Put simply, the facts are troubling: Black people in the United States are more likely to have serious illnesses such as cancer, heart disease, hypertension and diabetes.
The U.S. also has one of the highest maternal mortality rates in the developed world, with women of color especially at risk. Black women are three to four times more likely to die from pregnancy- or childbirth-related complications compared to white women.
Something needs to be done now.
It’s a task that Robyn R. Jones, M.D., FACOG, a board-certified OB/GYN and Senior Medical Director, Women’s Health, Office of the Chief Medical Officer, Johnson & Johnson, is passionate about tackling. Dr. Jones spoke about these racial disparities in health for Black women as a panelist at the Essence Festival 2020.
It’s a conversation that needs to continue in order for this global public health issue to be addressed. We sat down with Dr. Jones to learn more about the reasons for these disparities, how women of color can advocate for themselves—and what Johnson & Johnson is doing to help improve maternal health outcomes for Black mothers and their babies.
Q:
When we talk about racial disparities in maternal health, what does that mean? Why are Black women at such increased risk?
A:
There are two things at play here: health disparities, which are related to race, and social determinants of health.
In terms of health disparities, Black women may come to the pregnancy experience with underlying conditions, like hypertension, diabetes, obesity and asthma—all of which can put them at increased risk during pregnancy.
Black people also suffer from chronic stress just from being Black in America. We always must be aware of how we’re dressed, how we’re speaking and who we’re interacting with, which is stressful to deal with on a daily basis. Those types of stressors lead to what’s called “weathering,” or early health deterioration.
Social determinants of health have to do with how we live, learn, work, play and age. Black people in America may live in densely populated urban areas, there may be problems with the air or water quality, there may be more violence and the quality of the education in the Black community may be worse than what’s seen in other neighborhoods. All these things have the potential to impact how healthy we can be throughout our lifetime.
Then there’s the issue of adequate access to health services.
There may or may not be a healthcare institution near our homes. Around 50% of counties in the United States don’t have labor and delivery settings in their hospitals, particularly in the rural South, and this impacts many Black women.
We may not have transportation to get to appointments if the facility is too far from our homes, and we often work at jobs that don’t provide sick leave. Or we may not have continuous health insurance, which means we don’t see a doctor on a regular basis.
Also, things like the Tuskegee experiment carry down legacy-wise in the Black community, so there’s an overall distrust of the healthcare system.
Sometimes when a Black woman receives care, there’s an implicit bias in the healthcare professionals taking care of her. This means that they may make assumptions, such as ‘this patient doesn’t care about herself’ or that her pregnancy is unwanted.
Q:
In your role at Johnson & Johnson, what is your group doing to help improve maternal health outcomes for Black moms and babies?
A:
Our #1 goal is to champion inclusivity of women in terms of science and data collection, as well as deliver innovative products and treatments that are tailored to the needs of women.
In terms of helping to advance Black maternal health, we initiated the Equitable Maternal Health Coalition (EMHC)—in partnership with organizations like the March of Dimes, American College of Obstetricians and Gynecologists (ACOG) and Black Mamas Matter Alliance—which is focused on delivering safe, affordable and equitable access to healthcare for moms and their babies. The EMHC, for example, has supported provisions to continue Medicaid/CHIP insurance for 12 months postpartum to help reduce mortality rates.
We are also the only corporation to endorse the Black Maternal Health Momnibus Act of 2020, which is legislation that contains nine bills to comprehensively improve maternal health outcomes and end disparities. For example, the legislation will provide funding to community-based organizations working to improve maternal health outcomes for Black women and grow and diversify the perinatal workforce to provide every expectant woman with trustworthy care.
Globally, we’re working to reduce postpartum hemorrhaging in low- and middle-income countries by developing new ways to potentially deliver therapy for postpartum hemorrhage prevention. We’re also involved in projects in Tanzania, Haiti, Sierra Leone, Nigeria and other places that are designed to make pregnancy safer for Black women, including working to make sure that community health workers around the world get proper training.
Q:
Distrust in the healthcare system means Black people are less likely to participate in clinical research. What is Johnson & Johnson doing to help address this?
A:
Our company practices diversity and inclusion in clinical trials and we have what is almost like an internal mandate to include populations that are underrepresented in clinical research—Blacks, Asians, Hispanics, Indigenous people—in our studies.
This also means including more women in studies and including pregnant women in research when it’s safe to do so.
There is a lot of work behind the scenes and we’re approaching different community leaders to see how we can better educate under-served populations about clinical studies, and then be sure to include them in these trials.
Q:
What can expectant and new moms do to be advocates for their own health?
A:
This is something that’s really important. Sometimes when a Black woman receives care, there’s an implicit bias in the healthcare professionals taking care of her. This means that they may make assumptions, such as “this patient doesn’t care about herself” or that her pregnancy is unwanted.
Those types of biases—which can be based on race, disability, age, education, weight or speaking a different language—can impact the care the patient receives.
The key is really taking the opportunity to educate yourself about speaking up for yourself. You can find reference materials at your local library, and the internet also has a wealth of great health information through very targeted organizations like the Black Mamas Matter Alliance, Black Women’s Health Imperative, March of Dimes, WomensHealth.gov and the American Heart Association. Once you have that health literacy, then you can speak up from a space of knowledge, and you can be really thoughtful in your interactions with healthcare professionals. If you don’t have the knowledge yourself, it may be worthwhile to have a family member come to visits and advocate with you.
In general, it’s important to learn to not just be healthy, but to be well. That includes looking at your whole environment: your state of employment; relationships with other people; and physical, emotional and mental health.
We’d like to encourage a shift from sex-biased science and data to more sex-inclusive science and data to provide treatment and innovation that is specifically tailored for women.
Q:
What does Johnson & Johnson hope to achieve and advance when it comes to healthcare for women in the future?
A:
If you consider how women are studied today, people tend to think of women’s health as conditions that only affect women, which usually means the reproductive system and the breasts. We are now thinking more broadly about the health of women to include a holistic picture—everything from heart health to mental health and beyond.
We’d like to encourage a shift from sex-biased science and data to more sex-inclusive science and data to provide treatment and innovation that is specifically tailored for women. Part of that is providing data and evidence on what types of programs could be initiated in the healthcare system to hopefully lower the maternal mortality rate for all women.
That’s the future as our group sees it. Johnson & Johnson is well-positioned for this because of our legacy of supporting moms and babies. And we have a large global footprint, which means we can make maximum impact.
I think most people don’t have an awareness that the United States, a country that is very rich in resources, is the only developed country that has a worsening death rate for women related to pregnancy, and most of it is in the Black population.
There needs to be greater awareness and advocacy, and the health disparities must be addressed, so changes can be made.
