Maternal mortality is one of the most compelling indicators that America runs on racism. Here’s what we need to do to overcome this legacy and current reality.
As a Black mother and daughter, I was proud to witness the confirmation of Kentanji Brown Jackson for a seat on the Supreme Court. I was especially touched when she said during her confirmation hearings that she “did not always get the balance right” when juggling career and motherhood, “but if you do your best and you love your children … things will turn out okay.”
I hope and pray that things will turn out okay. But I am devastated by the news that the Court may soon overturn Roe v. Wade, the landmark decision that has given birthing people the right to bodily autonomy that can protect their physical health, emotional well-being and financial security. Any resulting restrictions on abortions would jeopardize these rights and force more Black birthing people—who bear the outsized burden of maternal mortality—to risk their lives carrying potentially dangerous pregnancies to term or die during childbirth.
The statistics are sobering. In my hometown of Washington, D.C., Black birthing persons account for 50 percent of pregnancies but 90 percent of pregnancy and birthing-related maternal deaths. In our nation’s capital, within a five-mile radius of the Supreme Court, Black mothers are somehow unable to survive childbirth.
The problem is only getting worse. The latest maternal mortality data from the Centers for Disease Control (CDC) show that from 2019 to 2020, rates of maternal mortality jumped 14%. The twin pandemics of COVID-19 and racism undoubtedly contributed to this rise. The testimony from Black and Brown birthing families across the United States continuously tells a story of disrespect and neglectful care. According to the CDC, “in 2020, the maternal mortality rate for non-Hispanic Black women was 55.3 deaths per 100,000 live births, 2.9 times the rate for non-Hispanic white women.”
In our nation’s capital, within a five-mile radius of the Supreme Court, Black mothers are somehow unable to survive childbirth.
Data from the CDC and UNICEF show that from 2011 to 2013, the maternal mortality rate for Black birthing persons in America was similar to that in countries such as Brazil, Mexico and Uzbekistan. For white birthing persons, meanwhile, the maternal mortality rate mirrored that of developed nations such as New Zealand, France and Japan.
In the United States, we live in two different realities. A Black birthing person may go to the same hospital with the same health history as a white birthing person, see the exact same doctors, and yet receive care equivalent to that available in a country with one-tenth of U.S. GDP.
Maternal mortality is one of the most compelling indicators that America runs on racism. Here’s what we need to do to overcome this legacy and current reality.
Acknowledge and Address the Impacts of Systemic Racism
Dr. Camara Jones’s definition of racism is “a system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call ‘race’), that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources.”
Ending maternal mortality ultimately depends on disrupting and eradicating all forms of racism. Housing discrimination, mass incarceration, employment discrimination, racist policing, climate change and other forms of systemic inequality all contribute to outsized mortality rates for Black birthing people and infants.
Addressing racism means that care will improve for all women and birthing people. Ending racism goes beyond changing policies and laws. We must fundamentally change the situations of Black and Brown people.
One clear example that Heather McGhee talks about in her book The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together is school desegregation. The law of the land changed with the Supreme Court’s ruling in Brown v. Board of Education in 1954—yet segregation in schools and neighborhoods persists across the country to this day. The most well-resourced schools in the country remain those that have predominantly white student bodies.
Similarly, even though healthcare has been formally desegregated, Black and Brown people are more likely to receive care of lower quality. We have to face society’s dominant beliefs about race and power to address the origins and consequences of our everyday decisions.
Expand Choices and Options for Birthing People
Alarmingly, most pregnancy-related deaths are preventable. At this point, hospitals and medical care providers are willfully participating in and accepting unequal treatment and care. The complacency of the healthcare system is killing Black birthing people. We have invested resources and attention in implicit bias training. Yet responding to and correcting our personal biases only works if people have the time and brain space to reflect on choices and decisions.
Most doctors and nurses are in highly stressed, over-taxed environments. It’s often hard to challenge or check their everyday beliefs and assumptions. Hospitals must fit their standards to the needs of Black birthing people—not expect Black birthing people to conform to pre-existing standards.
Expanding options for birthing care can help. Over 97 percent of births happen in impersonal hospital settings, but data shows 80 percent of U.S. births could safely take place in a birth center where people can be better heard, seen and receive culturally aligned care. For example, Birth Detroit is designing a Black-led birth center created based on the needs and voices of the community it serves.
Similarly, Community of Hope in Washington, D.C., is a freestanding birth center available and accessible to some of the area’s most vulnerable birthing families.
Moving to this model will also help take some of the pressure off hospitals and allow them to focus on high-risk pregnancies and patients having multiple babies.
Encourage Community Support and Partnerships
Doulas are professionals who specialize in supporting birthing families through the prenatal, birth and postpartum periods. They have been gaining attention for improving maternal and infant health outcomes. Community-based doulas are often able to provide resources and additional support and care for birth families. They can be buffers and protectors against racial bias and mistreatment, anchoring the needs and practices of the birthing family. Doulas also have the ability to center and infuse joy and love into one of the most life-changing and life-affirming moments for any family.
Normalizing, diversifying and building the capacity of birth workers can help save lives and reduce costs.
Policy
The Momnibus Act, designed by the Black Maternal Health Caucus in accordance with extensive research, is the most comprehensive piece of legislation to date to address this urgent need. Its 12 standalone provisions will help close the maternal mortality gap arising from structural racism in areas from nutrition to transportation, incarceration and workforce diversity. Congress must act to approve this critical legislation.
Lawmakers should also work to revive the stalled Build Back Better Act, which is slated to invest the most money in U.S. history to address maternal mortality. It includes $175 million to address housing, nutrition, and environmental conditions, $275 million to diversify the workforce, and $100 million for maternal mental health equity, among other investments. Passing the legislation would provide support for Black birthing families to survive and thrive.
Linda Goler Blount, CEO of the Black Women’s Health Imperative, sums it up best: “This problem of the Black maternal health crisis is 400 years in the making.”
Everyday acts of racism are insidious and silent like the air we breathe. Those who benefit from racism are not ready to give up the rewards of a system that provides them with optimal, often exclusive education, healthcare, job security and quality of life.
Erasing inequities will take more than saying “Black Lives Matter” or participating in trainings on how to be anti-racist. It will require a radical transformation in how we live and a belief that we can actually end racism in America.
“Anti-racism is a verb!” Act now.
Sign and share Ms.’s relaunched “We Have Had Abortions” petition—whether you yourself have had an abortion, or simply stand in solidarity with those who have—to let the Supreme Court, Congress and the White House know: We will not give up the right to safe, legal, accessible abortion.
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