Out of all other high-income countries, the United States, by far, has the most technologically advanced healthcare system in the world. Our health is also expensive, Americans pay $13,432 per person compared to the average of $7,393 in other similarly wealthy countries. Despite the expenses of healthcare and the technology available for treatment, the US has one of the highest maternal mortality rates of any high income country. Most pressing of all, African American mothers face the worst outcomes, with more than 50 Black moms dying per 100,000 births. White women, on the other hand, face the much lower rate of 14.5 deaths per 100,000 births.
Why is this the case? What has caused the wide disparity in maternal deaths between Black women and women of other races in America?
Our very own Dr. Demetra McILwain has some experience with these issues, both as a physician, and a Black mother. She has become acquainted with many of her Black female patients, who often experience great discrimination and stress in their personal lives. Dr. McILwain believes that a lot of this emotional and physical stress contributes to adverse health conditions by directly increasing cortisol. Cortisol is known to cause weight gain, increased blood sugars, higher blood pressures and can weaken one’s immune system, leaving them susceptible to many types of illnesses. This often leads to complications for expecting mothers.
Why would Black mothers experience so much stress? The answer lies in the history of neighborhood segregation, racism, and dis-investment in Black communities. We can use Buffalo as a good example of this impact.
Buffalo had long been home to a vibrant Black community since the days before the Civil War, when slavery was still the law of the land in America. Into the twentieth century, more African Americans began moving into Buffalo from the South to escape persecution as part of the Great Migration. They were searching for an opportunity to live safe and prosperous lives by finding work in Buffalo’s emerging industries. However, this group was often met with hostility from the city’s establishment. Large factories and plants avoided employing Black men, and if they did, they would often be sent to work the most dangerous and grueling types of work for low pay. Black families were also refused homes in predominantly White middle class communities; completely locked out of a significant source of American wealth. Through redlining, dis-investment, environmental hazards, and over-policing, the communities that Black people could live in were not compatible with long, prosperous lives.
Even today, we see that the conditions in which many African Americans live are not conducive to long-lasting health, let alone to producing many Black medical providers. Despite this, many Black physicians defy the odds and become valuable assets to their communities. There is still, however, a major shortage in Black medical providers, especially those who deliver babies.
Some patients lament negative interactions with their physicians, including moments of racial insensitivity and a lack of sympathy for their concerns. Dr. McILwain experienced this first hand when she was having her first child. While being prepared for an urgent surgery, she felt her questions and concerns were not being addressed appropriately. Instead, she was being told what they were doing rather than making sure she understood why they were doing it and exactly what was happening inside her own body. This is just one reason why Dr. McILwain stresses the importance of having more Black Family Medicine Physicians who practice obstetrics and gynecology.
“There is something to say about the feeling of walking into a room and seeing someone that looks like you. Your ability to relate to others through shared experiences makes a big difference,” Dr. McILwain stated.
“Black women are taught to be strong and brave, to withstand adversity, to keep pushing on despite the circumstances.” Dr. McILwain believes it is the result of this persona of the black woman that gives the illusion of a hardened exterior which unjustly allows others to treat them as such. “As if black women do not feel emotions and pain the same way that other women do.”
Jericho Road is dedicated to promoting improved health outcomes for Black mothers by caring for our patients comprehensively. Currently, Dr. McILwain is working at Jericho Road to create a pilot program that could help account for the social determinants of Black mothers’ health and ensure better care. With her help, we can work to improve the state of maternal health so that all have access to safe, high-quality maternal healthcare.
-Simeon Swaby, 2025 High Roads Fellow at Jericho Road Community Health Center
