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.
C | 因承办中超赛事需要满足各类条件，中足联筹备组决定对各俱乐部主场办赛条件进行实地考察。具体考察工作于7月7日，也就是联赛会议结束后第2天正式开始。考察组兵分两路，先后对6座候选赛区城市7家俱乐部的场地进行了考察。其中A组先后完成了对成都市凤凰山专业球场、武汉市体育中心体育场、五环体育中心体育场、郑州航海体育场；B组先后完成了对深圳龙岗大运体育场、长春市内的一座体育场、济南奥体中心（鲁能大球场）的考察。也就是说，成都蓉城、武汉三镇、武汉长江、河南嵩山龙门、深圳、长春亚泰、山东泰山7家中超俱乐部的主场首选场地均已接受了工作组的考察，且这些场地均通过了本轮考察。未接受本轮考察的场地 大多此前承办过大型赛事 至于余下中超各俱乐部场地未接受本轮考察，主要是因为其候选主场场馆此前大多曾成功举办过大型体育或足坛赛事，近期也接受过专业团队的考察，或正在承办职业足球赛事。比如，大连人俱乐部属地大连市、梅州客家俱乐部属地梅州市刚刚承办了中超联赛首阶段赛事，其比赛及训练场地自然满足承办主场比赛的条件。
D | 本周，从大连赛区传来消息，曾经承接中超联赛首阶段大连赛区部分赛事的大连市普湾体育场将成为大连人队本赛季的主场，相关信息已得到当地有关部门官方确认。浙江足球俱乐部计划将湖州市的一座球场申报为本队主场场地，在此之前，该场地曾作为杭州亚运会备选赛事场地接受过考察，条件亦符合中超办赛要求。
E | 广州赛区曾经多次承办过中超比赛，赛区内多座球场还曾成功承接过中国队备战与比赛接待任务，因此只要同城两家中超俱乐部与赛区属地及场地方面达成共识，那么重新承办中超赛事就非常有希望。北京国安、上海两支球队 能否在属地城市比赛还没确定 据了解，部分俱乐部在属地政府部门支持下，于联赛工作会议结束后两三天内就确认可以承办中超主场赛事。包括梅州客家、大连人、长春亚泰、河南嵩山龙门、武汉两家俱乐部在内的部分俱乐部，承接各自主场比赛的前景均比较乐观，有些甚至已经明确可以承办主场比赛。至于北京国安、上海两支球队能否在其俱乐部属地城市进行主场比赛目前还没有确切答案。不过，在过去两个赛季期间，距离上海市地理位置较近的苏州赛区，特别是其中的昆山赛区的球场曾经多次承办过两支上海球队的比赛，还曾承办过“上海德比”，且观众上座率较高。因此理论上来说，两支上海球队存在将苏州（昆山）赛区部分场地申报为本俱乐部队主场的可能性。
F | 文/本报记者 肖赧
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