Five years ago, it was widely reported that Pittsburgh is one of the worst places for Black women, who experience higher poverty and unemployment rates than their counterparts in many other U.S. cities, according to a study by the city’s Gender Equity Commission.
That study also found Black women’s maternal mortality is higher in Pittsburgh than nearly all similar cities, though it wasn’t due to lack of prenatal care. Black women here started care sooner than their counterparts in those other cities when the study was released in 2019.
A recent study by researchers at the University of Pittsburgh found another possible reason for poor maternal health outcomes: everyday racism and sexism.
The study followed more than 300 pregnant people living in the region over time, starting in their second or third trimester and ending one year after they gave birth. Using smartphones and Bluetooth-enabled scales, the participants regularly reported their weight and everyday experiences, including stress and race- and gender-based discrimination.
Suffering through discrimination was associated with weight retention after pregnancy among Black birthing people, which puts them at risk for diabetes and cardiovascular disease, among other chronic health conditions. The researchers didn’t find that association among white participants.
The finding flies in the face of a culture of “individual responsibility” around maternal health, said Dara Méndez, a Pitt associate professor of epidemiology and lead author of the study, which was published last week in the American Journal of Epidemiology.
“We have historically focused a lot more on attempting to correct individual pregnant people’s behaviors,” said Méndez, also associate director of the Center for Health Equity at Pitt’s School of Public Health, and a new appointee to the county Board of Health. But we need to look at those behaviors “within a larger context” of structural racism, sexism and misogyny, she added.
Fight racism in communities, not just doctor’s offices
The study confirms what Black doulas and other birth workers have experienced and witnessed.
“Of course we’re going to gain weight,” said Amber Edmunds, a doula at MAYA Organization in Swissvale, which supports Black and other marginalized birthing people. She’s experienced postpartum weight retention herself and said the stress caused by racism and sexism can lead to “levels of cortisol that are terrible for us. It’s what happens when we don’t have support.”
Only about 40% of people return to their pre-pregnancy weight, but Black people are two to three times as likely as white people to retain or gain extra weight after giving birth. Some studies have explored lifestyle changes as a solution to this disparity, but haven’t focused on the cultures and environments that Black people live in.
The participants were recruited while receiving care at a maternity hospital in Pittsburgh between December 2017 and March 2020. A Pitt spokesperson declined to name the facility, citing patient confidentiality. They were, on average, 30 years old, largely white (157 versus 63 Black people) and didn’t have comorbidities such as high blood pressure. Other racial groups were in the sample, but the study focused on Black and white participants.
Participants weighed themselves at least once a week. And they used their phones to complete daily surveys designed to capture their thoughts, behaviors and experiences in real time, while in their natural environment. They were asked how often they were treated unfairly on a given day because of their race or gender, and how stressed they felt on a scale of 0 to 4, among other questions.
With more traditional surveys, “it’s usually, ‘Tell me how you felt over the past month … or maybe even a year,’” said Méndez, which can lead to memory lapses or lack of detail in answers. This real-time data collection method minimizes that kind of bias.
Black participants reported higher rates of racial discrimination than white participants, though both groups experienced similar rates of gender discrimination. And the proportion of days on which they experienced racial discrimination was associated with increased weight retention: Black participants retained 0.3 more pounds for every 10% increase in the number of such days in the previous month. Gender discrimination was also associated with weight retention among Black participants, who retained 0.4 more pounds per 10% increase in such days in the previous month.
Media coverage of Black maternal health has focused on medical racism, barriers to care and how health systems fail Black women. “We should not make light of that,” Méndez said. “But this really builds the case … that the answers to addressing [health] inequities are not only shaped in our health care settings.”
The study highlights the need to also fight racism in communities, especially within institutions whose actions are leading to worse health outcomes for Black birthing people, she added. These can include banks that unfairly deny loans, employers who don’t hire Black people or cities that overpolice Black communities.
‘We are absolutely tired’
Edmunds, the doula at MAYA, would like to see more investments in programs supporting Black birthers, but said those efforts won’t change a system she believes is designed to marginalize people like her and her clients.
“I put the onus on us, because we know how the systems and how white people are going to operate,” she added. “There are some beautiful people doing some beautiful things in this city, but there aren’t enough of us and we are absolutely tired.”
Tayler Clemm is working to narrow disparities in postpartum weight retention through nutrition counseling. She founded DAWA, which means “medicine” in the Kiswahili language. The organization teaches Black birthing people about ancestral foodways to help them choose more seasonal and locally grown foods — even if they can only get produce at a food bank or pantry.
In partnership with Healthy Start Pittsburgh, Clemm has trained more than 100 people in the region over the past two years. Asked about the study’s findings, she pointed to food deserts in neighborhoods and other social determinants of health affecting Black birthing people.
“The resources that we have access to are not providing us with nourishing food,” she said, which can lead to health problems such as postpartum weight retention. “Moms and families … are not being properly supported or having the village that we need to thrive.”
Venuri Siriwardane is PublicSource’s health and mental health reporter. She can be reached at venuri@publicsource.org or on Bluesky @venuri.bsky.social.
This story was fact-checked by Rich Lord.
This reporting has been made possible through the Staunton Farm Mental Health Reporting Fellowship and the Jewish Healthcare Foundation.
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