Today marks the start of the Black Mamas Matter Alliance’s inaugural Black Maternal Health Week. This week seeks to magnify and bring attention to the voices of black mothers and women and increase attention to the issue of maternal mortality. Raising the profile of this issue could not be timelier. From the acclaimed ProPublica/NPR series spotlighting the stories of everyday women who have died from pregnancy-related complications to tennis star Serena Williams sharing the story of her health care provider ignoring her distress after experiencing a health complication the day after delivering her daughter, the maternal deaths of black women have recently been front and center in the media. America can no longer turn a blind eye to this urgent and ignored health issue. And while maternal mortality among black women is a major public health concern, fully addressing the issue lies within the very systems and institutions that affect various aspects of black life. For too long, these systems and institutions have operated in a way that devalues black women and perpetuates biases, in turn, robs them of mothering with dignity. Fully addressing maternal mortality calls for an acknowledgment that racism is the driving force behind these deaths, as well as examining the systemic barriers often fueled by bias, before policymakers can come up with concrete solutions that save black women’s lives.
Black mothers have long been devalued in American society. During slavery, black women were treated as chattel, where the sole purpose of their existence was to breed offspring for subjugation within a capitalist system fueled by slave labor on American soil. Indeed, the use of and assault on black women’s bodies—and the attack on their reproductive freedom—has been documented extensively. And while this gruesome subjugation and the institution of slavery itself are no longer present in America, the remnants can be seen throughout the history of blacks in this country—even in the present day. Ever since black Africans were first enslaved and brought against their will to the United States, black families have been torn apart due to state violence and mass incarceration; low-income black women have been sterilized without their consent; black women been have disproportionately represented in low-wage jobs; black women’s bodies have been used to advance surgical procedures in the study of obstetrics and gynecology; and much more. Stereotypical images and perceptions of black women are also perpetuated in the media and among conservative policymakers in a way that invokes sexual promiscuity and irresponsibility. This also devalues their roles as mothers and causes society to view them as less sympathetic or worthy of support. The ripple effects of this subjugation can even be seen in how policies and programs are developed and implemented in a way that shows minimal regard for black life and the importance of black women’s contributions to the productivity and resilience of this country. The devaluation of black women persists and is manifested through structural racism, which is defined as a system wherein public policies, institutional practices, cultural representations, and other norms work to perpetuate racial inequality. This has led to the significant black-white gap in maternal mortality and the absence of adequate responses that address this issue.
In the United States, black women are 243 percent more likely to die from pregnancy-related causes than their white counterparts. Research has shown that even when factors such as physical health, access to prenatal care, income level, education, and socio-economic status are controlled for, black women are still far more likely to experience maternal mortality than non-Hispanic white women. Social and environmental risk factors that instigate poor maternal health outcomes also disproportionately hurt black women. These risk factors can often include housing instability; lack of neighborhood safety and increased police violence; gender inequality in the workplace; poor access to quality health care, including comprehensive reproductive health care and mental health services; and food insecurity. And, much like Serena Williams’ health care providers, medical professionals far too often ignore or dismiss black women when they express pain or worry related to their health. Due to experience with these adversities in everyday life, which can undoubtedly induce stressors, black mothers and women have higher rates of depression when compared with the general population. These are examples of the compounding, ripple effects of a long history of black subjugation in America. The burden of these social and environmental risk factors lay heavily on black women, and these factors are products of structural racism.
Increasing access to quality health care, along with addressing racial bias among health care providers, are important aspects in a comprehensive approach to reducing black maternal mortality. Under the Republican-controlled Congress and Trump administration, health care has been under threat. There have been several efforts to repeal and replace the Affordable Care Act (ACA)—a law that has been vital in helping to close the uninsurance gap in this country, particularly among women and people of color. Some of these efforts have even included proposals to strip maternity care from the list of essential health benefits covered under the ACA. Medicaid, a publicly funded health insurance program that largely serves black women, has also been on the chopping block. President Trump has proposed drastic funding cuts to Medicaid, and his administration has created a pathway for states to impose predatory work requirements as a condition for health care coverage through the program. The assault on reproductive health and rights has been particularly profound, with the targeting of Planned Parenthood; undermining the Title X Family Planning Program; allowing religious and moral refusal of contraceptive coverage; and working to restrict abortion coverage through ACA repeal efforts and other anti-choice legislation.
Furthermore, the proposed cuts to nutrition and entitlement programs such as the Women, Infants, and Children (WIC) program as well as the Supplemental Nutrition Assistance Program (SNAP) show major disregard for low-income women and women of color who may be struggling to feed their families and grapple with food insecurity within their communities. The added burden of gender discrimination and lack of structural supports in the workplace are also critically important in helping black women experience better maternal health outcomes. When black women lack access to livable wages, flexible scheduling, and paid family leave, it can have a harmful impact on both their physical and mental health. Additionally, black women are more likely to be single mothers, as well as the primary breadwinner or sole head of household within their families. It is no coincidence that the aforementioned legislative and policy efforts are anti-woman and would have a particularly harmful effect on black women.
Despite a long history of devaluing black mothers in America, the tide can shift for the better. Policy and program solutions that address the root causes of racism and how it manifests to instigate high rates of maternal mortality among black women are drastically needed. The Center for American Progress, in partnership with black women-led organizations, is working to do just that. By confronting the role that racism plays in maternal mortality and implementing policies and programs that address the issue, we, in turn, save the lives of black mothers and show that they matter.
Jamila Taylor is a senior fellow at the Center for American Progress.
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Senior Fellow; Director, Women’s Health and Rights