When Your Zip Code Determines Whether You Live or Die

Amber Isaac Photo: Courtesy Bruce McIntyre/The City

On April 17, 26-year-old graduate student Amber Isaac tweeted, “Can’t wait to write a tell all about my experience during my last two trimesters dealing with incompetent doctors at Montefiore.” Her partner, Bruce McIntyre, told The City that throughout her pregnancy, Isaac had brooded over statistics that showed how much likelier black mothers were to die during or just after pregnancy; black New Yorkers are eight times more likely to die in childbirth than their white counterparts, according to the mayor’s office.

McIntyre said Isaac was worried about doctors’ replacing her in-person prenatal visits with video calls, a now-common practice to limit exposure during the pandemic, and begged her doctors to see her in person. When they finally did for the first time in roughly two months, doctors discovered her platelet levels were low. Within four days of her tweet, Isaac had given birth to a son at that Bronx hospital but lost her own life to a rare pregnancy complication. “She bled out,” said McIntyre.

A downstream effect of the coronavirus is that it has made it harder for even the uninfected to get the care they need, whether because nonessential care is shut down or because of the terror of going to the hospital. And new research shows that just as the virus has disproportionately affected black and Latino communities in particular neighborhoods, life-threatening pregnancy complications like the ones Isaac worried about also tend to correlate with where you live. A team of researchers at the Icahn School of Medicine at Mount Sinai tracked over 300,000 women giving birth in New York City hospitals between 2012 and 2014. Their findings amplify what public-health experts have long known, which is that anyone can get sick, but how they fare — who lives or dies — can depend on something as socially determined as your Zip Code.

What the researchers wanted to find out, co-author Teresa Janevic told me, was the role geography played in maternal mortality and morbidity, meaning life-threatening complications. What neighborhood you live in and what hospital you go to, she argued in an interview, is “a representation of structural racism, to look at the association between geography and these severe complications.” Past researchers have looked at how residential segregation affects health, but “it hasn’t been associated with maternal health before,” Janevic said.

What they found was stark. According to their paper, published in the May issue of Health Affairs, women who lived in a Zip Code “with the highest concentration of poor blacks relative to wealthy whites experienced 4.0 cases of severe maternal morbidity per 100 deliveries, compared with 1.7 cases per 100 deliveries among women in the neighborhoods with the lowest concentration.” They attributed a third of the difference to the hospital where these women delivered. “We found that women living in the majority black and poor neighborhoods were more likely to go to hospitals in similarly segregated neighborhoods, and they suffered the largest effect of being in these segregated neighborhoods,” says Janevic. “The associations between racial and economic spatial polarization and severe maternal morbidity were of the largest magnitude among black and Latina women,” she and her co-authors wrote.

Ethics rules dictated that the researchers not disclose the names of neighborhoods or hospitals, but it’s a reasonable assumption that many of the same preexisting health conditions that correlate with both maternal complications and poverty — obesity, hypertension, diabetes — have made the same communities vulnerable to the coronavirus. “It shows the need to address the root causes of what is making women sick and have poor access to quality care, which is this extreme racial and economic segregation,” said Janevic.

Last week, an emergency maternal-health task force convened by the Cuomo administration took note of the same conditions that had worried Isaac from the start, including the treatment of black and Latina women at hospitals. “Even prior to COVID-19, black women in particular voiced a desire to expand birthing options and to expand access to holistic care teams that engaged in shared decision making,” the task force wrote in its recommendations, which were immediately adopted in full by Cuomo. They recommended expanding access to midwifery services and birthing centers by expediting the licensing process. They also recommended more research and cooperation from the state Department of Health on how COVID-19 is affecting pregnancy and newborns, “with a special emphasis on reducing racial disparities in maternal mortality.” It was too late for Amber Isaac.

When Your Zip Code Determines Whether You Live or Die