Pharmacists Are in Key Positions to Tackle Black Maternal Mortality Disparities

Within the United States, there is an imperative need for diversity in the health care workforce. Black Americans make up only 5% of the more than 800,000 practicing physicians in the United States,¹ and only 7.3% of the more than 315,000 active pharmacists are Black.

The racial disparity seen in Black providers is reflected not only in the pharmacist workforce, but also in health outcomes. Black mothers in the US die at a rate nearly 3 times that of White mothers.² Taken together, these are alarming indicators that our provider workforce is not prepared to care for a diverse patient population.

The need for diversity among providers is further reflected in the benefits of patient–provider racial andgender concordance. Black female patients who are cared for by Black female doctors report having increased trust and greater communication.³ Such advantages strengthen the importance of having a diverse pharmacist workforce, especially for Black women. Seeing the outcomes of patient–provider racial and gender concordance suggests that improving diversity within our provider population should be a priority for improving the health of Black women. Without increasing the number of diversepharmacists, the benefits of such interactions cannot occur. In turn, the Black female patient population cannot be adequately served, and health disparities will continue to persist.

One alarming disparity currently affecting Black women involves pregnancy complications. Pharmacists once again are in key positions to help tackle this disparity.

In the health care context, the term “disparity” refers to “the unequal treatment of patients on the basis of race or ethnicity; gender and or other personal patient characteristics.”⁴ Black women consistently lead the nation with the highest maternal mortality rate. Studies show that Black women have a case-fatality rate 2.4 to 3.3 times higher than that of White women for 5 specific pregnancy complications: preeclampsia, eclampsia, abruptio placentae, placenta previa, and postpartum hemorrhage.⁵ Other factors also have a significant impact on pregnancy risk factors, including advanced maternal age, degree of education, poor socioeconomic status, and lack of prenatal care.⁶

As pharmacists, it is crucial to educate patients on their current health status. Pharmacists can ask questions to understand patients’ concerns or educate patient on managing chronic conditions, as well as urgent maternal warning signs that need immediate medical attention. Eliminating implicit bias that may impact patients’ care is also important for any health care provider. And of course, health care providers should always seek to provide quality care. Pharmacists in the retail and clinical setting have consistent contact with their pregnant patients and can thoroughly evaluate their treatment and whether they need to seek secondary counsel regarding health issues that may not have been taken seriously by providers.

Black women’s rate of pregnancy complications is a public health and human rights emergency and many of these deaths could have been prevented. Of course, social determinants of health are a pervading factor and greatly impact this vulnerable population, but an often-overlooked aspect as to why this disparity exists in the first place is the intersection between health equity and cultural competency in the workplace.

Bias and stereotyping regarding people of color can impact the level of health care they receive.⁷ Implicit and unconscious bias training must occur not only at the provider level, but at the student level as well. If training in this area is consistent throughout students’ didactic career, it will become standard of practice to leave their biases at the door prior to working with vulnerable populations.

In the health system environment, there are major financial implications that should incentivize providers to ensure Black mothers are treated with the best quality of care, such as lower readmission rates. Brushing off health concerns Black mothers have about their health pre- and post-conception can unfortunately lead to devastating consequences. Pharmacists can be at the forefront of this movement considering their almost daily contact with this population of women and can constantly and continuously reinforce these trainings as well as direct patients to the resources they need.

Black patients can do many things to make sure they are in control of their own health, including understanding and communicating past medical history to providers; continually managing chronic health conditions; and being aware of urgent maternal warning signs such as headaches that won’t go away, vision changes, trouble breathing, or extreme swelling of the hands or face.⁶ These symptoms could imply life threatening complications and awareness of them will aid in being able to identify and alleviate problems.

Pharmacists once again are in a prime position to help curb this disparity. Within the health system, pharmacists, and particularly transition of care pharmacists, can employ different discharge practices that may help educate patients about the care they received and how to proceed with their health moving forward. For instance, using select sections of David R. Williams’ Everyday Discrimination Scale⁸ while conducting discharge counseling can be helpful to gather real time feedback on how the patient felt throughout their stay. This can be evaluated periodically and trends, positive or negative, will be noted and changes made if necessary; it will serve as an accountability measure. Medication Safety Officers can also begin to create standard operating procedures that need to be met during patient interactions to ensure that biases are not infringing upon patient care.

A myriad of changes must occur before these inequities cease to exist. Hopefully, with intentional implementation of some of the strategies outlined above, we can make strides in creating a safer and more equitable environment, leading to more positive Black maternal health outcomes. Race is not and should never be a risk factor in health care.

References

1. Association of American Medical Colleges. Figure 18: Percentage of all active physicians by race/ethnicity, 2018. July 1, 2019. Accessed May 5, 2023. https://www.aamc.org/data-reports/workforce/data/figure-18-percentage-all-active-physicians-race/ethnicity-2018

2. Hoyert DL. Maternal Mortality Rates in the United States, 2020. NCHS Health E-Stats. February 23, 2022. Accessed May 5, 2023. https://doi.org/10.15620/cdc:113967

3. Wiltshire J, Allison JJ, Brown R, Elder K. African American women perceptions of physician trustworthiness: A factorial survey analysis of physician race, gender and age. AIMS Public Health. 5(2);122–134. https://doi.org/10.3934/publichealth.2018.2.122

4. McGuire TG, Alegria M, Cook BL, Wells KB, Zaslavsky AM. Implementing the Institute of Medicine definition of disparities: an application to mental health care. Health Serv Res. 2006;41(5):1979-2005. doi:10.1111/j.1475-6773.2006.00583.x. PMID: 16987312; PMCID: PMC1955294.

5. Howell EA. Reducing Disparities in Severe Maternal Morbidity and Mortality. Clinical Obstetrics and Gynecology. 61(2):p 387-399, June 2018. doi:10.1097/GRF.0000000000000349

6. Centers for Disease Control and Prevention. Working together to reduce Black Maternal Mortality. April 3, 2023. Accessed May 3, 2023. https://www.cdc.gov/healthequity/features/maternal-mortality/index.html

7. Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, et al. Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. Am J Public Health. 2015;105(12):e60-76. doi: 10.2105/AJPH.2015.302903.

8. Williams DR. Everyday Discrimination Scale. Accessed May 4, 2023. https://scholar.harvard.edu/davidrwilliams/node/32397