The health of a community can be measured by the health of its mothers. This spring, City Bureau spent 10 weeks trying to better understand Black maternal health and to discover which communities in Chicago are most impacted by maternal mortality. Nationwide, Black women are three to four times more likely to die in a pregnancy-related death than white women, according to the Centers for Disease Control and Prevention.
We know the state-level statistics on maternal mortality in Illinois. Here, Black women are six times more likely to die of a pregnancy-related condition than white women no matter their educational background, and Black women are three times more likely to die within a year of pregnancy as women of any other race or ethnicity despite making up just 17 percent of births statewide, according to the Illinois Maternal Morbidity and Mortality Report released last October.
It doesn't have to be this way. The report stated that 72 percent of the pregnancy-related deaths and a whopping 93 percent of violent pregnancy-associated deaths in Illinois are preventable. Racism, including systemic racism and health worker bias, is a driving reason behind health inequity and a barrier to achieving optimal health for all people in Illinois, according to the report.
The result: Our group of City Bureau reporters partnered with Austin Weekly News to publish a special issue devoted entirely to Black maternal health. While we intentionally chose an asset-based approach to our coverage, focusing on Black birth workers, resilient moms and other community-based solutions and resources, we could not ignore the stark numbers around maternal mortality in Chicago. We also heard from birth workers, those working closest with moms, who wanted Chicago-specific data on maternal mortality.
In Cook County, 52 women died during pregnancy or up to one year postpartum from December 2014 to May 2019, according to data from the Cook County Medical Examiner, which was shared with City Bureau by ProPublica Illinois. Most of these deaths took place on the South and West Sides of Chicago. City Bureau acknowledges that this is a small snapshot over a short period of time, considering how rare maternal mortality is. (Note: Due to data collection practices at the Medical Examiner's office, women who are Latinx or Hispanic are often classified as white.)
We heard over and over again from Black women that they are aware of the disparities and that knowing the numbers doesn't solve their problems alone—in fact the data is both disturbing and traumatizing. But we also cannot turn away from these facts. We are intentionally sharing these statistics in this special issue, balanced with stories of resilience, because we want readers to know that there are birth workers and community members who are fighting for their health.
Within the data set we received, here are some findings specific to the issues Black mothers face in Cook County that we hope will inspire action.
Black women make up most of the maternal deaths
The racial disparity in maternal deaths hits hard. In Cook County, 52 women have died since December 2014, and Black women made up 61 percent of these deaths despite Black residents composing only 24 percent of the population. In Chicago, 38 women have died. A shocking 74 percent of these deaths were Black women, though Black Chicagoans make up 31 percent of Chicago's population.
Medical complications play a large role in maternal death
The most common manner of maternal death in Cook County (22 out of 52) was "natural" or medical reasons (as opposed to homicide, suicide or accident). The most common causes of death were cardiomyopathy, eclampsia, and pulmonary thromboembolism. All three are cardiovascular issues; notably, Black people in America are more likely to be diagnosed with or die from cardiovascular disease than white Americans.
Majority of natural postpartum deaths happened before the six-week checkup
More than half of natural-cause maternal deaths (59 percent) occurred after the birth of the child. Three-quarters of these postpartum deaths were within 1 to 42 days after the birth of the child, or before the standard six-week checkup that hospitals recommend to moms. One woman was pregnant within a year of when she died, but the exact timing was unknown.
The South and West Sides are hit hardest
The highest concentration of maternal deaths in Chicago occurred on the South and West Sides in neighborhoods like South Shore, West Lawn and Roseland. Social determinants, like housing insecurity, unemployment or lack of grocery stores, affect a woman's ability to access and receive health care.
"We can't ignore the fact that Chicago is a highly segregated city," said Shannon Lightner, deputy director of the Office of Women's Health and Family Services for the state. Lightner remembers women leaving the hospital postpartum against medical advice to drop off rent so they wouldn't be kicked out of their apartments.
"Maternal death is not only what happened when a mom entered or left a hospital room; it's shifting thinking to what caused her to miss her doctor's appointments, or taking that medication she needed to stay well. It's looking at all the systemic issues that impact maternal health outcomes like a lack of affordable childcare or safe transportation," said Lightner.
About a third of moms die because of violence
A total of 37 percent of all deaths during this time period were classified by the Illinois Department of Public Health as "violent deaths," meaning they were caused by suicide (4 percent), homicide (21 percent) or drug overdose (12 percent) with drugs like fentanyl, heroin and benzodiazepine.
Gun violence is a part of the story, too
While homicides made up only 8 percent of violent deaths in Illinois, according to the Illinois Maternal Morbidity and Mortality report, homicides made up 58 percent of violent maternal deaths in the Cook County Medical Examiner data set. Eighty-two percent of homicide victims in this data set were Black women. Based on available news reports, the homicides were a mixture of intimate partner violence and street violence. Eight of the 11 cases remain unsolved by the Chicago Police Department, according to a police spokesperson.
Chicago's gun violence is a struggle for the Illinois Department of Public Health, Lightner said. With most homicides going unsolved, researchers can't find out how pregnancy fit into their deaths. Prenatal records might show if a woman mentioned she was fearful of her home life or community, but maybe not. Researchers are left with only media reports, Google and an autopsy report.
"All we can say is that community violence needs to be addressed," said Lightner. "We absolutely struggle with what to do without police records or investigations."
Black women disproportionately suffer complications of pregnancy, childbirth and violence in Chicago. Simply put, the health care system and the city need to put a priority on Black women's health and lives. Let's start with listening to and valuing Black moms in a Chicago where resources and respect are always there for moms before, during and after pregnancy.
This story was produced by City Bureau, a civic journalism lab based in Woodlawn. Learn more and get involved at www.citybureau.org.
Read all stories in our special Maternal Health Issue here.
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