged a “die-in” on the same corner where he had been placed in a chokehold by NYPD officer Daniel Pantaleo. She consistently shared her father’s story at protests and in the media in the years since, and started the Garner Way Foundation to preserve his legacy and advance a racial justice agenda.

In an interview three weeks before her death, Garner herself commented on the toll stress was taking on her. “I’m struggling right now with the stress and everything. . . . This thing, it beats you down. The system beats you down to where you can’t win.”

As Smith wrote, “the long-range trauma police brutality causes can be as deadly as a bullet.” For the Garner family, this truth now echoes for generations.

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