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Black women and COVID-19 — highlighting how the pandemic affects pregnant black women

Black women and COVID-19 — highlighting how the pandemic affects pregnant black women

Black Americans are disproportionately affected by the COVID-19 pandemic. Black Americans represent only 13 percent of the U.S population, yet they are the most affected with almost one-third of infections nationwide, and the equivalent in death. Historical and systemic inequalities largely contribute to the health disparities experienced by black Americans.

Already, in non-pandemic times racial disparities were evident in pregnancy outcomes. Black mothers are three to four times more likely to succumb to pregnancy-related deaths than white mothers and more than twice as likely to experience severe maternal morbidity, according to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). They are also more likely to experience preterm birth.

For black women, the pandemic could still have an adverse impact on their prenatal care. Women, and increasingly black women are more susceptible to anxiety and depression during their prenatal period. This could be worsened by the burden of the pandemic, as their risk for depression and anxiety heightens following adversity. Which then impacts their mental health, with increases in symptoms of anxiety and depression that could overall affect their birth outcomes. The long-term effects of the pandemic-related stressors could potentially cause adverse effects on the intrauterine environment which directly influences fetal development.

Many new moms have to confront the struggle and mental health challenges posed by the COVID-19. With feelings of isolation, loneliness, lack of physical connection and long periods at home caused by social distancing. Anxieties posed by these challenges affect the health environment for women in the postpartum period. Black women are at a greater risk for postpartum depressive symptoms and more likely to receive substandard depression care.

The same health care system has contributed to black women being at a higher risk for factors that lead to pregnancy complications, including obesity, diabetes, hypertension and heart disease that increase the risk of mortality from the Coronavirus. Especially since some women have to have their blood pressure monitored and temperatures taken during prenatal appointments, which was minimal at the onset of the pandemic. 

A reality that black women constantly have to confront is not being believed by health care providers. This prejudice, stereotyping, and implicit bias can lead to lower-quality care. With doctors spending less time with black patients, underestimating their pain and dismissing their health concerns. Anytime implicit bias exists, it always negatively affects the care that black women receive.

Among black women, decisions about whether to seek medical attention or continue to work in unsafe environments are proving costly. Many are facing substantial barriers in seeking care. The likelihood of black women working outside the home as essential workers is higher than white workers. Since black women are already working in professions in which they are essential yet undervalued — in custodial and clerical work at hospitals, as cashiers/clerks in grocery stores, or in high-risk jobs like caretaking in assisted living facilities, the choice between potential death and lack of livelihood is one too many black women are making and will continue to make as the pandemic continues. 

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The living environments of black women also affect their health. Black women are more likely to live in high-density areas where social distancing is not practical. Increasing their risk of contracting the Coronavirus or experiencing adverse effects as a result of fear. The burden of care on the black woman also increases her health risks. Multiple responsibilities including, as single parents, now faced with the challenges of virtual schooling during a pandemic, caregiving to parents, or financial responsibilities directly and indirectly contribute to their health outcomes. 

Black women have also faced the challenge of having to go through pregnancy and/or labor alone, during the COVID-19 restrictions. Social support during delivery has been found to improve the birthing process and physical health outcomes of black women. However, new guidelines by WHO recommends that pregnant women have a companion of choice present during delivery, regardless of suspected or confirmed COVID-19 infection. Whereas mothers could have upto three people in the delivery room before the pandemic, most facilities are only allowing for a single support person. The effect of this reduced support for black women who are already at a greater risk for adverse birth outcomes is high. Weighing the expertise of one potential support person against the sentimental relationship of another can be particularly stressful.

Most of the challenges faced by black women during the pandemic are not new. Systemic racial disparities have to be addressed holistically to lessen the burden of health disparities on black women and their newborns. The more simplistic and practical solution is for healthcare providers to listen to and believe black women when they voice their medical concerns. A life depends on it.

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