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Pregnant Women of Color in Some Parts of California Face Higher Risks, Data Shows

In the Central Valley, poverty and an OB-GYN shortage put some mothers and children at risk.

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Photo: Serr Novik.

For years, California has been known as a nationwide leader in reducing pregnancy-related deaths.

But there are areas of the state where challenges remain in ensuring that women don’t die due to health care complications during pregnancy or postpartum.

One of those areas is Kern County, which is rich with oil and fertile agricultural lands, but forms part of a region listed as the least advantaged in the state. The county lies in the southernmost portion of Central Valley, which registered 17.2 pregnancy-related deaths per 100,000 live births, according to a 2021 report by the state Department of Public Health’s Pregnancy Mortality Surveillance System. California’s overall rate is 12.8 per 100,000.

These are troubling statistics in this predominantly Latino community. The figures are even more worrisome considering that COVID-19 has had a disproportionate effect on Latino and Black communities. Researchers recently reported that maternal mortality rates among Latinas nationwide shot up by a whopping 74% after March 2020.  
 


Difficulty accessing health care is just one of many social and economic inequities plaguing Kern county, though it’s the seventh highest oil generating county in the United States and a top agricultural producer.


 
“For the first time in more than a decade, the maternal mortality rate for Hispanic women during the pandemic was higher than that for non-Hispanic white women, a shift that may be related to COVID and deserves greater attention moving forward,” Dr. Eugene R. Declercq, professor of community health sciences at Boston University, reported as part of a study published in JAMA Network Open in June.  

Lourdes Garcia, a lifelong Bakersfield resident who gave birth to a baby girl last year, says she was scared to go to the doctor for all her appointments because of the many uncertainties brought on by COVID-19. She was primarily concerned with her baby’s health and unsure whether getting vaccinated was the safest choice for her as a pregnant woman.

“There are already so many things to think about when you’re pregnant,” says Garcia, a mom of three who had her first baby eight years ago. “All of sudden, I had to also think about maybe getting infected [with COVID-19] and whether getting the shot was safe.”

Health officials describe most of Kern County as a “designated health care provider shortage area.” Difficulty accessing health care is just one of many social and economic inequities plaguing the county, though it’s the seventh highest oil generating county in the United States and a top agricultural producer. 

Substance abuse, asthma, mental health issues, sexually transmitted diseases and obesity were the top five health problems listed in the county’s 2018 community health assessment. Maternal mortality doesn’t figure in the list, but the report notes that the county falls short on early prenatal care. 

“I feel like it can be hit or miss when it comes to getting good health care out here in Bakersfield,” says Garcia, an administrative assistant in a human resources office. “I feel like I got lucky with my doctor, but I think that even he made mistakes.”

Garcia says that contrary to her wishes, a nurse administered Pitocin, a medication often dispensed to speed delivery of her baby last summer. 
 


Maternal mortality rates among Black women are even more alarming in Kern County, with women dying at nearly four times the rate as other women in the region.


 
“I didn’t want Pitocin. They gave it to me last time, and I suddenly had bigger contractions and the pain just got worse. Why couldn’t we have waited for the baby to come on her own terms? I think a big part of the problem is that they want to rush things,” Garcia says. “They don’t have enough time or don’t take the time.”

The number of pregnancy-related deaths among Black women also rose sharply after March 2020.  That rate increased by 40% during the pandemic, according to the JAMA Network Open study. 

Maternal mortality rates among Black women are even more alarming in Kern County, with women dying at nearly four times the rate as other women in the region. In response, county officials created the Black Infant and Maternal Health Initiative to tackle the inequity. 

Some believe that accessing health care in Kern County is especially problematic for those in the Latino community, who now make up almost 55% of the population.

 “There are a lot of economic issues at play. A lot of uninsured residents, a lot of women who’ve received little to no prenatal care,” says Michele Ramos, patient safety advocate at Consumer Watchdog in Los Angeles.

Earlier this year the Kern County Board of Supervisors declared May as Latina Maternal Health Awareness Month. 

“This is an issue that is especially close to my heart. As many of you know, my son Noah spent six weeks in the NICU,” Kern County Supervisor Leticia Perez said during the Board of Supervisors’ meeting presenting a proclamation to women whose loved ones have died as a result of pregnancy complications. “That was, of course, a miracle after three miscarriages, one where I almost lost my life. I was amazed through the process at how little I really knew about how much can go wrong.” 

In June, the newly founded Save a Mom, Save a Family Foundation hosted a Latina Maternal Health Fair to continue educating pregnant women and new moms. The fair was organized by Ramos and Tracy Dominguez, whose daughter and baby died during childbirth in April 2019.
 


The full effect of COVID-19 on women’s health remains to be seen. As well, the recent Supreme Court ruling on abortion rights will have major implications. The national shortage of OB-GYNs is only going to get worse.


 
Those deaths triggered a community educational campaign about Latina maternal health. The circumstances surrounding the deaths of 23-year-old Demi and her baby are described in investigative documents filed by the Medical Board of California and the state Department of Public Health. A  doctor who treated Demi during an ER visit surrendered his license in December 2021 and is not currently a practicing physician, according to state Medical Board documents

The full effect of COVID-19 on women’s health remains to be seen. As well, the recent Supreme Court ruling on abortion rights will have major implications. The national shortage of OB-GYNs is only going to get worse.

A shortage of OB-GYNs does not bode well for efforts to stem pregnancy-related deaths, particularly in areas with limited health care access. There are 72 doctors reporting that they specialize in obstetrics and gynecology in Kern County, 68 of them in Bakersfield, according to survey data gathered but not verified by the state Medical Board. The data, provided by Medical Board spokesperson Carlos Villatoro, shows that would equal about a ratio of one OB-GYN per every 12,700 residents in a county with 917,00 residents. 

According to estimates made in March 2021 by the U.S. Department of Health and Human Services, the number of OB-GYNs nationwide is expected to decrease by 7%, while demand is projected to increase by 4%, by 2030. Conversely, the workforce of certified nurse-midwives, women’s health nurse practitioners and women’s health physician assistants is expected to exceed demand, filling in some gaps in women’s health care. 

“The inadequacy of current care levels is evidenced by significant access-to-care issues and substandard health outcomes,” states the Department of Health and Human Services report. “These health outcomes are not distributed equally across racial and ethnic groups.”

Public health officials in California have proven to be leaders in reducing maternal mortality rates. But uneven results throughout the state require concentrated efforts in high-need areas such as Kern County. Her zip code shouldn’t determine whether a pregnant woman gets to live or die.


 
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