"It is personal for me. I think about the generations of women before me, and the generations that are coming after me, and I don't want this to be the legacy that we leave for them,"
Deciphering the Black maternal health crisis
What’s behind the Black maternal health crisis in the United States? There’s no one answer, Oliver said, but “it is not about a lack of educating yourself or going to the doctor.”
Consider a five-year study that found Black, college-educated mothers who gave birth in hospitals are more likely to die during pregnancy or childbirth than white women who never graduated from high school.
In some cases, access is an issue. Women in rural communities may have less access to an ob-gyn or a high-risk pregnancy specialist. And Black women are more likely to have complicated pregnancies, Oliver said.
While telehealth solutions help increase access, and one that Novant Health has ramped up in recent years, not everyone has access to internet or technology. But even having that access does not account for factors like race or ethnicity.
So, what’s damaging Black women and their chances at good health and healthy pregnancies? It’s likely a cumulative effect of “systemic bias and racism,” Oliver said.
“And here’s why I say that,” she continued. “Data has shown that African women who migrate to this country do not have the same rates of maternal mortality until the following generations. So, their risk of dying increases only after they’ve lived in the United States for a period of time.”
Dr. Pam Oliver: Executive, physician and parent
- She grew up in Rocky Mount, a city of about 50,000 people in eastern North Carolina, and enjoyed math and science from a young age.
- Oliver has two sons and a daughter and spends much of her time outside of work reading books, exploring nature or traveling with them.
- She received her undergraduate degree and her medical degree from the University of North Carolina at Chapel Hill. She also earned her master’s degree in public health, with a concentration in maternal and child health, from the UNC School of Public Health while enrolled in medical school.
- Oliver, a board-certified ob-gyn, has been practicing at Novant Health WomanCare since 2005. Although she’s a top executive at Novant Health, she’s still seeing patients.
- She treats a lot of women with fibroids, endometriosis and menstrual abnormalities, but she also loves taking care of women in all stages of life.
- In addition to her work at Novant Health, Dr. Oliver currently serves as chair for the Forsyth County Infant Mortality Reduction Coalition.
Find an ob-gyn who listens and understands you.
The weathering effect of racism
Take the weathering effect of racism in America as an example. The weathering hypothesis, first introduced in the early 1990’s, says the accumulation of racial stress over Black women’s lives may actually deteriorate their health.
There is evidence of weathering, which can begin at an early age and increase over time, regardless of a person’s socioeconomic status. Among the researchers’ findings:
- The cumulative effect of “social or economic adversity and political marginalization” leads to an earlier deterioration of health among Black women.
- On a biological level, “persistent, high-effort coping with acute and chronic stressors can have a profound effect on health.”
- Emotionally, the stress of living in a “race-conscious society that stigmatizes and disadvantages Blacks may cause a disproportionate physical deterioration.”
Weathering effect research also found that Black women may have the same morbidity or mortality of a white person who is significantly older than them.
“It’s complicated,” Oliver said. “But it also says that we cannot waste time. We have to act now if we’re going to have a chance at changing the direction for one to two generations out. And we cannot do it completely just in health care. We must have complex, broad solutions if we’re going to tackle this.”
A shared goal to advance policy
Oliver forged a relationship years ago with Congresswoman Adams, who founded the Black Maternal Health Caucus and represents North Carolina’s 12th congressional district.
Adams even invited Oliver to be her guest at the State of the Union address – a moment that was documented on social media in early 2020. They’re pictured together, standing proudly, at The Capitol in Washington, D.C., with a caption that read, “Maternal health is an important issue to both of us.”
Oliver listened to stories from other attendees, saying the experience “opened her eyes.” But it also afforded her the opportunity to shine a light on key issues, like Black maternal health.
“Most of our congressmen and women do not have a background in medicine. They need those of us who provide care day-to-day to help them understand what's happening real time,” Oliver said.
Since then, her advocacy has become more vocal. Oliver has spoken directly with members of Congress and participates in panels of physicians and advocates from around the country.
“Lawmakers get so many viewpoints on any given issue. They hear strongly from the insurance and pharmaceutical industries. As physicians and health systems who want to help foster healthy communities, and even as a patient myself, I’m honored to be that voice for women,” she said.
A ‘truly remarkable’ bill
Oliver has also been engaged in raising awareness for the Momnibus Act, something she said is “truly remarkable.” It’s a collection of several bills, all to address the Black maternal health crisis in the United States.
Some would require better data collection, while others aim to increase access to maternal care or birth advocates like doulas. Data shows that having a doula is one of the things that can reduce maternal mortality and morbidity.
“A doula is someone to help you have your voice and make sure your voice is heard. And that’s really important, because the one thing we hear consistently from Black women is they don’t feel seen and heard. They feel their issues are pushed to the side,” Oliver said.
“So, if we’re going to solve this crisis for future generations of women, it requires that we listen to Black women and take their issues seriously. It really requires a respect for every woman,” she added.
There’s a long way to go before the United States can declare victory in the Black maternal health crisis, Oliver said, but she’s optimistic the legislation will pass. (No word on when it may go up for a vote.)
Approachable advice on tackling big issues
Oliver is inspired by the slow but steady progress she’s witnessed in recent years. COVID shined a bright light on disparities in health, she said, and major corporations like Goldman Sachs have donated billions of dollars to advance racial equity and economic opportunity by investing in Black women.
"Black maternal health, like many health inequities and disparities, can be overwhelming when you think about it. But we cannot let that deter us from taking any small steps to get there,"
Small steps can be a catalyst for change, said Oliver, who offered the following:
- Educate yourself on the issues.
- Take time to pause, reflect and challenge your thinking on a more consistent basis.
- Identify and address any biases you may have, even bias that’s unintentional or unconscious.
- Be an empathetic listener, develop relationships and try to see different perspectives.
Additionally, two in three pregnancy-related deaths in the U.S. are preventable, according to the Centers for Disease Control and Prevention.
Support the pregnant women in your life by knowing the urgent maternal warning signs. It could help save a life.