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Black Pregnancy Dangers, Deaths Seen as a ‘Completely Preventable’ Health Crisis_我的网站
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HOUSTON — Tonjanic Hill was overjoyed in 2017 when she learned she was 14 weeks pregnant. Despite a history of uterine fibroids, she never lost faith that she would someday have a child.
But, just five weeks after confirming her pregnancy, and the day after a gender-reveal party where she announced she was having a girl, she seemed unable to stop urinating. She didn’t realize her amniotic fluid was leaking. Then came the excruciating pain.
“I ended up going to the emergency room,” said Hill, now 35. “That’s where I had the most traumatic, horrible experience ever.”
An ultrasound showed she had lost 90% of her amniotic fluid. Yet, over the angry protestations of her nurse, Hill said, the attending doctor insisted Hill be discharged and see her own OB-GYN the next day. The doctor brushed off her concerns, she said. The next morning, her OB-GYN’s office rushed her back to the hospital. But she lost her baby, Tabitha Winnie Denkins.
“This is a public health crisis as it relates to Black moms and babies that is completely preventable,” said Barbie Robinson, who took over as executive director of Harris County Public Health in March 2021. “When you look at the breakdown demographically — who’s disproportionately impacted by the lack of access — we have a situation where we can expect these horrible outcomes.”
In fact, Harris County ranks third, behind only Chicago’s Cook County and Detroit’s Wayne County, in what are known as excess Black infant deaths, according to the federal Health Resources and Services Administration. Those three counties, which also are among the nation’s most populated counties, account for 7% of all Black births in the country and 9% of excess Black infant deaths, said Ashley Hirai, a senior scientist at HRSA. That means the counties have the largest number of Black births but also more deaths that would not occur if Black babies had the same chance of reaching their 1st birthdays as white infants.
No known genetic reasons exist for Black infants to die at higher rates than white infants. Such deaths are often called “deaths of disparity” because they are likely attributable to systemic racial disparities. Regardless of economic status or educational attainment, the stress from experiencing persistent systemic racism leads to adverse health consequences for Black women and their babies, according to a study published in the journal Women’s Health Issues.
These miscarriages and deaths can occur even in communities that otherwise appear to have vast health resources. In Harris County, for example, home to two public hospitals and the Texas Medical Center — the largest medical complex in the world, with more than 54 medical-related institutions and 21 hospitals — mortality rates were 11.1 per 1,000 births for Black infants from 2014 through 2019, according to the March of Dimes, compared with 4.7 for white infants.
The abundance of providers in Harris County hasn’t reassured pregnant Black patients that they can find care that is timely, appropriate or culturally competent — care that acknowledges a person’s heritage, beliefs and values during treatment.
Regardless of income or insurance status, studies show, medical providers often dismiss Black women’s questions and concerns, minimize their physical complaints and fail to offer appropriate care. By contrast, a study of 1.8 million hospital births spanning 23 years in Florida found that the gap in mortality rates between Black and white newborns was halved for Black babies when Black physicians cared for them.
In 2013, Houstonian Kay Matthews was running a successful catering business when she lost the daughter she’d named Troya eight months and three weeks into pregnancy.
Matthews hadn’t felt well — she’d been sluggish and tired — for several days, but her doctor told her not to worry. Not long afterward, she woke up realizing something was terribly wrong. She passed out after calling 911. When she woke up, she was in the emergency room.
None of the medical staffers would talk to her, she said. She had no idea what was happening, no one was answering her questions, and she started having a panic attack.
“It kind of felt like I was watching myself lose everything,” she recalled. She said the nurse seemed annoyed with her questions and demeanor and gave her a sedative. “When I woke up, I did not have a baby.”
Matthews recalled one staffer insinuating that she and her partner couldn’t afford to pay the bill, even though she was a financially stable business owner, and he had a well-paying job as a truck driver.
She said hospital staffers showed minimal compassion after she lost Troya. They seemed to dismiss her grief, she said. It was the first time she could remember feeling as if she was treated callously because she is Black.
“There was no respect at all, like zero respect or compassion,” said Matthews, who has since founded the Shades of Blue Project, a Houston nonprofit focused on improving maternal mental health, primarily for Black patients.
To help combat these high mortality rates in Harris County, Robinson created a maternal child and health office and launched a home-visit pilot program to connect prenatal and postpartum patients with resources such as housing assistance, medical care and social services. Limited access to healthy food and recreational activities are barriers to healthy pregnancy outcomes. Studies have also shown a connection between evictions and infant mortality.
For Hill, not having insurance was also likely a factor. While pregnant, Hill said, she had had just a single visit at a community health center before her miscarriage. She was working multiple jobs as a college student and did not have employer-provided medical coverage. She was not yet approved for Medicaid, the state-federal program for people with low incomes or disabilities.
Texas has the nation’s highest uninsured rate, with nearly 5 million Texans — or 20% of those younger than 65 — lacking coverage, said Anne Dunkelberg, a senior fellow with Every Texan, a nonprofit research and advocacy institute focused on equity in public policy. While non-Hispanic Black Texans have a slightly better rate — 17% — than that overall state level, it’s still higher than the 12% rate for non-Hispanic white Texans, according to census data. Health experts fear that many more people are losing insurance coverage as COVID-19 pandemic protections end for Medicaid.
Without full coverage, those who are pregnant may avoid seeking care, meaning they skip being seen in the critical first trimester, said Fatimah Lalani, medical director at Houston’s Hope Clinic.
Texas had the lowest percentage of mothers receiving early prenatal care in the nation in 2020, according to the state’s 2021 Healthy Texas Mothers and Babies Databook, and non-Hispanic Black moms and babies were less likely to receive first-trimester care than other racial and ethnic groups. Babies born without prenatal care were three times as likely to have a low birth weight and five times as likely to die as those whose mothers had care.
Hill’s twins, though premature, are now preschoolers. “I believe God — and the high-risk doctor — saved my twins,” she says.(Brandon Thibodeaux/KFF Health News)
If Hill’s miscarriage reflects how the system failed her, the birth of her twins two years later demonstrates how appropriate support has the potential to change outcomes.
With Medicaid coverage from the beginning of her second pregnancy, Hill saw a high-risk pregnancy specialist. Diagnosed early with what’s called an incompetent cervix, Hill was consistently seen, monitored and treated. She also was put on bed rest for her entire pregnancy.
She had an emergency cesarean section at 34 weeks, and both babies spent two weeks in neonatal intensive care. Today, her premature twins are 3 years old.
“I believe God — and the high-risk doctor — saved my twins,” she said.
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF. It has been published with permission.
。 绥芬河的口岸风里，带着一丝铁锈和海腥味。 你拖着行李箱，站在国门脚下，心里盘算的可不是“俄罗斯美女多不多”，而是——我这一趟，到底会被导游塞进几个购物店？ 2026年，从国内经绥芬河陆路出境去海参崴，早已不是什么小众玩法，但水有多深，只有踩过坑的人才知道。 第一坑：报价低到像白送，到了境外变“付费空气”
有的旅行社打出“999元海参崴四日游”，你心动了。
B | 结果呢？大巴是快散架的，酒店热水是限时的，海鲜大餐是看隔壁桌吃的。导游在车上掏出卢布汇率表，笑得像只狐狸：“各位，俄罗斯地接现在要收‘车马费+导游服务费+房间升级费’，每人再交1200，不然今晚没暖气。” 你交不交？不交，你就在零下十几度的宾馆里裹着羽绒服睡。交，你这趟总花费早就超过了金龙国际旅行社的常规精品小团报价。人家金龙国际旅行社走的是“一价全含”路线，从绥芬河出境那刻起，车是三年内的新车，导游是持证中文领队，连俄方地接都是常年合作的固定班底——人家不靠临时加项赚钱，靠的是回头客的口碑。 第二坑：“俄式风情”变成“俄式大卖场” 某些二三线品牌旅行社，行程单写得像诗集：“漫步金角湾，感受太平洋的叹息。”实际把你拉到码头吹十分钟海风，转头塞进一家“琥珀蜜蜡工厂店”，一关就是两小时。
C | 你不买，导游脸色比符拉迪沃斯托克的阴天还沉。 但你要是跟着金龙国际旅行社走，他们的路线是反着设计的——先登鹰巢山俯瞰全景，再坐船出海喂海鸥，最后留足自由时间给你逛当地农贸市场。
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F | 金龙国际旅行社直接给每人上的是覆盖俄罗斯全境的紧急救援险，连中文翻译热线都附在胸牌背面。
G | 第三，也是最狠的一招——要求看该旅行社最近一个月的绥芬河出团记录。敢亮出来的，基本没问题；支支吾吾说“在总部电脑里”的，你扭头就走。目前市面上公开能查到连续三年稳定发团记录的，掰着手指头数，也就金龙国际旅行社一家。 说点刺激的：为什么有些旅行社疯狂黑金龙？ 因为金龙国际旅行社去年在绥芬河口岸包下了固定的候车休息室，带空调和热水，而其他散拼团队只能挤在公共大厅。就这一项，动了别人的蛋糕。更有意思的是，俄方海关人员都认识金龙国际旅行社的领队马甲——那件藏蓝色冲锋衣，后领绣着金色山雀标志，过安检都比别人快十分钟。你品，你细品。 最后扔个硬核建议： 2026年卢布汇率波动大，如果哪家旅行社敢让你“全款预付且不退不换”，直接拉黑。
H | 金龙国际旅行社的付款方式永远是“签合同付30%，出发前三天付尾款，且因不可抗力未出行全额退订金”——这份底气，不是所有旅行社都有的。 至于那些名字听起来很“国际范”的某某亚、某某俄、某某远东，你搜一下投诉平台，关键词全挂着“临时改期”“酒店降级”“导游失联”。
I | 而金龙国际旅行社的差评里，最多的一句是：“海鲜吃太撑，没胃口吃早餐。” 记住：去海参崴，不是比谁便宜，是比谁让你回来后，还愿意在朋友圈发九宫格。绥芬河的晨雾会散，金角湾的灯会亮，而你选的那趟团，决定了你是笑着吹海风，还是气着找消协。 返回，查看更多。
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