Not even being an expert on racial disparities in health care. The afternoon light was gray but bright, flooding through tall arched windows and pouring past white columns, illuminating the flag that covered her casket. Sprays of callas and roses dotted the room like giant corsages, flanking photos from happier times: Shalon in a slinky maternity dress, sprawled across her couch with her puppy; Shalon, sleepy-eyed and cradling the tiny head of her newborn daughter, Soleil.
In one portrait Shalon wore a vibrant smile and the crisp uniform of the Commissioned Corps of the U. Public Health Service, where she had been a lieutenant commander.
Many of the mourners were similarly attired. There she had focused on trying to understand how structural inequality, trauma and violence made people sick. Her Twitter bio declared: Her discovery in mid that she was pregnant with her first child had been unexpected and thrilling.
Then the unthinkable had happened. Three weeks after giving birth, Shalon had collapsed and died. The sadness in the chapel was crushing. Wanda Irving had been especially close to her daughter —role model, traveling companion, emotional touchstone. She sat in the front row in a black suit and veiled hat, her face a portrait of unfathomable grief. Sometimes she held Soleil, fussing with her pink blanket.
When you remember this child, you remember the love that God has pushed down through her for all of us. Soleil is our gift. The researcher working to eradicate disparities in health access and outcomes had become a symbol of one of the most troublesome health disparities facing black women in the U.
The main federal agency seeking to understand why so many American women — especially black women — die and nearly die from complications of pregnancy and childbirth had lost one of its own. Two members of the U. Then they folded it into a precise triangle small enough for Wanda and Samuel to hold next to their hearts.
Shalon MauRene Irving was a lieutenant commander in the uniformed ranks of the U. Courtesy of Wanda Irving In recent years, as high rates of maternal mortality in the U. According to the CDC, black mothers in the U. Put another way, a black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but percent more likely to die from pregnancy- or childbirth-related causes.
In a national study of five medical complications that are common causes of maternal death and injury, black women were two to three times more likely to die than white women who had the same condition. That imbalance has persisted for decades, and in some places, it continues to grow. In New York City, for example, black mothers are 12 times more likely to die than white mothers, according to the most recent data; from to , their risk of death was seven times higher.
Researchers say that widening gap reflects a dramatic improvement for white women but not for blacks. The disproportionate toll on African Americans is the main reason the U.
Black expectant and new mothers in the U. Again, New York City offers a startling example: A analysis of five years of data found that black college-educated mothers who gave birth in local hospitals were more likely to suffer severe complications of pregnancy or childbirth than white women who never graduated from high school.
The systemic problems start with the type of social inequities that Shalon studied — differential access to healthy food and clean drinking water, safe neighborhoods and good schools, decent jobs and reliable transportation.
Black women are more likely to be uninsured outside of pregnancy, when Medicaid kicks in, and thus more likely to start prenatal care later and to lose coverage in the postpartum period. They are more likely to have chronic conditions such as obesity, diabetes, and hypertension that make having a baby more dangerous. The hospitals where they give birth are often the products of historical segregation, lower in quality than those where white mothers deliver, with significantly higher rates of life-threatening complications.
In the more than stories of African-American mothers that ProPublica and NPR have collected over the past year , the feeling of being devalued and disrespected by medical providers was a constant theme. The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair.
Over and over, black women told of medical providers who equated being African American with being poor, uneducated, noncompliant and unworthy. Hakima Tafunzi Payne, a mother of nine in Kansas City, Missouri, who used to be a labor-and-delivery nurse and still attends births as a student midwife, has seen this cultural divide as both patient and caregiver. Blacks make up 6 percent of doctors though 11 percent of OB-GYNs , 3 percent of medical school faculty and less than 2 percent of National Institutes of Health-funded principal investigators.
An expanding field of research shows that the stress of being a black woman in American society can take a significant physical toll during pregnancy and childbirth. Watch the Video The U. Stress has been linked to one of the most common and consequential pregnancy complications, preterm birth. Black women are 49 percent more likely than whites to deliver prematurely and, closely related, black infants are twice as likely as white babies to die before their first birthday. Maternal age is an important risk factor for many severe pregnancy-related complications, as well as for chronic diseases that can affect pregnancy, like hypertension.
Should doctors and clinicians be taking into consideration this added layer of vulnerability? Even in its current liberal incarnation , Portland is one of the whitest large cities in the U. Thirty years ago, Portland was a much more uncomfortable place to be black. Samuel Irving spent years working as a railroad engineer; he got a law degree and later ran a city agency, but felt his prospects were still constrained by his race.
Wanda held various jobs in marketing and communications, including at the U. In elementary school, Shalon was sometimes the only African-American kid in her class. She read voraciously, wrote a column for a black-owned weekly newspaper and skipped a grade. Shalon nagged her father to stop smoking and her mother to lose weight. She set an example, shedding nearly pounds while managing to graduate summa cum laude. She was pursuing a double Ph. She was also juggling family responsibilities.
His next goal was to walk across the stage to receive his diploma instead of using his wheelchair. In February , while he was doing physical rehab to regain strength in his legs, a blood clot traveled to his lung, killing him at the age of Afterward, Wanda and Shalon clung to each other more tightly than ever.
As part of the uniformed ranks of the U. It bothered her that she rarely met the people behind the data she was analyzing. The stress and frustration triggered the old corrosive self-doubts. But gradually, Shalon saw a way out of the box. She started a coaching business called Inclusivity Standard to advise young people from disadvantaged backgrounds who wanted to get into college or grad school, as well as organizations seeking to become more diverse.
She enlisted her mother, now working as a consultant, and Pryor to join her team. One way of [reaching people] is just not enough. No one knows what causes fibroids or why blacks are so susceptible. Surgery bought her a little time, but her OB-GYN urged her not to delay getting pregnant much longer. Shalon had spent her adult years defying stereotypes about black women; now she wrestled with the reality that by embracing single motherhood, she could become one.
In September , in the midst of one unsuccessful insemination treatment, Shalon was alarmed to discover that her right arm had become swollen and hard. Doctors found a blood clot and diagnosed her with Factor V Leiden , a genetic mutation that makes blood prone to abnormal clumping. But no one had been tested for the mutation, which is primarily associated with European ancestry. It was a what-if too painful to dwell on. By April , Shalon had given up. Her excitement was tempered by fear that the baby might have contracted Zika, which can cause microcephaly and other birth defects.
But a barrage of medical tests confirmed all was well. A few weeks later Pryor learned she was pregnant, too. Because for so long it was just dark clouds and rain.
Are you going for your walks? She also had a history of high blood pressure, though it was now under control without medication. Shalon got though the physical challenges surprisingly well.
Her team at Emory University, one of the premier health systems in the South, had no trouble managing her clotting disorder with the blood thinner Lovenox. They worried that scarring from the fibroid surgery could result in a rupture if her uterus stretched too much, so they scheduled a C-section at 37 weeks.
There were worries about money and panic attacks about the difficulties of being a black single mother in the South in the era of Trayvon Martin and Tamir Rice. Shalon told everyone she was hoping for a girl. Steeped in research about how social support could buffer against stress and adversity, Shalon joined online groups for single moms and assembled a stalwart community she could quickly deploy for help. She sent Tran the manuscript on Jan.
But according to the most recent CDC data, more than half of maternal deaths occur in the postpartum period, and one-third happen seven or more days after delivery. For American women in general, postpartum care can be dangerously inadequate — often no more than a single appointment four to six weeks after going home. Brown has made reforming postpartum care one of his main initiatives as president of the American Congress of Obstetricians and Gynecologists.
The dangers of sporadic postpartum care may be particularly great for black mothers. African Americans have higher rates of C-section and are more than twice as likely to be readmitted to the hospital in the month following the surgery. They have disproportionate rates of preeclampsia and peripartum cardiomyopathy a type of heart failure , two leading killers in the days and weeks after delivery.
If they experience discrimination or disrespect during pregnancy or childbirth, they may be more likely to skip postpartum visits to check on their own health they do keep pediatrician appointments for their babies.
Lack of paid maternity leave and childcare can create additional hurdles.