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The Administration’s DEI Ban Undermines Black Maternal Health

Soon after the executive order was issued, critical public health data was taken down from federal government websites to evaluate whether they aligned with the new policy. Since then, funding for research studies focused on health disparities was suspended, and in some instances, the Administration completely halted the collection of racial and ethnic data. Due to the executive order, the Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation announced it will no longer collect data on race, ethnicity, sexual orientation, gender identity, and preferred language.

Despite attempts to suppress maternal health data, the evidence is clear that Black and Native American/Alaska Native birthing people still have higher rates of maternal morbidity and mortality compared to white women. Because of the ban on DEI and its impact on the collection of race and ethnicity data, we are less likely to understand how to implement programs and policies that effectively address the U.S. maternal health crisis.

Research shows that racial disparities in maternal health are primarily due to systemic and medical racism that creates inequitable access to social drivers of health and healthcare inequities, not genetics. Data show that Black women with a college degree face higher maternal mortality rates than white women with similar or lower educational attainment. Studies also reveal that high-income Black women have the same risk of maternal death as white women with the lowest incomes. That is why having to rely on economic factors as a proxy for race when race and ethnicity data are unavailable is ineffective. Because of how racism drives maternal health disparities, addressing Black maternal health requires a unique, tailored approach informed by comprehensive data.

Race-Neutral Approaches Ignore the Reality of Black Birthing People

The executive order’s prohibition on diversity, equity and inclusion has widespread impacts on public policy. Policymakers and public health practitioners have begun applying a race-neutral lens to their jobs to adhere to the executive order and avoid retaliation from the Administration. Race-neutral policies operate under the false belief that if all groups are seen equally under the law, they will share equally in social and economic benefits. Implementing race-neutral policies makes it impossible to fully understand our society, enforce civil rights, promote equity, or engage in evidence-based policymaking. It does not help that the Administration is concealing history that contextualizes data used to inform our policies. At the root, race-neutral policies ignore how racism has systematically impacted marginalized communities and allow for the erasure of people’s identities and existence.

More Black birthing people will experience maternal morbidity, near-death experiences, or die because of our inability to target interventions for their specific needs due to this executive order. If our data and public policies do not account for Black women, the consequences are disastrous.

Failing to implement targeted approaches for Black women hurts all birthing people. As the curb-cut effect demonstrates, laws and programs designed to benefit marginalized groups, such as people with disabilities or people of color, often end up benefiting everybody. Making the state option to extend Medicaid postpartum coverage from 60 days to one year permanent exemplifies this. This legislative win, championed by Black maternal health advocates, particularly helps Black birthing people as Medicaid disproportionately covers their births, and the measure especially helps birthing people in states that have chosen not to expand Medicaid, which have a greater proportion of Black residents. Medicaid postpartum extension also helps any low-income birthing person, regardless of their race. In addition, states that adopt this option see broader benefits for their residents and communities, including improved quality of care due to increased continuous healthcare coverage. Postpartum Medicaid coverage invests in state maternal health systems, improving maternal health for all.

Where Do We Go From Here?

Amid restricted access to data and the prohibition of focusing on health disparities, we have to be even more creative in our approach to advancing Black maternal health. Our need to tap into our imagination and community power is not unfamiliar to those of us who have been centering Black and Brown communities for decades and will continue to do so. Race is a tool that has been and will continue to be weaponized to advance the conservative agenda at the expense of Black and Brown bodies.

In the current political climate, we must continue to discuss maternal health equity and center Black and Indigenous birthing people when advocating for maternal health. Failing to do so risks falling into complacency and eroding the already thin line of trust that has been built between policymakers, national organizations, and Black and Brown communities. Ask yourself, are you falling into their trap, self-censoring, and shying away from centering Black and Brown birthing people in your efforts? If so, consider asking yourself these additional questions:

• What are you afraid will happen to your organization and/or to you individually by centering Black and Indigenous birthing people?
• Who is your silence appeasing, and why are you accommodating them?
• Is your silence and self-censoring worth the harm that will happen to Black and Brown birthing people?
• Do you trust Black and Indigenous birthing people and birth workers and believe they know the way forward?

As organizations committed to advancing Black maternal health, we must work in concert with each other to uplift, listen, and defer to the voices of Black and Indigenous birthing people and birth workers.