America has a maternal health crisis, and it is rooted in our nation’s long history of racism that persists to this day. The US is one of the most dangerous high-income countries in which to give birth. It is especially perilous for women of color: Black women are 3 to 4 times more likely to die in pregnancy, at child birth and in the following year than White women, and Indigenous women 2 to 3 times more likely.
To achieve birth equity and justice — the idea that all who give birth should have healthy pregnancies, healthy babies and the ability to thrive — we must dismantle the structural racism and health inequities that fuel these disparities. This must be a starting point as we look to address a system that is failing women in every state every day.
Given the magnitude of the maternal health crisis, America needs to invest for the long haul and tackle our complex systemic issues — whether the lack of or limited maternal care in about half of the nation’s counties, according to the March of Dimes 2020 maternity care report, limited access to prenatal care, unequal treatment and discrimination in health care settings, and racism’s pervasive impact on the opportunities people have. However, by prioritizing critical federal and state policy changes and centering the voices and experiences of Black, Indigenous and other people of color, we can save lives and end suffering now.
Deep wounds of racism
The US Centers for Disease Control and Prevention, the American Medical Association and local and state leaders have called racism a public health threat. It most certainly is. The impact of racism contributes to Black women’s higher maternal mortality and premature birth rates.
The deep wounds of racism and the relentlessly cumulative effect of discrimination experienced by Black people also lead to poor health outcomes ranging from diabetes to hypertension and asthma. Black women face daily stressors that damage their health, like casual racism and microaggressions at work, when shopping in businesses, and at the doctor’s office. And there are many documented instances of Black women and their families not being taken seriously when they express medical and mental health concerns — from celebrities like tennis players Serena Williams and Naomi Osaka, to the Duchess of Sussex Meghan Markle and Atlanta mom Kira Johnson, whose husband tried to advocate on her behalf during a complicated cesarean section but lost her in childbirth anyway.
Black people who give birth are too often faced with unfair treatment in the health systems meant to heal them. In a California study, more than 1 in 10 Black mothers said they were treated unfairly in the hospital when giving birth because of their race or ethnicity. For example, they said they were not encouraged to make their own decisions or were pressured to induce. They also said medical providers argued with them about their treatment or that of their infants. Just 1% of White women raised these same issues.
Medical and nursing schools and health systems are beginning to tackle the implicit biases, casual racism and microaggressions that confront families of color in medical settings. Over the past two years, March of Dimes has trained 15,000 health care professionals to acknowledge the ways patients of color are treated differently and has been working with them to change their practices — often beginning with simply listening. And the Robert Wood Johnson Foundation has supported an initiative in which women of color define what respectful care means to them so hospitals can implement equitable quality standards.
Mapping progress nationwide
Momentum is also growing for large-scale legislative change to address racism in our birthing systems. Congress should enact the Black Maternal Health Momnibus bill — a set of 12 bills introduced in the House earlier this year — which would coordinate and fund federal programs that ensure all pregnant people, regardless of skin color, have access to housing, transportation, food and other needs that influence health. Importantly, the bills were informed by the contributions of dozens of grassroots organizations led by Black, Indigenous and other people of color.
Progress is building at the state level, too. All but two states — Vermont and North Dakota, both with relatively few births each year — have maternal mortality review committees that track and investigate deaths during pregnancy and a year past birth. Many states also have State Perinatal Quality Collaboratives that work to use the data and recommendations from these committees to improve the quality of maternity care. And thanks to a provision of the American Rescue Plan, states can extend Medicaid for pregnant women from 60 days to one year postpartum, a critical time for health and well-being. Every state should do so. Finally, the federal government should provide states with resources to collect and analyze data about pregnancy complications and maternal deaths by race. Doing so will help inform locally focused, targeted health interventions.
We need to recalibrate how we’re investing in and thinking about maternal health solutions. Federal, state, local and philanthropic funders should invest in people-centered, community-based solutions while working to improve hospital care for Black, Indigenous and other women of color. We also must increase the number of birth support people, such as doulas, who support women before, during and after birth, and make sure that health insurance, including Medicaid, covers these services. Other promising solutions exist across the country — from a birth equity platform proposed in Colorado to SisterSong, in Atlanta, which rallies women of color across the nation to represent themselves and their communities on reproductive issues, to community-based birth centers like Birth Detroit. These efforts need financial support and more visibility to grow their impact.
We will only bring about sustainable change by addressing the root causes of the crisis and by listening to, and acting on, the wisdom of those impacted. The solutions are out there; now we must summon the will to act with urgency.