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How does race and ethnicity intersect with other identities (including sex, gender identity, etc.) in ways that compound barriers to health care and lead to health disparities?

Every mother and every infant deserve high-quality maternity care. Yet despite the fact that the United States has many of the best medical professionals and facilities in the world, our health care system is failing to meet the maternal health care needs of millions of women, and Black women are at particular risk.

The statistics are striking. According to the Centers for Disease Control and Prevention (CDC), Black women are more than three times more likely than White women to die from pregnancy-related causes. Infants born to non-Hispanic Black mothers are more likely to be born preterm and nearly twice as likely to have low birth weights as infants born to White mothers. And the preliminary infant mortality rate in 2010 for Black infants was more than twice that of White infants. Further, only 54 percent of Black babies have ever been fed breast milk, compared to 74 percent for White babies, 80 percent of Latino babies, and 81 percent of Asian American babies. So what’s the cause behind such troubling disparities and what is being done to combat them?

First, the problem of infant mortality among Black women cannot be dismissed as a result of lower educational attainment. College educated Black women also suffer an infant mortality rate that is more than double that of their White counterparts – 11.5 deaths per 1,000 births for Black mothers compared to 4.2 per 1,000 for White mothers. White women who dropped out of high school have a lower rate of infant mortality than college-educated Black women – 9.1 deaths per 1,000 births compared to 11.5, according to the National Center for Health Statistics.

Rather, health researchers suggest that a lifetime of stress related to navigating systems plagued by race and gender bias has the additive effect of wearing on the body. That is, when the body is stressed it produces a hormone called cortisol, which can work to induce labor. Beyond equalizing access to health care services, more must be done to combat these stressors for Black women.

Over the past eight years, The March of Dimes’ Prematurity Research Initiative has provided nearly $22 million to address these issues broadly, and in 2012 alone has provided grants totaling nearly $3 million for this work. Targeting funding through these types of initiatives could do a lot to address, head on, this troubling disparity.

Second, more than 22.4 percent of Black women – compared to 12.7 percent of White women – have no health coverage. Black women are also more likely to be without a usual source of care than White women. Consequently many Black women don’t have access to the health care they need before, during, and after pregnancy. Many are without:

1) Community resources and health care services that can help them stay healthy before pregnancy (for example, 7.5 percent of Black women compared to 3.3 percent of White Women have been diagnosed with diabetes – a condition associated in pregnant women with greater risk of pregnancy complications, birth defects, and spontaneous abortions or miscarriages);

2) Contraception to help them plan families and appropriately and safely space pregnancies (Black women face a significantly higher rate of unintended pregnancies);

3) Preconception and prenatal care to allow doctors to identify and treat any health issues early (Black women are more than twice as likely as White women to receive prenatal care starting in the 3^rd trimester or not receive prenatal care at all); and

4) Postpartum care to assist mothers with breastfeeding (as noted earlier, Black babies are less likely to be breastfed. Research has shown that breastfeeding can reduce the rates of a range of chronic conditions, including obesity, type 2 diabetes, and asthma. Further, Black adults are likely to suffer from all of these conditions at higher rates than are Whites. Thus, it is possible that encouraging breastfeeding may help to alleviate some of the disparities that Blacks disproportionately face later in life.

The Affordable Care Act (ACA) contains a number of important provisions that will help us tackle these barriers. It makes significant investments in prevention (in both the health care and community settings) and expands affordable health coverage to millions of women. The ACA also specifically aims to improve conditions for pregnant women and new parents by providing comprehensive maternity coverage and supports for low-income mothers, and improving the infrastructure for breastfeeding. In addition, through the Strong Start Initiative, providers, states, and others have the opportunity to build public-private partnerships to reduce early elective deliveries, and to test innovative approaches to provide access to high-quality prenatal care. Targeted efforts through these programs will be imperative to reducing disparities in access to needed care services.

The National Partnership for Women & Families is committed to making sure the ACA delivers on these important protections, by working closely with both federal and state officials as they implement the law and combating efforts by opponents in Congress to undermine it.

By Christine Monahan, Health Policy Advisor and Kalahn Taylor-Clark, Director of Health Policy, National Partnership for Women & Families