Mothers are monitored less, their concerns are often dismissed, and they tend to be sent home without adequate information about potentially concerning symptoms. The suggested that community and kin networks may be more protective for health than income and education. According to the World Health Organization, their odds of surviving childbirth are comparable to those of women in countries such as Mexico and Uzbekistan, where ificant proportions of the population live in poverty.
But for people who face chronic threats and hardships—like struggling to make ends meet on a minimum wage job or witnessing racialized police brutality—the fight-or-flight response may never abate. When that turned up nothing, she was finally sent for the lung CT. It found several blood clots. When Williams was finally released from the hospital, she was confined to her bed for six weeks. In the s, even researchers who broached the topic of racial differences in health outcomes—and few did—focused on small pieces of the puzzle.
For members of the public, the experiences of prominent black women may prove to be a teachable moment. The tide began to turn in the early s, when former Health and Human Services Secretary Margaret Heckler convened the first group of experts to conduct a comprehensive study of the health status of minority populations.
She had a clotting disorder and a history of high blood pressure, but she also had access to top-quality care and a strong support system of family and friends.
Barfield, who is African American, had grown up largely protected from the harsh realities of U. Veterinary medicine seemed like an obvious career path, but as an undergraduate at the University of California—Irvine, she learned about another vulnerable population in need of her big heart. She could never turn away a creature in distress, she says, and often had a stray dog or cat at home under her care. While most such studies put mothers into broad of teen and not-teen, Geronimus looked at the risks they faced at every age. We just wanted to teach them about contraception.
For African American mothers, the risks jump at each stage of the labor, delivery, and postpartum process. Researchers focused on this issue while ignoring broader systemic factors. And she noticed that they seemed older, somehow, than girls the same age whom Geronimus knew.
Allostatic load causes cells to divide faster to keep repairing themselves.
The were surprising even to her. But hours after her last medical appointment, Irving took a newly prescribed blood pressure medication, collapsed, and died soon after at the hospital when her family removed her from life support.
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Byrates had more than doubled. Public Health Service and director of the Division of Reproductive Health at the CDC, was the kind of kid who would tend to an injured squirrel that fell out of a palm tree. Some were looking at genetics, others at behavioral and cultural differences or health care access. According to the U. Agency for Healthcare Research and Quality, pre-eclampsia—one of the leading causes of maternal death—and eclampsia seizures that develop after pre-eclampsia are 60 percent more common in African American women than in white women, and also more severe.
She recently led a study of telomere length in Detroit among low-income individuals of multiple races and ethnicities. She could still devastate opponents with the power of a serve once clocked at But in Septemberon the day after delivering her baby, Olympia, by emergency C-section, Williams lost her breath and recognized the warning s of a serious condition.
In the early s, research on telomeres—protective caps on chromosomes—provided further evidence that weathering is not merely a metaphor but a biological reality. Her mother told ProPublica that at these appointments, clinicians repeatedly assured Irving that the symptoms were normal. At 36, Williams was as powerful as ever. She walked out of her hospital room and approached a nurse, Williams later told Vogue magazine. The emerging science gives the concept of weathering a kind of substance or credibility, which has allowed more people to be open to it.
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Over time, her ideas would become harder to dismiss. White women in their 20s were more likely to give birth to a healthy baby than those in their teens. An epidemiologist at the U. Irving knew her pregnancy was risky. But after she returned home, things quickly went downhill.
S erena Williams knew her body well enough to listen when it told her something was wrong. African American women are three to four times more likely to die during or after delivery than are white women. And the implications were staggering. Once a baby is born, he or she becomes the focus of medical attention.
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As a result, health risks rise at increasingly younger ages for chronic conditions like hypertension and type 2 diabetes. Geronimus has incorporated the study of allostatic load and telomere length into her own work. Williams, the Florence Sprague Norman and Laura Smart Norman Professor of Public Health at the Harvard Chan School, an internationally recognized expert in the ways that racism and other social influences affect health. But now, I can describe this even more specifically, in terms of physiological mechanisms.
And, just as Williams had suggested, heparin did the trick. She visited them in their crumbling apartments and accompanied them to medical appointments where doctors treated the girls like props, without agency in their own care. The CDC now estimates that to new and expectant mothers die in the U. More than half of these deaths and near deaths are from preventable causes, and a disproportionate of the women suffering are black.
When she headed off to Princeton as an undergraduate, she resolved to find a way to fight against injustice. Indeed, in this study population, poor white individuals actually experienced more weathering than poor minority populations, and Hispanics with more education experienced more weathering than those with less education.
His Everyday Discrimination Scale is one of the most widely used measures of discrimination in health studies. Her initial plan to become a civil rights lawyer gave way when she discovered the power and potential of public health research. Put simply, for black women far more than for white women, giving birth can amount to a death sentence. According to the conventional wisdom at the time, Geronimus says, teen pregnancy was the primary driver of maternal and infant deaths and a host of multigenerational health and social problems among low-income African Americans.
Geronimus sought to connect the dots between the health problems the girls experienced, like asthma and type 2 diabetes, and negative forces in their lives. Black babies were twice as likely to die within their first year as white babies, Barfield read in the Heckler Report. She just needed to wait it out.
Severe coughing had opened her C-section incision, and a subsequent surgery revealed a hemorrhage at that site.
Then, inresearchers identified a physiological mechanism that could finally explain weathering: allostatic load. One of those speakers was a fellow Harvard Chan alumna and a public health professional who was in a position to make a difference.
Depression and sleep deprivation become more common. She was doing so well after the C-section birth of her baby, Soleil, that her doctors consented to her request to leave the hospital after just two nights three or four is typical.
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But among black women, the opposite was true: The older the mother, the greater the risk of maternal and newborn health complications and death. That insight was life-changing. Williams insisted that something was wrong, and a test was ordered—an ultrasound on her legs to address swelling.
Each time cells divide, telomeres get a little shorter. If young black women were already showing s of weathering, how would that play out over the rest of their lives—and what could be done to stop it? She felt a chasm open up between what some of her white male professors were confidently explicating about the lives of these adolescents and how the young women themselves saw their lives.
People are also more likely to engage in risky coping behaviors, such as overeating, drinking, and smoking. For the next three weeks, Irving made visit after visit to her primary care providers, first for a painful hematoma blood trapped under layers of healing skin at her incision, then for spiking blood pressure, headaches and blurred vision, swelling legs, and rapid weight gain.
There is a very fine line between clinical intuition and unconscious bias. The result is earlier deterioration of organs and tissues—essentially, premature aging. Geronimus worked as a research assistant for a professor studying teen pregnancy among poor urban residents, and, as a volunteer at a Planned Parenthood clinic, witnessed close-up the lives of pregnant black teens living in poverty in Trenton, New Jersey.
Gasping out her words, she said that she feared another blood clot and needed a CT scan and an IV of heparin, a blood thinner.
She hopes to dig further into this line of inquiry, to find out which social stressors matter the most for health, how they can be disrupted, and how the scientific findings can be turned into policy. In public health, the condition of a baby is considered a reliable proxy for the health of the mother. Molecules called pro-inflammatory cytokines are produced to help heal any wounds that result.
Viewed up close, the deaths of mothers like Irving are devastating, private tragedies.