By Carla F. Ortique, MD
Chair, TMA Committee on Maternal and Perinatal Health
Recently, at TMA’s annual fall conference, I began my first term as chair of the Texas Medical Association’s Committee on Maternal and Perinatal Health. During our meeting, we created a list of priorities, including increasing access to women’s health care services in Texas, reducing maternal morbidity and mortality, increasing healthy births, and lowering rates of maternal obesity.
As a practicing OB-Gyn in Houston, I see these health challenges on a daily basis, and it is troubling. Even more troubling for me is the disproportionate impact these issues have on minority patients, especially African-American women.
A mass of data now show African-Americans suffer poorer health and worse disease outcomes than whites and other minorities in this country, and in Texas in particular. Although lower socioeconomic and education status certainly contribute to these disparities, controlling for these factors does not eliminate the problem. African-American women in Texas have a higher risk than the general population for hypertension, heart disease, obesity, premature births, infant and maternal deaths, and HIV/AIDS. In Texas, African-Americans make up 11 percent of the population but account for 35 percent of the people estimated to be living with HIV/AIDS. AIDS is the second-leading cause of death among African-American women aged 25-34 in Texas.
Among women, African-Americans have the highest rate of obesity. Obesity increases an individual’s risk for developing hypertension and diabetes during pregnancy as well as obstetric bleeding. The infant death rate among African-American infants in Texas is twice as high as that of Hispanic or white infants. Premature birth is the leading cause of infant death, and in Texas African-American women have 1.5 times more premature births than their white counterparts. Obstetric bleeding and hypertensive disorders are the leading causes of maternal death in the United States, and may explain the high rates of premature birth and maternal death for African-American women.
So, in light of these grim statistics how can we, as physicians, best serve our patients?
Education is key. I still recall a conversation about nine years ago with a respected colleague who admitted that, in spite of having a large percentage of African-American patients, he was not aware that they were at increased risk for early labor based on ethnicity alone. Likewise, studies have shown that more than 50 percent of African-American women in this country are unaware of their increased risk of early delivery and racial differences in infant survival rates. The mistaken belief that these statistics are primarily related to low socioeconomic status or lack of college education creates a false sense of security and lack of concern by some patients and physicians.
The 2002 Institute of Medicine Report, “Unequal treatment: Confronting Racial and Ethnic Disparities in Healthcare” clearly documents that African-Americans and other minority patients often receive care that is culturally incompetent and below standard. Heightened awareness and education for physicians and patients are critical elements for eliminating disparities. Increased awareness of risk often leads to increased surveillance, earlier diagnosis, and preventive measures.