We must keep working towards Birth Equity

Serena Williams had just given birth to her daughter Olympia when she started having trouble breathing. She was coughing so hard that she ripped open the stitches from her C-section. Her medical team did not believe her at first when she kept insisting that that she had a pulmonary embolism, which is a blood clot in one of the major blood vessels of the lungs. Serena knew what pulmonary embolisms feel like, because she had experienced them before, and they are deadly if not treated early. But Serena had to advocate for herself repeatedly, before she finally convinced her caregivers to test her and find the embolism that she knew was there¹.

If a celebrity like Serena Williams has a hard time getting an obstetrics team to take her concerns seriously, perhaps it is not surprising that the United States fares poorly in statistics of maternal mortality from pregnancy complications. Among developed nations, the US has one of the highest rates of maternal mortality and infant mortality^2-4. This is true even after correcting for differences between countries in how they track maternal mortality⁴. It is true despite the US having the world’s highest per capita spending on health care². And the most damning statistic of all is that maternal mortality in the US is three times higher among black women than among white women (based on 2020 CDC data)³.

The goal of “Birth Equity” means to strive for optimal birth conditions for all expectant mothers, regardless of their race or any other variations in their background. The existence of racial disparities in maternal outcomes from pregnancy is not a matter of political interpretation, these disparities are facts that can be demonstrated with hard data and statistics. Moreover, statistics published in the peer-reviewed medical literature shows that the disadvantage of being black overwhelms other advantages such as education and socioeconomic status⁵.

Among human beings there is no biologic basis for racial definitions^6,7. Any two humans have 99.9% of their DNA in common, regardless of their race⁷. But a patient’s race can be correlated with other factors that impact their health, such as living conditions and access to quality healthcare. It is said that, while race is not biology, racism has biological effects⁵.

Birth Equity Index from Wallace et al. 2017
CLICK IMAGE to view full size

Joia Crear-Perry, MD FACOG, is the founder of the National Birth Equity Collaborative (NBEC)¹¹. The NBEC is dedicated to researching the causes of racial disparities in pregnancy outcomes. The NBEC has also launched a campaign to reduce black infant mortality in those metropolitan areas with the highest disparities. They project that, by targeting 20 cities over 10 years, it is possible to save the lives of 3,000+ babies.

Dr. Crear-Perry and a team of researchers have developed a Birth Equity Index which incorporates social determinants found to correlate with better health¹². These include factors such as: prevalence of smoking and obesity, access to healthy food, community rates of homicide and incarceration, level of air pollution, residential segregation, rates of unemployment, degree of education, poverty incidence, type of health insurance, and more. Using statistical methods to combine these into a Birth Equity Index, they were able to quantify the level of risk or promise in different metropolitan areas throughout the US.

On his first day in office, US President Trump issued an executive order to terminate all federal support for “equity action plans”⁸. For now, a court order by a federal judge has preserved public access to health-related webpages and datasets^9,10. However, if the federal government is not going to fund or promote projects in health equity, it becomes more important than ever for private organizations to support this work.

Although Birth Equity is a broad public health issue, it would benefit cord blood banks to incorporate this topic in their health awareness campaigns. Both public and private cord blood banks already communicate the benefits of cord blood transplants to families that are at risk of Sickle Cell Disease, a condition which is most prevalent among people from Africa¹³. Because parents that might be concerned about Birth Equity cross socioeconomic classes, they include the demographic of parents that are considering family cord blood banking. Family banks in the US are constantly trying to improve their outreach, for example by structuring their price plans to be more affordable and by appealing to a younger demographic of parents¹⁴. When companies that provide healthcare services demonstrate awareness and concern about social issues, it is a classic example of “doing well by doing good”, where brands that have a reputation for social responsibility are also more profitable¹⁵.

The NBEC has a list of recommendations to improve Birth Equity by breaking barriers to holistic care^11,12. Everyone who works with expectant parents can be part of the process of improving Birth Equity for all families.

References

1. Williams S. How Serena Williams Saved Her Own Life. Elle. Published 2022-04
2. Gunja MZ, Gumas ED, Williams II RD. U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes. Commonwealth Fund. Published 2023-01-31
3. Taylor J, Bernstein A, Waldrop T, Smith-Ramakrishnan V. The Worsening U.S. Maternal Health Crisis in Three Graphs. The Century Foundation. Published 2022-03-02
4. Stone L. The U.S. Maternal Mortality Crisis Is a Statistical Illusion. Foreign Policy. Published 2024-01-31
5. Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. The Lancet, 389(10077):1453 - 1463.
6. Next Generation Science Standards (NGSS). Why Humans Do Not Have Biological Races. LabXchange. Updated 2024-07-10
7. Collins FS, Morgan M, Patrinos A. The Human Genome Project: Lessons from Large-Scale Biology. Science. 2003; 300(5617):286-290.
8. Presidential Actions. Ending Radical And Wasteful Government DEI Programs And Preferencing. Executive Order. Signed 2025-01-20
9. Associated Press. Judge tells agencies to restore webpages and data removed after Trump’s executive order. APnews. Published 2025-02-11
10. U.S. Centers for Disease Control and Prevention (CDC). Working Together to Reduce Black Maternal Mortality. Women's Health. Published 2024-04-08
11. Crear-Perry J. National Birth Equity Collaborative. New York State Task Force on Maternal Mortality and Disparate Racial Outcomes. slide show Published 2018-06
12. Wallace ME, Carmen Green C, Richardson L, Theall K, Crear-Perry J. “Look at the Whole Me”: A Mixed-Methods Examination of Black Infant Mortality in the US through Women’s Lived Experiences and Community Context. Intnl. J. Env. Res. Public Health. 2017; 14(7):727
13. Verter F. Role of Cord Blood Transplants to Treat Sickle Cell Anemia & Thalassemia in the Age of Gene Therapy. Parent's Guide to Cord Blood Foundation Newsletter Published 2023-08
14. Verter F, Silva Couto P. Cord Blood Banking Affordability in the USA. Parent's Guide to Cord Blood Foundation Newsletter Published 2021-10
15. Mischke J, Woetzel J, Birshan M. The Necessity of Doing Well by Doing Good. Milken Institute Review. Published 2021-04-12