anjau – Contemporary Concerns in Medicine

Impact of Covid-19

Pre-pandemic, caregiving for adult family members was already more commonplace in Black families than in white families. In fact, 18% of Black women reported caregiving compared to only 12% of white women.⁴ Similar to the gender makeup of caregivers for all races, Black women take on the brunt of caregiving work.⁵ The pandemic both exacerbated stress for existing caregivers and forced more women to become caregivers, with an additional 11% of Black female KFF survey respondents reporting that they started or picked up additional caregiving duties for family members during the pandemic.⁴

Covid-19’s health risks and disruption of work habits played a big role in the pandemic’s negative impacts on Black caregivers. Black workers and other workers of color were much more likely to be on the frontlines of the pandemic, which added the stress of having to keep working while simultaneously caregiving during their few hours spent at home.¹ When considering the fact that Black Americans are less likely to have received at least one vaccine dose than Latinx or white Americans, the fear of bringing home illness to a physically compromised loved one adds to existing caregiving stress.¹

The pandemic also caused upset in the dynamics of homes with adult caregivers– the massive disruption of routines made it difficult for many caregivers to help family members readjust to a new way of life. Such as in the case of Sabrina Scott, a 56-year-old Black woman who was the primary caregiver for her maternal grandmother through the pandemic, disrupted routines may have contributed to the health decline of her grandmother and other adults who depended on caregiving.¹ The pandemic’s disproportionate health, financial, and work-related effects on the Black community directly impacted the mental and physical health of both Black caregivers and their loved ones they looked after.

It Takes a Village

“Healthcare providers aren’t patient, don’t listen and tend to make assumptions about African Americans and Blacks.”

Anonymous respondent to American Society on Aging survey

According to the American Society on Aging, Black caregivers are less likely to have undergone formal training or enlist the help of paid caregivers/care facilities.²This can be due to multiple reasons, such as the fact that there is a stigma against entrusting the care of loved ones to others outside of family, friends, and community members. Due to a historical bar of access and subsequent poor interactions with medical staff, many Black families are deterred from the traditional medical system of caregiving. When attempts to use the traditional system are made, 56% of surveyed Black caregivers report some or a great deal of difficulty coordinating with health care professionals such as doctors, nurses, and service workers.² A respondent to the aforementioned survey included the sentiment “Healthcare providers aren’t patient, don’t listen and tend to make assumptions about African Americans and Blacks,” exemplifying the reason why loved ones who cannot advocate for themselves are not commonly left in the care of medical professionals.²

This cultural attitude towards refusing formal caregiving assistance was noticed by Sabrina Scott, who felt the added pressure to take care of her grandmother herself. Her family resisted a higher level of care for both her maternal and paternal grandmothers, essentially saying, “We don’t do that.”

“We meaning Black people,” Scott further explained.¹ Overall, informal sources of support such as friends, family, church congregations, and other community members are much more common for Black caregivers who enlist additional help.²

“We don’t do that. ‘We’ meaning Black people.”

Sabrina Scott

Cultural practices play a large role in the dynamics of Black caregiving– both in positive and negative ways. The value placed on community and family can help provide additional support networks and often justifies the reason family members are willing to make sacrifices to care for their loved ones. While roughly half of the respondents to a National Alliance for Caregiving survey reported that they felt they had no choice in caregiving, the majority said they found an important sense of purpose or meaning in their role (more so than white and Asian respondents).³

However, cultural factors can also have negative impacts. Black caregivers work the most unpaid hours of any race, averaging 31.4 hours weekly, and 54% of Black caregivers provide high intensity care.¹ This is likely due to the reluctance to enlist formal medical services to assist in caregiving, although the cultural mistrust of such services is justifiable. Cultural generational differences can also create tension in households, which adds to caregiver stress. While Millennials are more likely to be open about mental health issues, the deeply ingrained stigma about mental health in the Black community makes discussing mental health a point of contention for many Black seniors.⁵ The role that cultural dynamics play in Black caregiving is important to consider when trying to integrate healthcare and formal support workers into caregivers’ support networks.

Conclusion

Moving forward, it is essential that an effort is made to regain and establish the Black community’s trust in medical professionals, particularly those that work in long term care or assisted living sectors. Healthcare workers must continually check in on the mental and physical health of Black caregivers, and all formal support workers must be educated on how they can begin to heal the divide of mistreatment and mistrust. Partnering with faith-based or community-based organizations to spread the word about assistance for caregivers would be a step in the right direction.² While family and community holds an incredibly important position in many Black communities, caregiving is still labor.

Photo taken from Pexels

Pregnancy is viewed as a normal process of life, a cycle that is repeated so frequently that the risks are often forgotten. However, millions of pregnant women die before, during, or after birth each year, largely due to preventable causes. Lack of access to health care (an obstacle faced by many women living in rural areas) is a huge risk factor for maternal and infant mortality/poor birth outcomes. Furthermore, the intersection of little to no health care and impacts of climate change poses an even greater risk for rural women. Surmounting evidence shows that the negative effects of climate change compound on pregnant women in rural areas to a higher degree than women in nonrural areas. As the earth continues to warm, healthcare initiatives must be put in place to protect rural pregnant women and prevent poor birth outcomes.

Living on the Moon

The shocking distance from health providers experienced by some communities can be perfectly encapsulated by Stan Brock, the creator of Remote Area Medical (a program that provides free pop-up clinics to rural communities). When describing a trip to a rural area of the Amazon, locals told him that the nearest doctor was 26 days away by foot. After relaying the story to astronaut Ed Mitchell, Brock was told that astronauts on the moon were a mere 3 days away from the nearest doctor.² Brock’s grave revelation that people living in remote areas of the world are basically living on the moon has stark implications for pregnant women.

“People in the rural Amazon and rural America basically live on the moon.”
Stan Brock from Remote Area Medical²

Pregnant women living in rural areas with little to no access to healthcare have heightened vulnerability to several factors that climate change also influences, such as environmental health and housing/food security. The limited access to health providers increases risk of poor birth outcomes when complications from these factors occur; in fact, over half of rural American women live at least 30 minutes away from a hospital with a labor and delivery unit.⁵ It is also common for rural women to attend prenatal appointments much later in their pregnancies than nonrural women.⁵ Furthermore, environmental hazards from industries commonly found in rural areas (such as agriculture, logging, and mining), unsafe housing that lacks temperature control and other necessities, and limited access to fresh and affordable food pose existing threats to the health of pregnant rural women.⁵ These social determinants of rural health compound the effects of climate change, creating a dangerous environment for rural women to go through their pregnancies.

Climate Change and Pregnancy Outcomes

As the effects of climate change become increasingly drastic, it is important that healthcare workers are prepared to combat the negative consequences on pregnant women’s health. As global temperature hikes increase the frequency and intensity of extreme weather events such as droughts, food insecurity subsequently increases. Such weather conditions also make homes without temperature control unsafe to live in, which can lead to negative birth outcomes, increased morbidity, and forced migration. Tropical developing countries, along with any areas with high poverty rates, poor healthcare systems, or little to no healthcare access will be hit the hardest by these effects.³ Many rural communities fall into all of these high risk areas, meaning increased prenatal care to rural women is integral.

As the most vulnerable members of society, pregnant women, fetuses, and newborns are prone to suffering from the effects of food/housing insecurity and high ambient temperatures. During pregnancy, energy demand increases by 20%.³ This means that more food is required for all of a pregnant woman’s bodily functions to operate at full capacity, but food insecurity means that food is not a reliable source in equal quantities throughout the pregnancy. Underweight women are more likely to give birth to underweight or intrauterine growth restricted babies, which inherently places newborns in a vulnerable position.³ Additionally, food and water insecurity leads to mass migration. With an estimated several hundred million climate refugees by 2050, prenatal care will be virtually impossible for displaced women.³ Throughout the upcoming decades, the lives and health of pregnant women and newborns are in imminent danger.

Ugandan Case Study

“During the dry season, it’s suffering. If you don’t save what [food] you had during the rainy season, then in the dry season you find you have nothing when you are pregnant.”
Women from rural communities in Kanungu District of Uganda_¹

The damage to the health of pregnant women living in tropical, rural areas is exemplified by a case study conducted in the rural Kanungu District in Uganda. This area is already threatened by food insecurity due to droughts and other weather that harm the region’s agriculture, particularly in the dry season. In a series of interviews conducted with adult women of all ages, it was noted that the rainy season is the best because “every crop grows” and that the insecurity has reached a point where food grown in the rainy season must be saved for the dry season to avoid starvation.¹ The women reported many negative symptoms during pregnancy, including “nausea”, “general malaise”, “dizziness”, “shivering”, and “weakness”, in addition to a recent increase in babies that are “weak”, “small”, and “having more sickness”.¹ They noted that this was due to mothers not having enough to eat anymore due to droughts. Another observation indicated that babies born in the rainy season are typically stronger due to an increase in food availability towards the end of pregnancy. Since food variability late in pregnancy becomes increasingly detrimental to the health of the baby, some mothers expressed interest in trying to plan pregnancies around rainy and dry seasons, although this often isn’t possible due to family planning challenges.¹ The health observations by these mothers make it evident that climate change is already affecting rural regions negatively and that it will only continue to do so as global temperatures increase.

Source: *Seasonality, climate change, and food security during pregnancy among indigenous and non-indigenous women in rural Uganda: Implications for maternal-infant health.*

Implications

Although millions of rural women are at risk of increasingly dangerous pregnancies in the upcoming decades, there isn’t a lot of research documenting the physiological reasons negative birth outcomes due to various climate change effects occur.⁴ How can public health officials be prepared to face a crisis that they aren’t armed to fight? Until research investigating the physiological effects of factors such as heat exposure at different gestational periods, chronic heat exposure, and heat acting in tandem with environmental pollutants becomes available, increasing the amount of prenatal care to rural women is the best solution.⁴Hopefully, awareness of the risks that rural pregnant women face in the upcoming decades will become more widespread before a major public health crisis occurs. In our ever changing world, we cannot let rural women and their babies fall through the cracks.

References

¹Bryson, J., Patterson, K., Berrang-Ford, L., Lwasa, S., Namanya, D. B., Twesigomwe, S., Kesande, C., Ford, J. D., & Harper, S. L. (2021). Seasonality, climate change, and food security during pregnancy among indigenous and non-indigenous women in rural Uganda: Implications for maternal-infant health. PloS One, 16(3), e0247198. https://doi.org/10.1371/journal.pone.0247198

²Remote Area Medical. Directed by Farihah Zaman and Jeff Reichert, Candescent Films, 2013.

³Rylander, C., Øyvind Odland, J., & Manning Sandanger, T. (2013). Climate change and the potential effects on maternal and pregnancy outcomes: an assessment of the most vulnerable – the mother, fetus, and newborn child. Global Health Action, 6(1), 19538–19539. https://doi.org/10.3402/gha.v6i0.19538

⁴Samuels, L., Nakstad, B., Roos, N., Bonell, A., Chersich, M., Havenith, G., Luchters, S., Day, L.-T., Hirst, J. E., Singh, T., Elliott-Sale, K., Hetem, R., Part, C., Sawry, S., Le Roux, J., & Kovats, S. (2022). Physiological mechanisms of the impact of heat during pregnancy and the clinical implications: review of the evidence from an expert group meeting. International Journal of Biometeorology, 66(8), 1505–1513. https://doi.org/10.1007/s00484-022-02301-6

⁵ “Social Determinants of Health for Rural People.” Social Determinants of Health for Rural People Overview, Rural Health Information Hub, 6 June 2022, https://www.ruralhealthinfo.org/topics/social-determinants-of-health.

Author: anjau

Caregiving In the Black Community