As a pediatric chief resident at Indiana University’s medical school, Dr. Chaniece Wallace had a list of blessings. This fall, the 30-year-old was interviewing for jobs around the country — and preparing for the birth of her first child.
On Oct. 20, baby Charlotte was born a month premature. Days later, the new mom died.
Her death shook the maternal health care community and has left a “heaviness in our hearts,” says pediatric chief resident Dr. Amalia Lehmann. She’s reminded of her “beloved” friend and coworker when she passes a now-empty chair in her office.
“Chaniece has this strong calm,” Lehmann says, “but she also had a fierce passion for her family, friends, and patients and would advocate strongly for them when needed. She will be greatly missed by all who knew her and truly the loss is great even for those whose lives she was sure to impact in a future that was cut tragically and suddenly short.”
Wallace’s death highlights a stark racial disparity in maternal mortality rates. Nationwide, Black women are at least twice as likely to die in pregnancy, childbirth or within a year of pregnancy as white women.
Wallace’s husband Anthony took to GoFundMe to share how his daughter was born prematurely via C-section. He said his wife developed pre-eclampsia, a pregnancy complication of high blood pressure that disproportionately affects Black moms-to-be.
"Chaniece fought with every piece of strength, courage, and faith she had available," he wrote.
The young doctor’s death has resonated far from Indianapolis. Dr. Shawnté James, a newborn pediatrician in Maryland, mourned for a woman she never knew, lost to a disparity all too common in her patients of color.
“Childbirth isn’t safe for Black Women in America,” Dr. James wrote on Twitter.
She tells Side Effects Media that her first thought was, “not again.”
“Every Black mother that has a pregnancy-related complication that leads to mortality is heartbreak,” she says. “I look at her and she's me. She's a pediatrician, she’s a Black woman, she's just beginning her career. It hurts even more because I always identify with these moms but I saw myself in her.”
The Centers for Disease Control and Prevention reports maternal mortality has historically been used as a key indicator of the health of a population.
Marion County Public Health Department chief medical officer Dr. Virginia Caine says socio-economic factors are barriers to maternal health, and they predate the coronavirus pandemic. For example, low-income pregnant women may lack access to good food or face evictions.
In Indiana, Caine says, Black moms die at nearly three times the rate of their white counterparts.
“It’s those critical early months that we need to have our Black mothers get into care,” Caine says. “Poverty contributes to it.”
James says maternal mortality is bigger than one doctor or hospital, and is due to the systemic racism that more institutions are calling out as a public health crisis.
“Black women are not being well-served by the health care delivery system as it exists now,” she says. “There’s no way, as a Black woman in America, to overcome the systematic institutionalized racism in medicine that is causing this disparity. I can't advocate for myself. Dr. Wallace could not advocate enough for herself to overcome something that’s just built into healthcare.”
Meanwhile, Indiana is addressing a related problem: the number of babies who die before their first birthday.
The Marion County Public Health Department reports the overall infant mortality rate improved in 2019 from the previous year, and the rate for Black babies was the lowest ever. The Black infant mortality rate in Marion County was 10.9 deaths per 1000 live births in 2019, a significant drop from 14 a year earlier.
Gov. Eric Holcomb’s goal is for Indiana to have the lowest infant mortality rate in the Midwest by 2024.
Officials say the statewide infant mortality rate has fallen to the lowest level in recorded history. State Health Commissioner Dr. Kris Box notes that among many successes, Indiana has seen a nearly 30 percent drop in Indiana’s black infant mortality rate in just two years.
Still, the mortality rate for Black babies is significantly higher than for white babies.
Last month, the Indiana Hospital Association and Box began a program to honor birthing hospitals that do a good job addressing key drivers of infant and maternal health.
IU Health, Wallace’s former workplace — but not where she gave birth — is one of the program awardees. The IU Health Methodist labor and delivery and mother-baby teams were recognized for implementing best practices in key areas, including safe sleep, breastfeeding and tobacco prevention and cessation.
Prenatal care is another important factor. Caine says only about 55% of Black moms in Marion County seek prenatal care, compared to 75% of white moms, which can lead to complications for both mom and baby.
“If you're starting [prenatal care] late in your pregnancy,” she says, “you may have a simple bladder or a urinary tract infection that can cause the baby to be born prematurely.”
Dr. Lauren Dungy-Poythress, a Black woman who specializes in maternal-fetal medicine at Riley Children’s Health, didn’t personally know or treat Wallace. But she says women with underlying medical conditions — like high blood pressure, diabetes or lupus — are at increased risk for pregnancy complications such as pre-eclampsia.
Singer and cultural icon Beyoncé’s pregnancy highlighted the disparity of Black moms having complicated pregnancies even when money are not an issue. In a 2018 interview with Vogue, she opened up about a difficult pregnancy with twins Rumi and Sir, revealing she was “swollen from toxemia,” also known as pre-eclampsia.
Dungy-Poythress says all doctors can be more aware of how implicit bias associated with race and identity can impact patients.
“I don't know anything about Dr. Wallace except that she was a lovely woman that was loved by her family,” Dungy-Poythress says. “I know she was educated and I know she was a physician and that implies to me that she did not lack access to care. So that's not the only factor that puts you at risk.”
This story was produced by Side Effects Public Media, a news collaborative covering public health.
This story was reported as part of a partnership between WFYI, Side Effects Public Media and the Indianapolis Recorder.