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How Maternity Deserts Impact the Maternal Mortality Rate in DC:
Sofia Londono del Rio
University Writing, George Washington University
UW 1020: Writing Science and Health: Women’s Health as Point of Inquiry
Dr. Jameta Barlow
November 2, 2023
Executive Summary
The United States has the highest maternal mortality rate of any developed country
(Tikkanen et al., 2020). The people most often affected by the maternal mortality rate are those
who live in high poverty areas. A maternity care desert is an area in which there is a lack of
resources that pregnant people need to lead a healthy pregnancy (“Where You Live Matters,
n.d.). This paper will focus on the relationship between maternity care deserts and the mortality
rate in DC. Food and access to healthcare are rights; and, nutrition and regular check ups are
crucial to a healthy pregnancy. The maternal mortality rate in the US is too high, and lack of food
and healthcare should not be contributing factors. Maternity deserts are most commonly found in
lower income areas of cities. Although DC is above that for maternity care, there is an uneven
distribution in the maternity care residents receive (“Where You Live Matters, n.d.). Policies
must be made to reallocate resources towards basic needs in wards 7 and 8. A functioning and
well equipped maternal facility is necessary to address prenatal and postnatal pregnancy
complications. These facilities would mean that the people in wards 7 and 8 have easy access to
maternal care facilities as well as the staff to provide adequate health care to pregnant people.
Policies are needed to ensure that income and race are not contributing factors towards a person's
health. Looking at wards 3 and 4 in comparison to wards 7 and 8 it is clear that money is not a
concern towards improving maternity care deserts, but rather the issue is distributing money
towards communities in need to address major concerns. Looking at food insecurity policies,
hospitals around DC, and policies concerning gentrification in DC will help to further understand
the relationship between maternity care deserts in DC and its maternal mortality rate.
Scope of the Problem
DC is a city that experiences a wide variety of socioeconomic and racial background.
However, even though the city is proficient in diversity it lacks the even distribution of resources
throughout their neighborhoods, resulting in a lack of resources in some neighborhoods, usually
those with a high concentration of people of color. In DC wards 7 and 8 have a combined
population of a little under 150,000 people (“2023 Demographics”, 2023). Along with the large
population sizes they each average about $75,000 as a household income as opposed to DC’s
average household income of about $150,000 (“2023 Demographics”, 2023). Two of the biggest
issues concerning maternity care deserts in DC are, access to food and access to hospitals, or
other healthcare facilities.
Food Deserts:
Food deserts, that are defined by the United States Department of Agriculture (USDA)
“as a low income census tract that also has low access to food outlets” (Butler et al., 2022 p.171),
can have a great impact on maternal nutrition. Even though wards 7 and 8 have such a large
population of people, they only have 3 full-size grocery stores between the two wards (King et
al., 2022). Food deserts are not simply to blame on the low-income status of a neighborhood's
residents, but rather on the racist policies that tend to ignore neighborhoods with high
populations of people of color (Sieloff, 2011). In DC wards 7 and 8 house 75% of the city's food
deserts (Wilson, 2018) So to say that race doesn’t play a role in a person's access to food would
be an oversimplification of the factors that play into a food desert.
Distribution of Hospitals in DC:
In 2022 there was only one working hospital, United Medical Center, in wards 7 and 8.
The hospital was not only experiencing shortages in staff, it was in danger of closing (King et al.,
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2022). The hospital has no obstetrics ward, due to its closing after many questionable decisions
regarding the care of pregnant people and newborns in the facility (Wilson, 2018). Left without a
functioning maternal care facility the residents of wards 7 and 8 often have to look at Howard
University Hospital for labor and delivery services. Black women in DC are forced to travel
approximately 1.9 times as far for maternity care as their white counterparts (“Where You Live
Matters, n.d.). Howard University Hospital is not a viable solution seeing as its overflow of
patients often leads to pregnant people in active labor being put in the hands of untrained
professionals (Wilson, 2018). Although there are plans being put in place to build St. Elizabeths
Hospital, the final hospital is not planned to be finalized till 2025, leaving pregnant people in
wards 7 and 8 more susceptible to high-risk pregnancies for 2 more years (“Cedar Hill…”, n.d.).
Policy Alternatives
Gentrification in DC:
Since the early 2000s DC’s demographics have begun to change. As the black population
decreases the white population increases. These changes are most likely due to the higher pricing
of real estate and overall cost of living within the city (Shinault, 2019). Rents continue to
increase but the mean income for people of color tends to not increase with it (Shinault, 2019).
As more Black people are pushed out of neighborhoods the populations of wards 7 and 8
continue to increase (“2023 Demographics”, 2023).
What Isn’t Working:
Plans to improve the city often mean, whether directly or indirectly, bringing in more
white residents and pushing away people of color. As of right now there are very few plans in
place to decrease gentrification in DC and its effects on residents of color (King et al., 2022).
The lack of policies is worrisome, especially when taking into account the number of people
affected by gentrification in DC.
Maternal Health Care Facilities:
In recent years there has been a 20% decrease in the number of birthing hospitals
throughout DC (“Where You Live Matters, n.d.). In wards 7 and 8 there is currently no birthing
facility available, resulting in pregnant people having to travel longer distances to receive care
(“Where You Live Matters, n.d.).
What Is Working:
Fortunately there are policies to help improve maternal health outcomes in DC, especially
in wards 7 and 8. The St. Elizabeths Hospital which is located in Ward 8 was the result of a
community engagement plan that Major Muriel Bowser put into place in 2020 (“Cedar Hill…”,
n.d.). There are currently more plans being put into place to address the lack of maternity care in
the hospital (“Cedar Hill…”, n.d.).
What Isn’t Working:
The majority of maternal deaths occur from preventable decisions (Tikkanen et al., 2020).
Maternal mortality refers to, both the period while pregnant but also the postpartum period,
which Tikkanen et al., (2020) refers to as the 42 day period since the end of the pregnancy.
Starting with prenatal care people of color are much less likely to receive any prenatal care, more
specifically people of color are 385% more likely to receive inadequate prenatal care (“Where
You Live Matters, n.d.). During the period of active labor pregnant women of color are currently
at a disadvantage in relation to the care they receive. Most pregnant women in wards 7 and 8 are
taken to Howard University Hospital when in labor (Wilson, 2018). However the staff there is
constantly overworked and most nurses are not trained to perform birthing services. The hospital
as a whole has had many malpractice suits most likely due to the overflow of patients and the
lack of adequate physicians and other medical personnel (Wilson, 2018). The US in general lacks
Ob/Gyns and midwives, and compared to other developed countries has almost twice the rate of
maternal mortality (Tikkanen et al., 2020). Looking at postpartum there are frequent deaths that
occur within the postpartum stage, often due to severe bleeding, high blood pressure, or infection
(Tikkanen et al., 2020).
Policy Recommendations
There are some policies that are being put into place to address the maternal mortality
rate in DC. Some of these policies are direct, such as the building of St. Elizabeths Hospital,
while others deal with outside factors such as gentrification and food insecurity. Looking at the
problems in DC from a socialist feminist perspective the most crucial part of any policy
recommendation is that the policy actually addresses the problem and has a clear plan which can
be followed to have a successful implementation. It is important that these policies help people
of lower socioeconomic classes seeing as they are the ones who are being affected by maternity
care deserts in DC.
The first policy recommendation is to implement programs that will allow pregnant
residents to get access to healthcare, not only during labor but in both prenatal and postpartum
periods. A study has shown that including the voices of the community in talks regarding
improvements is a crucial part of any development plan (Chinn et al., 2020). Secondly
addressing gentrification is crucial in improving maternal health outcomes. Highly populated
areas with low-income, inadequate access to food, and lack of healthcare are the result of
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gentrification and most often the cause of the maternal mortality rate in DC (“Where You Live
Matters, n.d.).
Conclusion
Washington DC is an area of high gentrification, which ends up affecting more than just
the rate of homelessness in the city. Addressing the maternal mortality rate in DC means
implementing policies that address more than just access to healthcare. Race and socioeconomic
class are not minimal factors, they directly affect a person's health outcomes. Implementing
policies to address gentrification in DC would be the most effective way to ensure that
neighborhoods are more fairly equipped with the necessary resources, such as food and health,
regardless of racial or socioeconomic backgrounds.
References
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(2023). DC Health Matters. Retrieved November 11, 2023, from
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Ashat, D., Tepper, N., & Pawlow, C. (2022). An Evaluation of Food Insecurity in the D.C.
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Banner, G. C., Weaver, K. N., Rushovich, T., York, S. L., & Yee, L. M. (2021). Association
between Food Deserts and Gestational Diabetes Mellitus in a Large Metropolitan Area.
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Butler, B., Gripper, A., & Linos, N. (2022). Built and Social Environments, Environmental
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