Black Maternal Health Week is a week-long initiative that raises awareness of the diminished maternal outcomes for Black women in America, who experience higher rates of pregnancy- and childbirth-related deaths. Alarmingly, Black women are three to four times more likely than white women to die from pregnancy-related causes. The CDC lists multiple factors that lead to increased rates of mortality for Black mothers, including implicit bias and discrimination, variation in quality of health care, and underlying health conditions. While differences in coverage and access to care certainly contribute to poorer health outcomes for Black women, they are still facing disparities in maternal and infant health regardless of their socioeconomic circumstances, including their education level or income. While Black women of any background should not be subjected to such poor maternal health outcomes, this starkly demonstrates how racism and discrimination factor into Black women’s maternal health experiences. Worse, Black women had the highest maternal mortality rates across racial and ethnic groups during the pandemic in 2020 and 2021 and had the largest increase when compared to data from 2019. Overall, the United States ranks worse in overall maternal health outcomes than all of our Organisation for Economic Cooperation and Development (OECD) counterparts. Additionally, the only countries with rising maternal mortality rates are the United States, Afghanistan, and Sudan.
Compounding the Black maternal health crisis in the U.S. is the Supreme Court decision to overturn Roe v. Wade. Now, 26 states have fully banned some or basically all access to abortion care, forcing millions of women of reproductive age to navigate their health care options where it is essentially impossible to obtain an abortion care.
Black women are disproportionately harmed by abortion restrictions and bans, which will likely widen the already stark disparities in maternal and infant health in this country. We know that teen birth rates declined over the last several decades thanks to expanded access to reproductive health care, but were higher among Black, Hispanic, American Indian and Alaska Native, and Native Hawaiian and other Pacific Islander teens compared to their white counterparts.
Meanwhile, the recent ruling by a Trump-appointed Texas District Court Judge to take back its approval of mifepristone, a drug for inducing abortions, used safely in this country for 23 years, is threatening to worsen U.S. Black maternal mortality. More than half of all U.S. abortions are done through medications. Mifepristone has been used by nearly 5 million people in the U.S. since it came to the market and is proven to be safer than Tylenol or Viagra. With this ruling, 40 million more could lose access to abortion care, stripping away their ability to make their own choices about their health care because of the egregiousness of one unelected, right-wing judicial activist. One in four women will have an abortion in their lifetime, and the average person who seeks abortion care is a woman of color who is already a mother and lives below the federal poverty line.
While access to abortion care will not fix the maternal health crisis in this country, restricting it will most certainly contribute to worsen America’s devastating maternal mortality crisis. Per the UN General Assembly, carrying a pregnancy to term against a person’s will is, by definition, a violation of human rights. Research confirms that women who are denied access to abortion care are more likely to experience poorer health outcomes. For example, abortion is one option for treatment for gestational diabetes and gestational hypertension, which are contributors to eclampsia. Preeclampsia is one of the most common disorders during both pregnancy and postpartum, and occurs at a 60% higher rate for Black women than white women. Because of the increased maternal mortality for Black women, it is particularly unconscionable to force them to continue an unwanted pregnancy.
Concurrently, this country has also seen a disturbing increase of maternity care deserts. In fact, 36% of U.S. counties are now maternity care deserts, meaning that 7 million women across the country live in these areas where access to maternity health care services is limited or nonexistent. Per a March of Dimes report, American counties classified as deserts increased by 2% since their 2020 report. Overall, one in eight babies born in the U.S. were born in maternity deserts, and one in six Black babies are born in areas with limited or no maternity care services. We are witnessing, in real time, a full on split of this country into abortion and maternal health deserts, prohibiting millions of Americans from accessing lifesaving care.
The Biden administration has taken some significant steps to addressing the maternal mortality crisis. In October 2022, the Department of Health and Human Services (HHS), through the Centers for Medicaid and Medicare (CMS), announced that through the American Rescue Plan (ARP) that was enacted in March 2021, more than half of all states have expanded Medicaid and the Children’s Health Insurance Program (CHIP) to provide 12 months of extended coverage after pregnancy. An estimated 418,000 Americans have now gained this coverage in combination with previously approved state extensions. If remaining states all approved this expansion, an estimated 720,000 Americans would be guaranteed Medicaid and CHIP coverage for 12 months postpartum. Last June 2022, the Biden administration released a blueprint for addressing the maternal health crisis, which offers a broad vision and call to action to address the maternal health crisis.
The most visible effort to address Black maternal mortality in Congress is the Momnibus Act of 2021, sponsored by Congresswomen Alma Adams (D-N.C.), Lauren Underwood (D-Ill.), and Senator Cory Booker (D-N.J.) and other members of the Black Maternal Health Caucus. The Momnibus Act of 2021 is a package of 12 bills that builds on existing legislation to address various issues within the Black maternal health crisis, including: making critical investments in social determinants of health as well as for community-based organizations, providing resources to diversity the perinatal workforce, invests in telemedicine and innovative payment models, and provides support for mothers with maternal mental health conditions and substance use disorders, among others. The Protecting Moms Who Served Act, which supports the Department of Veterans Affairs in studying the unique maternal health risks facing pregnant and postpartum veterans, became the first of these bills to become law in November 2021. The Momnibus Act is highly popular, with support from 72% of registered voters.
The intersection of the curtailing of abortion access and the growing Black maternal mortality crisis in this country, while a preventable and unnecessary circumstance, is a political and policy choice. What does it say about the state of this society and the future of this country if we cannot care for all life givers, especially Black mothers, to ensure that at the very least, they live through their birth experiences? Black mothers deserve to thrive; they deserve to return home to their families, to rest and heal from the life-altering experience of giving birth, to receive support and care from their communities and health care providers. Black women deserve so much more than the bare minimum of surviving pregnancy — they should be able to decide how, when, and whether to grow their families and should receive high quality health care that is accessible, safe, respectful, and culturally competent.
