Sometimes the subtle cues can mean life or death.
They’re the human reactions that warn health care providers of a patient’s emotional discomfort, feelings of being unwelcome, misunderstood, not listened to, sometimes silenced.
As an African American woman, Dr. Terri Ashmeade can spot them right away. She notices communication barriers between Black women and non-Black doctors. Rifts that can erode trust and lead some women to put up guards — to the point that they don’t seek care.
Some worry they might not get the best care because they’re Black, said Ashmeade, a professor of pediatrics at USF Health and a neonatologist in Tampa General Hospital’s intensive care unit. Black women question whether doctors will believe them when they say they have a problem or concern. They question how they might be perceived and if doctors are listening.
Inadequate communication, partially due to lack of cultural understanding, is one of many factors that perpetuate racial disparities in infant mortality, an issue that resurfaced last month in a new study with strong Florida connections.
Black babies are more likely to survive birth when cared for by Black doctors as opposed to white doctors, according to the study, published in the journal Proceedings of the National Academy of Sciences of the United States of America. When cared for by white doctors, Black newborns were nearly three times more likely than white newborns to die, the researchers found.
The mortality rate for white babies largely remained unaffected by the race of the physician.
The study was based on data from nearly 2 million hospital births in Florida from 1992 to 2015. It’s the first of its kind to offer evidence that racial concordance — meaning the matching of races — between patients and physicians affects the racial gap in infant mortality, the researchers say.
The study was performed by four researchers with public health and business backgrounds from George Mason University, the University of Minnesota–Twin Cities, and Harvard University.
Some local experts question the researchers’ methodology and assumptions, such as the deciphering of doctors' race based on photos and a lack of discussion surrounding the team-based care offered in hospitals.
Still, statistics point to a lower quality of care for Black babies in intensive care units.
In Tampa Bay, the number of deaths per live births generally has been declining since 2015, except for an increase in 2019, said Leisa Stanley, an epidemiologist with the Healthy Start Coalition of Hillsborough County. However, racial disparities between Black and white babies persist despite the decline.
Since 2016, the data has shown that Black babies born in Hillsborough are more than two times more likely to die than white babies during and after birth. In Pinellas, they are almost two times more likely to die than white babies, according to data from 2017 and 2019, the most recent numbers available.
The Hillsborough disparity is largely linked to premature births, experts say. Black mothers have a higher rate of low birth weight deliveries than white mothers, Stanley said. Lower birth weight deliveries are often associated with the health mothers bring into their pregnancy.
High blood pressure, which is particularly prevalent within the Black community, is one of the main factors linked to premature deliveries, said Ashmeade, the Tampa General doctor.
“Any health issues that affect the mom often affect the baby,” she said, adding that those conditions frequently predate pregnancy. That means the quality care before and between pregnancies for mothers is vital for ensuring the healthy delivery of babies, she said.
To make births safer, Ashmeade said, “we have to start thinking about the health of women from when they’re young.”
Black mothers’ physical health is one aspect of a broader system of institutional racism and implicit bias, many experts say. And the disparities in infant mortality persist across a multitude of social factors, making them greater than a matter of the patient’s socioeconomic status and level of education.
The culmination of a lifetime of consistent stress has significant effects on Black women’s autoimmune systems and their rates of hypertension, said Estrellita “Lo” Berry, president and CEO of REACHUP, a Tampa-based organization focused on mobilizing resources to achieve equality in health care. This accumulation of stress is sometimes referred to as the weathering effect of racism.
The barriers to equity in infant and maternal care vary, said Kimberly Brown-Williams, the program director for Healthy Start at Johns Hopkins All Children’s Hospital in St. Petersburg. Yet “the thread that holds everything together is racism.”
“This is a social issue rather than a medical issue,” said Brown-Williams, who works directly with families during and after pregnancy. Some women feel discriminated against and, as a result, don’t seek care, she said.
“We all have biases," said Dr. Washington Hill, a Sarasota-based maternal-fetal medicine specialist. He notes that physicians often don’t realize they are acting on implicit bias, which are attitudes and stereotypes that unconsciously affect one’s decision-making.
“The first thing we have to do is admit that,” Hill said.
Developing protocols, guidelines and standards — and insisting they are followed throughout care — may mitigate some disparities, he said.
But, more simply, making sure each patient feels welcome and comfortable at all steps of care — from the greeting at the front door to messaging from hospital administration — will help build trust and allow Black women to feel comfortable with communication, Hill said.
Ideally, the workforce in hospitals would reflect the local population in order to create well-balanced teams that might reduce gaps in communication and cultural understanding, said William Sappenfield, a University of South Florida professor who focuses on maternal and child health, epidemiology, and public health practice.
However, increasing the representation of doctors of color is a more long-term, systematic approach.
More immediately, community-based programs like Healthy Start chip away at infant and maternal health disparities by working directly with Black women.
The first step is educating women on the importance of quality care in the early stages of pregnancy, said Brown-Williams. After that, the focus is on teaching women how to be advocates for themselves, to speak up when they don’t understand, and to ask questions when they arise.
But also, doctors must meet women where they are, said Berry of REACHUP.
“Listen to the women," she said. "Listen to the Black women.”
This story was funded in part through a grant from the Foundation for a Healthy St. Petersburg. Donors are not involved in the reporting or editing process.