By Dr. G.S. Potter | oped

When Black women get pregnant, they take extraordinary measures to protect themselves and their unborn children. They change their diets to eliminate toxins like alcohol and caffeine. Some even stop eating fish and soft cheeses. They change their exercise patterns to ensure that they can stay healthy while preventing injury as they adjust to loosening ligaments and shifts in balance.  And they work with their doctors to adjust or eliminate prescription medication that might be harmful to the child they are carrying.  Black women go above and beyond to protect their children – and, of course they do, because this is the gold standard for any woman who gets pregnant. This is the type of preparation and care that medical professionals, in fact, recommend.

Yet, despite all of their best efforts there is a threat always looming. They just cannot protect themselves from their zip codes and the environmental hazard those locations present.

The  Commonwealth Fund reports that nationwide Black women are 2.5 times as likely to experience pregnancy-related deaths than White women. As devastating as that statistic is, the number of Black women dying from pregnancy related complications grows even higher in certain cities.  According to the Philadelphia Maternal Mortality Review Committee, for example, “Black women are 4 times more likely to die from pregnancy related causes than White women” in the City of Brotherly Love and Sisterly Affection. They account for 74 percent of all pregnancy-related deaths.

While efforts are underway to identify the exact causes of this lethal inequity, there is one factor that is consistently overlooked: the environment.

While the medical field tends to focus on what Black women are putting into their bodies, there is little focus on the havoc that the environments Black women live in are wreaking on their bodies.  The negative effects of pollution and climate crisis are disproportionately experienced by Black bodies. This is no mistake.  Black people live in Black communities where their needs are neglected.  Black people also live in communities where environmental hazards are generally packed or confined to those spaces so that the effects are not felt by neighboring White communities. For example, numerous studies have found links between higher pollution exposure and rising autism rates in either low-income, distressed or historically disadvantaged Black, Latino and Indigenous communities.

There Really is Something in the Air

Air pollution caused by smog, motor vehicle emissions, power stations, ground-level ozone, industrial emissions, wood burning, wild fires, and fuel-burning effects the air quality for all residents in places like Philadelphia.  Poor black communities, however, are more frequently inundated with pollutants than White communities.  Oil refineries, power stations, congested intersections, and industrial areas are not surrounded by wealthy White Philadelphians living in well ventilated homes.  They are placed in poor Black communities so that White Philadelphia can avoid the worse pollution impacts as those are passed on to their less privileged counterparts.

It is in these polluted air-scapes that Black women are having their children.

According to the Center for American Progress:

“… [A]ir pollution can have deleterious effects on maternal health, leading to preterm birth, low birth weight, and stillbirth due to changes in the maternal cardiopulmonary system, systemic inflammation, and placental injury.¹¹ A study examining the association between air pollution and poor maternal health outcomes found that in the 10 years after a California coal power plant closed, there was a 27 percent reduction in the rate of preterm births in the surrounding region.¹² The effects of air pollution on maternal health are more pronounced for women of color, including Black mothers.¹³ Indeed, communities of color and low-income communities are more likely to live near polluting power plants and other hazardous facilities and experience cumulative negative health effects due to this exposure.^”

One in five Philadelphians suffer from asthma. Air pollution is far more dangerous for those with asthma than those without …. and pregnant women living with asthma are among the most effected.  As the New York Times reports:

“One study found that severe preterm birth, defined as a birth that occurs fewer than 28 weeks into pregnancy, increased by 52 percent for asthmatic mothers exposed to high levels of air pollution.

Most of the studies that examined the link between air pollution and preterm birth or low birth weight found that the risks were greater for black mothers.”

Research also shows that preterm births and low birth weight are associated with maternal mortality.  Air pollution is a threat that is killing Black women and children alike. But that is not the only lethal threat they face.

The Impact of “Heat Deserts”

Just as Black communities are located in areas with businesses and activities that cause air pollution, they are also locked heat deserts during times where record temperatures are being broken and reset regularly.

The BBC reports:

“In all but six of the 175 largest urbanised areas in the continental US, people of colour endure much greater heat impacts in summer.

For black people this was particularly stark. The researchers say they are exposed to an extra 3.12C of heating, on average, in urban neighbourhoods, compared to an extra 1.47C for white people.”

Philadelphia is a prime example.  As the City itself reports …

“Some parts of Philadelphia can be as many as 22°F hotter than other neighborhoods. When looking at the index, the blocks in red are the hottest places in the city. These blocks are located in the central regions of North, West, and South Philadelphia. Tall buildings, roads and pavement, and black rooftops on homes trap in heat, and a lack of trees and vegetation prevent the area from cooling down. This is called the ‘urban heat island effect.’”

Extreme heat can lead to heat stroke and other heat-related illnesses.  It can also lead to dehydration which, according to Climate Health Connect, “releases labor-inducing hormones.”  Extreme heat events can thus lead to preterm birth, low birth weight and infant mortality.  They can also lead to maternal mortality. And once again, the Black women forced to reside in neighborhoods where “urban heat islands” proliferate are at greater risk than their more privileged white counterparts.

Trash Impacts Pregnancies

Black women are also disproportionately forced to carry their children in areas where trash and solid waste are piling up on the streets. The failure of cities to provide adequate sewage and waste management is also costing the lives of the Black mothers that reside there. This is particularly prevalent for Philadelphia during pandemic, a time when the region finds itself struggling with waste management woes and piling trash. Trash is even piling up in the yards of Philadelphia schools where Black children learn.

Ecube Labs explains …

“Overflowing waste bins are an ideal breeding ground for bacteria, insects and vermin. The flies that visit the garbage are also the same flies that roam around your lunch buffet and drop their offsprings on your plate. By doing so, they increase the risk of you contracting with salmonella, which causes typhoid fever, food poisoning, enteric fever, gastroenteritis, and other major illnesses. Besides flies, other animals that thrive from the garbage in and around the containers include rats, foxes and stray dogs.”

Waste can also lead to respiratory problems, skin and blood infections, and intestinal issues. Overflows of trash also contribute to air pollution and water contamination.  Philadelphia is infamous for refusing to implement proper sewage and waste disposal programs.  And low income Black communities in the areas of Southwest Philadelphia, North Philadelphia, South Philadelphia and West Philadelphia are the hardest hit.

Interestingly enough, more affluent and middle class white communities are not suffering from trash overflows.  The pregnant women who reside in these communities are not facing the threats caused by hazardous waste piles. Instead, it is Black women that are absorbing these attacks on their health and their unborn (and already born) children.

How Do We Fix This?

If we want to lower the rates of maternal (and infant) mortality in the Black community, we have to do the work of cleaning up the environments that they are carrying their children in. We also have to provide extra protection while they are still in those places.

And, first and foremost, low-income Black women need better access to medical care.

In 2019, the Black Maternal Mortality Caucus was established in Congress. In 2020, this caucus produced the Black Maternal Health Momnibus Act, which was just reintroduced by the Caucus and is currently being reviewed by the House of Representatives.  This act seeks to expand medical care for low income Black women.  This is crucial. As the Philadelphia Maternal Mortality Committee notes, “… [c]urrently, women with Medicaid lose their insurance 60 days after delivery. Of all pregnancy associated deaths, 75% of women had Medicaid and 6% had no insurance at the time of their pregnancy.”

Lack of proximity to doctors and lack of access to transportation also prevent pregnant Black women from being able to access the care they need to increase their chances of survival. That’s a geographical problem that can only be explained by years of systemic racism. By expanding access to health insurance, more Black women can increase the chance that they will receive the care they need to have healthy pregnancies and deliveries.

Once Black women access medical care, though, they need to be assessed for exposure to environmental hazards and assisted accordingly. Doctors should be instructed to identify whether or not patients are living in areas with waste hazards, heat islands, and air pollution. There is currently a movement of medical students, residents and professionals who are demanding training for exactly that. They should then work closely with patients to monitor their health in relation to these hazards and provide information that will increase their chances of a healthy delivery.

Organizations at the state, local, and federal level have been formed to collect data and make recommendations in efforts to confront the maternal mortality crisis.  A number of Maternal Mortality Review Committees have been formed to accomplish these goals: to date, we see these in 49 states, plus the District of Columbia, New York City, Philadelphia and Puerto Rico. These committees should be instructed to collect data regarding exposure to environmental hazards and maternal health. They should also be charged with making environmentally focused recommendations to policymakers.

It is now essential that air pollution, heat islands and waste disposal impacts are confronted and mitigated head on. Cities like Philadelphia need to treat their poor Black communities with the same respect and response they treat their wealthy White communities.  They need to pick up their trash and keep their streets clean.  Heat deserts must be cooled off by planting trees in and around heat zones, installing green roofs and cooling roofs, and passing legislation that ensures that landlords are responsible for managing maximum temperatures just as they are responsible for managing minimum temperatures. Aggressive efforts must be taken to reduce ground level ozone, industrial air pollution and pollution caused by power plants. Shifting to solar and increasing the efficiency of public transportation would facilitate this reduction.

And cities like Philadelphia must be held accountable for inequitably distributing the hazards of environmental degradation to low income Black communities.  Zoning laws and processes should be examined and altered to prevent poor Black communities from being dumping grounds. Patterns of environmental hazard distribution should be examined for potential Fourteenth Amendment discrimination lawsuits.  Legislation should be passed to lower the emission production allowed by the city’s largest pollution producers.

Every last one of these measures would not only help clean up the cities that implement them, but they would quite literally save the lives of Black women and their unborn babies. Black women are dying from pregnancy related complications at unacceptably high rates.  If we want to save their lives, we need to not only take care of them, but we need to surround them with the healthiest environments possible.