Racism In Healthcare Is Killing Black Women, And It Killed Tori Bowie

We are all enraged to learn that world champion sprinter and three-time Olympic medalist Tori Bowie was eight months pregnant and died of birth related complications in May. Her autopsy revealed that she was in labor at the time of her death and likely died of complications related to preeclampsia, a very dangerous rise in blood pressure and elevated protein levels during pregnancy and can cause headaches, dizziness, and swelling. Not treated, it can lead to respiratory distress, seizures, stroke, and death. 

Preeclampsia is one of the most common and severe pregnancy related disorders, affecting at least 5-8% of all pregnancies, according to the Preeclampsia Foundation. The preeclampsia rate among Black women is 60% higher than in white women, which is one contributing factor in our higher maternal mortality rates. But there’s an important understanding of how racism—specifically America’s brand of racism—increases that risk for  Black women and birthing people and leaves us more vulnerable to complications even when we are getting prenatal care. 

A breakthrough study found higher rates of preeclampsia among Black women born in the United States when compared to Black women who immigrated to the country, which leads back to what Black maternal health advocates have been saying for years: it’s Racism, not race, that’s disproportionately killing Black women before or after childbirth. 

Data on the diverse group of 6,000 Hispanic, Black and white women was gathered over a 28-year period as part of the Boston Birth Cohort study, with analysis led by researchers at Johns Hopkins Medicine. Their findings: all three groups of women who gave birth and were born in the U.S. had a higher risk of cardiovascular disease than foreign-born counterparts, even after accounting for differences in weight, alcohol use, stress, smoking, and diabetes. 

But for Black women, birth status outside the U.S. and a shorter time living in the U.S. (those who lived in America for less than 10 years) resulted in a 26% lower odds of preeclampsia. Read that part again. To be clear, birthplace status and length of time living in the U.S. was not significantly associated with the odds of preeclampsia among Hispanic and white mothers. 

Black women who were born outside the U.S. are less likely to have preeclampsia until they have been living in America’s racist system for some time. The stress of systemic racism—including experiencing discrimination, the feeling of having to fight all the time, racist housing policies, loan discrimination, workplace stressors, wage inequality, bias in health care interactions, dealing with Karens, Beckys, and other stressful factors—is creating such an impact on our bodies that even “healthy” people are at risk. Educated and high income people are at risk. 

While it is so easy to problematize Black women, blaming them for not getting prenatal care or having other health conditions, the fact remains that multiple studies prove that regardless of prenatal care, education or even income, Black women are dying more—as are our babies. In January, a study based on California data found that college educated Black women, with incomes over $100,000 were more likely to die than low income white women. This is not about us, it is about what living among systemic oppression does to us. 

It’s called weathering and it’s a well-documented scientific concept that years and years of racism actually wears down on our bodies —even athletic and well-trained bodies—and makes us more vulnerable during pregnancy. There is very little you can do during the nine months of pregnancy to fully undo years of systemic oppression wearing down your body and elevating your stress levels. We bring these impacted bodies into our pregnancies and even despite our best efforts, we are vulnerable and we are at risk. 

After details of Tori’s death were released, social media was flooded with comments from her teammates–many of them sharing their own negative experiences in pregnancy and childbirth, highlighting this sobering reality: three of the four members of America’s gold-winning relay team have suffered life-threatening complications while giving birth. 

These are healthy, fit, athletic women who don’t fit the “Black women are unhealthy and overweight” trope they often like to pin on us. These are women who were likely very focused on diet and nutrition with serious exercise regimens as top performers in track and field and not lacking access to prenatal care. 

What they couldn’t access was an anti-racist health system. What they couldn’t access were providers who saw them beyond their skin color to see their humanity to listen to their concerns, and then respond immediately and appropriately and value their input. 

As my mind goes to sadness about our sister Tori dying alone and likely thinking about herself and her unborn baby, I have to ask: where was her provider? Where were the signs of pre-eclampsia such as increasing blood pressure and higher protein levels in urine and were these ignored? Given that Black women have a higher risk of eclampsia, where was this higher risk profile included in her care plan? Did Tori complain of headaches and dizziness but was dismissed by providers who don’t take our concerns seriously? 

I see it far too often in our Irth app reviews and our work is to leverage Irth as an early warning detection system, to find hospitals and providers where key dangerous practice behaviors such as —dismissiveness of pain levels, ignoring request for help, comments based on racial stereotypes—are reported in high frequency by Black and brown parents so we can alert our community and that hospital of those practices and prevent deaths. 

In our Irth App database of over 10,000 ratings and reviews from Black and brown parents and pregnant people, over 68% of Black birthing people reported “my requests for help were ignored or refused” or “my pain levels were dismissed.” 

Our qualitative analysis of Irth App reviews also showed a high frequency of folks reporting that when they do advocate for themselves, they felt they received backlash, retribution or even harsher treatment. Damned if you, damned if you don’t. 

This cannot continue. The Black maternal mortality crisis cannot be advocated away. This is not about what more Black women need to do to save themselves. It’s about holding the health systems and people, who are being paid to provide care, accountable to do so equitably and respectfully. It’s about ensuring that the community-centered solutions which are proven to improve outcomes, such as midwifery-led care and doula support, are accessible and affordable for all.  Tori Bowie deserved better. All Black women and birthing people do.