Recently,
Dr. Lauren Dungy-Poythress, Professor of Maternal-Fetal Medicine at Indiana University School of Medicine, came to Fort Wayne to share her expertise on how implicit bias impacts maternal healthcare.
Her presentation, “Perspectives on Implicit Bias in Maternal Healthcare,” introduced the concept of implicit bias as, “attitudes, thoughts, and feelings that exist outside conscious awareness.” Dungy-Poythress says these biases often have to do with race, gender, disability, socioeconomic status, and weight.
Implicit bias is detrimental in the healthcare setting because it can lead to covert discrimination and institutional bias. She says people of color deal with implicit biases from childhood on.
A 2016 study by Yale University showed that even Black preschoolers were seen by their teachers in a more negative light than their white counterparts. Dungy-Poythress cited a
Project Implicit study conducted by Harvard University in which 75 percent of participants showed a preference for whites.
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Dr. Dungy-Poythress speaks about implicit bias and how it impacts Black maternal and infant health at the University of Saint Francis.“These problems can be long-term and last well until adulthood,” says Dungy-Poythress. “Sometimes the consequences are tragic.”
How does that translate to healthcare?
Many social factors impact a person’s health Dungy-Poythress says. In the case of Black people, that can include hate crimes directed toward people of color, negative personal experiences, microaggressions and other stress factors.
“These can affect pregnancy,” she explains. “Black women are exposed to stuff that white women are not.”
Dungy-Poythress says all this accumulated stress leads to what is known as “weathering” in Black women. Stress can even affect DNA and the quality of health.
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A mom and baby at A Mother's Hope.
“Black women are chromosomally seven years older than their white counterparts,” she says as a result of stress and weathering.
Black women, Dungy-Poythress says, are more likely to die from cervical cancer, breast cancer, and endometrial cancer. Preterm births are 40 percent higher among Black women than white women, and severe maternal morbidity is 70 percent worse for Black women.
“Structural racism is for real,” she says. “Racism drives health inequities.”
At the emergency room, Dungy-Poythress says people of color receive less analgesia than white people do, and people of color are often perceived by healthcare staff to be noncompliant or medicine-seeking.
A 2017 survey conducted by Harvard University, NPR, and the Robert Wood Johnson Foundation revealed that 21 percent of Black women avoided healthcare due to fears of discrimination.
In her presentation, Dungy-Poythress told the story of Shalon Irving, a Black Lieutenant Commander in the U.S. Public Health Service and an Epidemiologist with the Centers for Disease Control and Prevention.
Three weeks after she gave birth, she died from high blood pressure. Dungy says that despite a blood pressure reading of 174 over 118, which is considerably high, she was sent home. Then, even after she gained nine pounds in 10 days and suffered from edema, the swelling of the legs due to a build-up of fluid
, up past her knees, she was told that she had just had a baby and should give it time.
The hospital, says Dungy-Poythress, refused to conduct an autopsy, and an autopsy in another state, which cost $4,500, revealed the cause of death was a hypertensive disease of the heart.
Dungy-Poythress says this is a prime example of how not even professional status or affluence protects Black women from implicit bias.
Efforts in Fort Wayne to help moms and babies
In 2020, the maternal mortality rate for Black women in Indiana was 208 per 100,000 births, higher than for white women (108) and Latina women (71),
according to a 2022 Indiana University Public Policy Institute report.
“Maternal health is adversely impacted by discrimination resulting from structural inequities and provider bias,” the report says.
Meg Distler, Executive Director of the
St. Joseph Community Health Foundation says too many mothers and babies are dying in Indiana and in Allen County.
“The numbers in our state and county are higher than the national average and higher than in many developed nations,” she says. “And there is a startling difference in the numbers when you look at race. Nationally, Black women are three to four times more likely to die during or within one year of the end of pregnancy. The maternal mortality rate for Black women in Indiana is 93 percent higher than for white women. This is unacceptable.”
The St. Joesph Community Health Foundation works locally to help the community through grant funding, collaboration with community partners, and engaging in transformative initiatives. The Foundation helps provide solutions to improve access to care and advocates for the health and well-being of Allen County residents. They invited Dr. Dungy-Poythress to Fort Wayne as part of their initiative focused on prenatal and infant care.
“We invited Dr. Lauren Dungy-Poythress to help us better understand the causes and how we, with community partners, can do better,” says Distler.
Dungy-Poythress says her presentation at the University of Saint Francis was not to complain but to raise integrative awareness, to do her part in solving the structural racism that has claimed the lives and damaged the health of so many Black women and babies.
She is not alone, as others in Fort Wayne are working toward the same goal.
Journey Beside Mothers, an Associated Churches ministry, provides mentors, peer-to-peer relationships, and play groups to help women navigate their motherhood journeys.
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A zoo outing with Journey Beside Mothers.Julie Reece, Coordinator of Journey Beside Mothers, says the relationships made in their program can be crucial for the moms they help.
“Our focus is giving these moms relationships, whether it’s with a mentor or through play groups,” Reece says. “I feel like if we can get the moms, especially those who are waiting for a mentor, to get connected with a playgroup, sometimes that’s all it takes. Isolation is not good when you’re a mom and you’re just trying to get through the day, the hour, and trying to figure out finances and all those kinds of things.”
Reece says the relationships they form have the power to save the lives of mothers.
“If we have a pregnant mom or a mom who might be experiencing post-partum depression or showing signs of that sort of thing, we try to help them find their voice when it comes to interacting with their doctor’s office. We had a mom who has had high blood pressure issues, and we have been able to help her have her voice, to make sure that she and her baby are getting the care they need.”
Journey Beside Mothers tries to get mothers and their mentors together about once a quarter through events like cookouts and meetings.
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A Christmas party with Journey Beside Mothers.Reece says she’s excited about a new mental health counseling program from
The Mission House, available to mothers who participate in Journey Beside Mothers.
“Mental health is a huge thing in the Black community, so when they realize that it’s in a place that they’ve been and they trust the people that are there, we’re hoping that we’re going to get more moms getting that kind of help.”
A Mother’s Hope is another organization working to help local mothers. They provide shelter to pregnant mothers and new mothers who are homeless. New moms may stay at A Mother’s Hope up to a year after giving birth. In addition to receiving shelter, they also receive opportunities and training, which include educational opportunities, employment coaching, community connections, and attention paid to individualized action plans.
“We have found that focusing on these areas of the residents’ lives provides the most opportunities to gain confidence, knowledge, and hope, ultimately supporting them in creating stability for themselves and their children,” says Stasia Roth, Executive Director of A Mother’s Hope.
These efforts aside, Roth says she and other staff at A Mother’s Hope have witnessed the differences in the experience of pregnancy for Black moms compared to white moms.
Roth says back in 2019 a Black baby staying at the shelter passed away in his sleep. The baby had medical issues, and A Mother’s Hope was working with his mom on taking him to the doctor.
“It was really traumatic on this young woman,” Roth says. “She still contacts us and talks to us about what happened. You wonder if the outcome would have been different if her race was different—I don’t know.”
What Roth does know is she has seen Black women treated differently.
“Before I was in this role, I would go to the doctor with women sometimes, and I saw it firsthand,” she says. “I even said to someone one time, ‘I can’t believe you just said that. You never would have said that to me if I was the one sitting here.’ I’ve seen it firsthand, and I’ve seen it be more prevalent with Black women and the way they are treated differently.”
Angela Stanley, Vulnerable Populations Program Officer with the
St. Joseph Community Health Foundation, says there’s research that points to Black mothers fell heard a little bit more, that their needs are being met, and that they’re being cared for when their healthcare providers are Black.
“But we don’t have as many Black providers in Fort Wayne,” she says. “We do have a lot of service providers and organizations that work with Black mothers and babies and who want to help.”
Stanley says she believes that Dungy-Poythress’s presentation highlighted problems and sparked ideas of how services can be improved.
“My hope is that she sparked some conversation that people can take back to their organizations and figure out how to tap into that,” she says.
Kathy Detweiler, Director at
Parkview Health says being open about your health concerns and seeking out a provider who you can relate to can help.
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A Christmas party with Journey Beside Mothers.“We have
nurse navigators who try to help with this too,” Detweiler says. “Support is available, and you don’t have to do it alone.”
While changing the system can’t be left completely up to the patients, like Black moms who aren’t getting the care they deserve, local organizations are doing their part to step in and address the changes needed to make the system better work for everyone.
“We all have implicit biases—we all need to address these issues,” says Dungy-Poythress. “The better we make it for everybody, the better we make it for everybody.”