There is a Black maternal health crisis in the U.S.—and the breadth and seriousness of these issues grow more critical each day. According to a new study conducted by the The Journal of the American Medical Association, effects of climate change, such as exposure to high temperatures and fine particle air pollution, are having a negative effect on pregnancy outcomes, and Black women are suffering at a disproportionate rate. Reviewing 57 recent studies that examine environmental factors on adverse pregnancy outcomes including pre-term birth, low birth weight, and stillbirth, the research analyzed a total of 32 million births, largely in the last trimester of pregnancy, across the U.S.. 84% of these studies confirmed heat and air pollution to be risk factors.
"Climate change is an urgent women's health concern and racism is a major public health challenge as well," explains Dr. Jessica Shepherd, a Dallas-based OB/GYN. "As we've seen with the spread of COVID-19, economic inequality and deteriorating infrastructures filter into all these different systems that affect the African American community. It's shown in poor maternal health outcomes, and of course extreme climate-related events, with more exposure to hazardous waste and water pollution, are going to be a factor that plays in for pregnant women."
For Rupa Basu, a co-author of the paper and the chief of the air and climate epidemiological section for the Office of Environmental Health Hazard Assessment in California, quantifying the correlation between climate change and racial injustice was an important component of the study. "If you look at air pollution or heat exposure on its own, without any health outcomes or any health risks at all, you know that the air pollution risk is higher for Black women, and also Hispanic women, just because of the areas where they mostly live," explains Basu. "There’s fossil fuel industry, such as power plants nearby, and they’re closer to freeways. So there's the traffic exposure, with diesel exhaust being especially harmful." In addition to air pollution, these communities face more outdoor heat exposure ("more blacktops, less green space," she says, referring to the urban heat island phenomenon), as well as less mitigation, with less access to air conditioning due to inequalities in housing and socioeconomic barriers. Then, there are also the disparities in access to early and adequate prenatal care. "Even if there is prenatal care, there’s differentiation for the type of prenatal care that people receive based on skin color and on socioeconomic status and that is not giving the infant a chance from the start," says Basu. According to the CDC, Black women are three to four times more likely to experience a pregnancy-related death than white women. In 2018, the rate of pre-term birth among Black women was about 50 percent higher than the rate of pre-term birth among white women.
"It's a crisis, but it's a sustained crisis," says Harriet A. Washington, medical ethicist and author of A Terrible Thing to Waste: Environmental Racism and Its Assault on the American Mind, of the poor state of maternal health for Black women in the U.S. "I think what's really important is to understand that there's a synergy here. In addition to environmental exposures, such as heat island, what other things contribute to the problem?" In terms of the systemic onslaught of toxic exposure, Washington asserts it's not just the current climate injustices that need to be addressed, but the pre-existing ones as well. It's an intergenerational issue, too. "A lot of the [environmental] exposures that cause problems are not necessarily exposures of the mother, the exposure that consigns to baby with ill health might be the toxic exposures that her grandmother had," explains Washington. "We often talk about nature versus nurture, but sometimes environmental toxins can affect both, making [a mother and child] genetically predisposed to problems later on. There's a lot going on that we need to look at for the future."
While this is just the beginning for mass awareness and understanding of climate change's impact on women's health, and more specifically maternal health as it relates to racial injustice, Dr. Shepherd hopes that with the global pandemic exposing health inequities, this emotionally charged time can spur actionable change. "It’s like that pictorial of an iceberg, there's this little peak at the top, but below it's catastrophic," she says. "It's the perfect analogy of how racism affects health. You’re just seeing the tip, but there are all these ways it impacts quality of life and health outcomes for African Americans."