Black Women’s Maternal Deaths Go Unquestioned
Statistics showing that African-American women die at much higher rates in childbirth and pregnancy don’t surprise Dr. David R. Williams.
”This pattern is not unique to childbirth,” said Williams, a professor of African and African-American studies and of sociology at Harvard University in Cambridge, Mass. ”It affects the health of African Americans from cradle to grave and has continued for over 100 years. Today African Americans are more likely to die of 13 of the top 15 causes of death than are whites.”
While college-educated Black women who have well-paying jobs do have better health outcomes than poor unemployed black women who don’t finish high school, Williams says they still don’t do as well as their white counterparts because of the inequalities in society.
Despite federal anti-poverty programs, the civil rights movement and major advances in obstetrics, African-American women are three to four times more likely to die in childbirth than white women.
In 2005, 347 White women died compared to 245 black women, according to Dr. William M. Callaghan, acting chief of the maternal and infant health branch of the division of reproductive health at the Atlanta-based Centers for Disease Control and Prevention (CDC). But African American women’s far smaller share of the national female population means their death rates are four times higher, on average, than those of white women.
In places such as New York City, the risks are even greater–African American women die seven times more often than pregnant white women.
”Leveling the playing field for African American women in childbirth will require healing the health care system as well as the woman,” Williams said. ”Hospitals and health care providers must change their policies and practices.”
Lack of Data Stalls Change
Changing hospital policies and practices of health care practitioners is hampered by the lack of data.
The CDC estimates that 1,000 American women die of pregnancy-related complications each year, but the number may be even higher because there is no federal requirement to report maternal deaths.
”Only 30 states have formed maternal review committees, so it is difficult to draw conclusions based on the limited number of deaths in a particular state like New York or California,” said Dr. Jeffrey C. King, chair of the maternal mortality special interest group of the American College of Obstetricians and Gynecologists, the Washington-based professional organization of physicians with advanced training in women’s health.
”America must do better,” King added. ”Every maternal death needs to be investigated in the United States–as it is in Great Britain–so that changes can be made to improve the quality of care. While the total number of maternal deaths is small, it is worrisome because every woman who dies is a tragedy for her family and society.”
A recent report by the New York Academy of Medicine and the New York City Health Department found that African Americans–only 24 percent of city’s maternity wards–had the largest percentage of deaths in all four leading causes of maternal mortality: embolism, hemorrhage, infection and pregnancy-induced hypertension.
Compared to Whites, Blacks nationwide receive less income at the same level of education and have fewer assets at equivalent incomes that can be tapped to pay for quality health care. Black women also may have had limited income earlier in life, so that hypertension, heart disease and other conditions that can lead to childbirth-related death are not diagnosed or treated appropriately.
But some insurance data in the New York study cast doubt on the extent to which a woman’s personal finances can be specifically correlated to things going wrong in pregnancy and childbirth.
Toll of Discrimination
Discrimination over a lifetime and institutional racism take an immeasurable toll on women’s health. Recent studies have shown that prolonged stress may increase anyone’s risk for infection. Stress may also trigger the release of hormones that lead to premature labor.
America’s overall record on maternal mortality is poor. A 2010 report by the United Nations placed the United States 50th in the world for maternal mortality.
The U.N. data indicated that the vast majority of countries reduced maternal mortality ratios for a global decrease of 34 percent between 1990 and 2000, while the rate nearly doubled in the United States. America’s standing is alarming because the United States spends more on childbirth-related care than any other area of hospitalization–$86 billion a year.
Maternal mortality suffers from a poverty of interest.
The CDC estimates that quality maternal care could prevent 40 to 50 percent of maternal deaths and 30 to 40 percent of near-deaths and complications. But research to determine more effective practices has languished in the last 40 years because scientists and clinicians have focused on reducing infant deaths.
”At the beginning of the 20th century, the number of maternal deaths plummeted because we took a close look at why women were dying and came up with innovations in prenatal care and delivery,” said Dr. Franklyn H. Geary Jr., a professor and director of the division of maternal fetal medicine of obstetrics at Morehouse School of Medicine in Atlanta. ”Similar research is needed today because maternal mortality is a daunting problem, especially for African Americans.”
Head of Planned Parenthood Calls on Students to Fight for Women’s Health
In the wake of threats to federal funding for Planned Parenthood, President and CEO of Planned Parenthood of the Southern Finger Lakes Joe Sammons spoke to students on Wednesday about the future of the organization and the upcoming budget discussion.
Prefacing his discussion with the proposed cuts to Title X, a federal grant program that provides comprehensive family planning, Sammons described what he called the public’s misconceptions concerning Planned Parenthood’s primary activities and purposes.
Contrary to common belief, Sammons said, abortion does not make up the majority of Planned Parenthood’s services.
94 percent of Planned Parenthood’s services are preventative, such as providing contraception and cervical cancer screenings. Abortion makes up the remaining six percent, he said.
Sammons noted that the public, swayed by “well organized and well funded” campaigns, considers Planned Parenthood primarily to be a crusading voice for abortion. This association with the “loaded dirty word” serves as a “wedge issue” to withhold funding from the organization as a whole, according to Sammons.
Julie Spalding ’11, who attended the event, agreed with Sammons’ statement about the misconstrued purpose of P.P.
“The general population does not know that Planned Parenthood offers services other than those dealing with … abortion,” Spalding said. “Planned Parenthood is not just abortion, it is women’s health.”
Because Planned Parenthood does not use government funding for abortions, the organization’s stance on abortion should not apply to the recent government funding debate, Sammons said.
“I do not have the time to list every service that we use federal funds for, but I can tell you one that we do not: abortion,” Sammons said.
Moreover, Sammons added, most of the services for which Planned Parenthood does use government funding are preventative in nature or provide family planning assistance and work to decrease the overall number of abortions, Sammons said.
Sammons also said that, in the event that government funding is cut, Planned Parenthood of the Southern Finger Lakes may be unable to provide community programs, such as the local rape crisis hotline, which derives 80 percent of its funding from government sources.
“I cannot imagine how we could support [the rape crisis center] program if those funds went away,” Sammons said. “I cannot imagine what would happen to those assault victims if those funds went away.”
Sammons also discussed to discuss the importance of the sexual education that Planned Parenthood provides to a society that downplays sex as an issue.
“When we start talking about sex in this country, we distort, we exploit, we vilify, we mock. We do everything except talk about and inform people about sex,” Sammons said. “We need to go out to wherever there are young people, wherever there are teachers, wherever there are parents and have a real honest dialogue about sex and sexuality.”
Sammons said that the opposing option, abstinence-only education, does not provide the knowledge teens need to make informed sexual decisions.
“Abstinence on its own does not mean all that much,” Sammons said. “What young people do is they act — whether they have good information, bad information or no information at all.”
Discussing the decades-long fight for increased access to healthcare for women, Sammons expressed concern that advances made in previous eras are being revoked by government propositions to discontinue funding programs like Title X. As questions about government funding for sexual and reproductive health programs are raised, society is moving “backwards” concerning women’s health freedoms, Sammons said.
“You would think that the rights we earned in one generation are preserved for the next, but they are not,” Sammons said.
Sammons called upon activists in the audience to stand with Planned Parenthood and defend the rights of women to “compassionate” healthcare.
“This is not about money. This is about women’s health and giving women the freedom to make decisions about their lives,” Sammons said.
Sammons noted that the “change in the conversation” regarding Planned Parenthood’s government funding occurred mainly because of public support. Politicians respond to the people who vote for them, Sammons said.
“We did not let [the withholding of government funding from Planned Parenthood] happen. More specifically, you did not,” Sammons said. “Over 5,000 calls went in to the congressional offices in New York State alone. Your voices changed the conversation.”
Protect Yourself from a Wrong Diagnosis
In the quest to cure what ails you, doctors sometimes don’t consider the health differences between the sexes. That may lead to a wrong diagnosis. Here are 3 medical conditions often overlooked in women and tips on how to protect yourself. Plus, test your smarts with our women’s health quiz…
1. Heart Disease
Nausea, shortness of breath and sharp chest pain are common symptoms of cardiovascular disease. In women, though, they might be blamed on anxiety or heartburn.
Many physicians still assume women under 55 years old seldom have heart attacks, says Hardy Schwartz, M.D., medical director of non-invasive cardiology at the Sarasota Memorial Heart & Vascular Institute in Florida. That means women who show symptoms of heart disease are almost seven times more likely to be misdiagnosed than men.
“Part of the problem is that so little research has been done on women, although it’s getting better,” he says.
Why it’s hard to diagnose: “Health care for women has traditionally focused on screening for breast, ovarian, cervical and other cancers,” says Norma Keller, M.D., clinical chief of cardiology at Bellevue Hospital in New York. “But ironically, heart disease is the No. 1 killer of women over 45, killing 1,400 women every day.” That’s more deaths than all cancers combined.
Most heart attacks are caused by coronary artery disease, usually the result of arteriosclerosis. This buildup of plaque causes arteries to harden and narrow, which prevents the flow of blood and can result in a heart attack.
Women manifest different symptoms of heart disease than men, particularly if they’re suffering from coronary microvascular syndrome (CMS), reports the Journal of the American College of Cardiology. In women with this condition, plaque collects in small arteries of the heart, which can be overlooked in routine angiograms.
How to prevent misdiagnosis: Women who experience heart disease symptoms – pressure or burning in the chest, shortness of breath, irregular heartbeat, dizziness, sweating, fatigue and nausea – should ask their doctor about a nuclear stress test or stress echocardiogram, Schwartz says.
Also, just as they do for cancer, women should get screened for heart disease and be aware of their risk factors:
* Find out if your parents or grandparents suffered from heart disease.
* Monitor your blood pressure regularly, especially if high blood pressure runs in your family.
* Have your cholesterol measured annually, more often if it’s high.
* If you smoke, quit.
* If you’re obese, lose weight. Exercise 30-40 minutes at least four times per week.
* If you’re diabetic, take your insulin as instructed, eat a balanced diet low in sugar and engage in daily exercise, such as walking.
For more info, check out our Heart Disease Health Center.
2. Fibromyalgia
About 10 million Americans – mostly young women – suffer from fibromyalgia (FM). It’s often called an “invisible” illness or disability because symptoms may seem unrelated and conventional medical tests typically come back normal.
But fibromyalgia is a chronic condition marked by widespread pain, intense fatigue, heightened sensitivity and needle-like tingling of the skin, muscle aches and spasms, weakness in the limbs and nerve pain. People with FM may also have problems sleeping and deficits in short-term memory.
For more on fibromyalgia, click here.
Its cause is unknown, although some experts believe stress or genetics play a role. Pain may worsen because of increased stress, excessive physical exertion, lack of deep sleep, and changes in humidity and barometric pressure.
One theory suggests that decreased levels of serotonin, a neurotransmitter that regulates sleep patterns, mood, feelings of well-being, concentration and tolerance to pain, may be a factor.
Why it’s hard to diagnose: “Symptoms vary from person to person,” says Bart Price, M.D., who practices internal medicine in Florida. “They overlap with other diseases and there are no definitive blood tests for it.”
FM is diagnosed by eliminating other conditions, but that’s why patients often get a wrong diagnosis. Other disorders, such as chronic fatigue syndrome, depression, Lupus, Lyme disease and thyroid conditions, can produce similar symptoms.
It’s also relatively rare: Only about 2% of the population has been diagnosed with FM.
There’s no universally accepted cure for fibromyalgia, but prescription muscle relaxants and nonsteroidal anti-inflammatory drugs are recommended. Mild exercise and sleep may reduce pain and fatigue, some studies suggest. Heat applied to the painful areas also may help, as well as physical therapy, massage and acupuncture.
How to prevent misdiagnosis: Be persistent with your doctor, Price says. Ask questions about your symptoms, request blood tests to rule out other diseases and seek a second opinion from a rheumatologist if necessary.
If you suspect you have FM, here are 8 important questions to ask your doctor:
* Have you checked for fibromyalgia?
* What can I do to ease my symptoms?
* What medications can I take?
* What drugs, foods or activities should I avoid?
* What alternative therapies or stress management techniques might help me?
* Do you recommend counseling?
* How do I explain my condition to others?
* Are there clinical trials in which I can participate?
3. Thyroid Disease
Thyroid disease is one of the most often undiagnosed and misdiagnosed diseases. It may affect up to 27 million Americans, according to the American Association of Clinical Endocrinologists; more than 50% of them go undiagnosed.
In fact, 1 in 8 women will develop a thyroid condition in their lifetime.
The thyroid gland regulates the pace of the body’s metabolism through the production of hormones. Hypothyroidism (associated with a slow metabolism) occurs when the thyroid fails to produce hormones triiodothyronine (T3) and tetraiodothyronine (T4).
Symptoms of hypothyroidism include:
* Weight gain
* Facial puffiness
* Fatigue, depression
* Dry skin
* Brittle nails
* Hair loss
* Development of a goiter
* Hoarseness
* Increased sensitivity to cold
* Constipation, muscle pains
* Cramps heavy menstrual flow
* Slow heart rate or congestive heart failure
With hyperthyroidism (associated with an overactive metabolism) T3 and T4 are overproduced. It can be caused by Graves’ disease (an autoimmune defect) or inflammation of the thyroid.
Symptoms of hyperthyroidism include:
* Weight loss
* Hot flashes
* Nervousness
* Anxiety
* Fine or brittle hair
* Increased sensitivity to heat
* Rapid heart rate
* Difficulty sleeping
* Frequent bowel movements
* Muscular weakness and lighter menstrual flow
* Eyes bulge with Graves’ disease
Why it’s hard to diagnose: “The symptoms are non-specific and come on gradually,” says Joseph Rand, M.D., a board-certified endocrinologist. “The condition is typically genetic and there are no other identifying risk factors.”
Undiagnosed and untreated thyroid disorders can lead to elevated cholesterol levels, heart disease, high blood pressure and depression. A blood test determines diagnosis, and hormone replacements can be taken in the case of hypothyroidism, Rand says.
With hyperthyroidism, doctors typically prescribe drugs to block the overproduction of thyroid hormone, radioactive iodine to destroy overactive thyroid tissue or surgery to remove the gland.
Should hysterectomy mean the ovaries come out too?
(Reuters Health) – Women who are having a hysterectomy should consider also getting their ovaries removed, suggests a new study.
The report showed that women who had their ovaries taken out had lower rates of ovarian cancer and were not more likely to get heart disease or a hip fracture – which had been a worry in this group because of the quick drop in hormones that happens once the ovaries are gone.
That doesn’t mean that all women who are getting a hysterectomy before menopause should also have their ovaries out.
“I’ve always said to my own patients, this is a woman’s individual decision,” Dr. William Parker, a gynecologist affiliated with the University of California, Los Angeles, told Reuters Health.
“Ovarian cancer is a terrible disease, but an extremely rare disease,” said Parker, who was not involved in the current study. “I think it’s important (to consider the options), and I don’t think there’s a pat answer.”
Led by Dr. Vanessa Jacoby from the University of California, San Francisco, the researchers used data from the Women’s Health Initiative study to compare women who had their uterus and ovaries removed with those who just had their uterus taken out.
Hysterectomies are often performed in women who haven’t hit menopause but have heavy bleeding or are bothered by benign tumors growing in the uterus. More than half a million women have the surgery every year in the U.S.
The current study included more than 25,000 women age 50 to 79. Researchers followed the women for an average of 7 to 8 years to determine how many were diagnosed with ovarian cancer, heart disease, or a hip fracture.
Ovarian cancer was very rare in both groups of women — 1 in 300 women who only had a hysterectomy were diagnosed with the disease, compared to 1 in 5,000 women who had their ovaries removed with the hysterectomy.
The authors calculated that 323 women would have needed to have their ovaries removed to prevent each case of ovarian cancer.
Both groups of women were diagnosed with heart disease and hip fractures at similar rates, and about the same amount of women in both groups died during the study – 8 of every 1,000 women each year.
Those findings differ from a previous study, co-authored by Parker, which found that women who had their ovaries removed were more likely to be diagnosed with heart disease and die than women who didn’t.
Two reasons for the difference, researchers say, may be that Parker’s study followed women for a longer period of time and included women who were younger, on average, than the women in the current study.
That makes the studies difficult to compare, said Lauren Arnold of Washington University in St. Louis, who wrote an editorial accompanying the new research in Archives of Internal Medicine.
“It just underscores that there’s a lot that goes into the decision about whether to remove the ovaries,” Arnold told Reuters Health. “Sometimes the decision is fairly clear cut,” such as for women who have a gene that puts them at a high risk for ovarian cancer.
In that case, most doctors recommend women have their ovaries out because the survival rate for ovarian cancer is so low – most women aren’t diagnosed until the cancer is advanced, and then fewer than one in three will survive another 5 years, the researchers report.
“But if you don’t have an ovarian cancer risk, you have a lot of different factors to weigh,” Arnold said.
Parker said that women should also consider if they or anyone in their family has a history of heart disease – which his study suggested would mean that leaving in the ovaries is a good idea.
Jacoby said the question of whether or not to remove the ovaries can be based on a woman’s personal feelings about ovarian cancer, heart risks, and her own body.
“The main message that I hope women get is this is a very personal decision and they should really talk to their doctor about the risks and benefits of removing their ovaries,” Jacoby told Reuters Health. “There’s no right answer.”