Risking Death for Pregnancy and Childbirth

Three weeks after Cassaundra Lynn Perkins gave birth to premature twins, she returned

to the hospital, feeling unwell. She phoned her mother from her hospital bed at

3:30 in the morning. "I'm just not feeling good," she said. Surely it was just another

bout of the mysterious illness her daughter had been suffering from for most of

her pregnancy, Cheryl Givens-Perkins thought as she rushed over to San Antonio's

North Central Baptist Hospital. When Givens-Perkins walked into the room, her


daughter looked exhausted. She begged her mother to comb her hair. "I need to get

ready," she said. "Please get my hair in order." "She may have known she was dying,"

Givens-Perkins said.

Every year, around 700 women in the United States die as a result of pregnancy or

delivery complications. As many as 60,000 expectant mothers suffer problems that

come close to costing them their lives. America is one of the most developed nations

in the world. Average life expectancy has been generally increasing over at least

the last five decades, and deaths from illnesses that were once widely fatal, including

polio, smallpox, tuberculosis and AIDS, are sharply falling.

Yet when it comes to the natural process of childbearing, women in the U.S. die

in much higher numbers than those in most developed nations, where maternal deaths

are generally declining.

A woman in the U.S., where the maternal death rate more than doubled between 1987

and 2013, is more likely to die from pregnancy-related causes than in any country

but Mexico among the 31 industrialized countries of the Organization for Economic

Cooperation and Development that reported data.

There are various theories why persistent poverty, large numbers of women without

adequate health insurance, risk factors related to stress and discrimination. All

come together here in Texas, with a twist that has become one of America's most

confounding public health problems: African American women are dying of pregnancy-

and childbirth-related causes here at stunningly high rates. The maternal death

rate in Texas after 2010 reached "levels not seen in other U.S. states," according

to a report compiled for the American College of Obstetricians and Gynecologists,

based on figures from the U.S. Centers for Disease Control and Prevention.

Black women in Texas are dying at the highest rates of all. A 2016 joint report

by the Texas Department of State Health Services' Maternal Mortality and Morbidity

Task Force found that black mothers accounted for 11.4% of Texas births in 2011

and 2012, but 28.8% of pregnancy-related deaths. "This is a crisis," said Marsha

Jones, executive director of the Afiya Center, a Dallas-based nonprofit that has

taken on the issue. In May, the center published its first report: "We Can't Watch

Black Women Die."

Perkins, who already had a 2-year-old, worked at Great Clips salon and hoped to

one day open her own salon. Her pregnancy with twins in 2014 was challenging. "She

was sick to where she could not keep anything down," Givens-Perkins said. Doctors

said it was an infection. Then six months into her pregnancy, Perkins' liver started