The United States has become even more dangerous for Black people to give birth.
Regardless of socioeconomic status, Black women and birthing individualsNOTE: We recognize and respect that pregnant, birthing, postpartum, and parenting people have a range of gender identities and do not always identify as “women” or “mothers.” In recognition of the diversity of identities, this issue brief uses both gendered terms, as well as gender-neutral terms such as “people,” “pregnant person,” and “birthing people.” In referencing studies, we use the typically gendered language of the authors. in the United States are three times more likely to die from pregnancy than their white counterparts. While institutional and structural racism have long undermined the health and economic outcomes for Black women and families, the COVID pandemic exacerbated inequities and worsened the Black maternal health crisis. Black childbearing people – who were more likely to be essential workers and have increased risk of COVID-19 exposure – were three times more likely than white parents to have a COVID-19-attributable maternal death.National Partnership for Women & Families. Raising the Bar for Maternal Health Equity and Excellence, accessed October 7, 2023, https://nationalpartnership.org/health-justice/raising-the-bar/
Black individuals deserve bodily autonomy in safe and health-promoting environments to decide whether, how, or when to become parents. To improve Black maternal health, health care itself must make institutional and structural changes to transform the delivery and quality of care. Decisionmakers at all policy levels must establish comprehensive policy change to address the social drivers impacting health, such as the environments where people are born, live, learn, work, play, worship, and age that also affect a wide range of quality-of-life outcomes.U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. “Social Determinants of Health,” accessed October 6, 2023, https://health.gov/healthypeople/priority-areas/social-determinants-health These transformations require listening to, supporting, sustainably funding, trusting, and respectfully engaging with Black-led organizations, and a commitment to building trusted relationships, ceding or sharing power, and creating pathways that allow community-based solutions to succeed.
To Solve the Black Maternal Health Crisis, We Must:
Transform the Delivery of Black Maternal Care
- Congress must pass the Black Maternal Health Momnibus Act (S. 1606 and H. R. 3305), which addresses every driver of maternal mortality, morbidity, and disparity in the country by making investments in social drivers of health that influence maternal health outcomes.
Destigmatize and Treat Black Maternal Mental Health
- Sixty percent of Black mothers do not receive any treatment or support services for prenatal and postpartum emotional complications due to lack of insurance coverage, social and cultural stigma related to mental health needs, logistical barriers to services, and lack of culturally appropriate care.
Protect and Expand Access to Reproductive Health Care
- A National Partnership for Women & Families analysis reveals that Black women who have recently given birth are substantially more likely than other women to live in a state that has banned abortion or is likely to ban it.
- Sixty-one percent of Black women who have given birth in the last 12 months were living in states that have banned abortion or are likely to ban it post-Dobbs, compared to 50 percent of women overall and 53 percent of white, non-Hispanic women.
- Nearly 6 million Black, non-Hispanic women – or three in five U.S. Black women ages 15 through 49 – live in states that have banned abortion or are likely to ban it.Katherine Gallagher Robbins, Shaina Goodman, and Josia Klein. “State Abortion Bans Harm More than 15 Million Women of Color: Dobbs Impact Felt Nationwide,” National Partnership for Women & Families, June 2023, https://nationalpartnership.org/report/state-abortion-bans-harm-woc/ ; March of Dimes. “Population,” accessed October 9, 2023, https://www.marchofdimes.org/peristats/data?reg=99&top=14&stop=127&lev=1&slev=1&obj=8
- Congress must pass laws like the Equal Access to Abortion Coverage in Health Insurance (EACH) Act (S. 1031 and H.R. 561) to restore abortion coverage to people who receive health care or insurance through the federal government.
Eliminate Economic Inequities & Close the Wage Gap
- Black women face wealth and income gaps that negatively impact economic outcomes. These gaps remain due to a stark history of deliberate policy choices based in white supremacy, systemic racism, sexism, misogynoir, and ableism, designed to keep Black women and other women of color in poverty.
- A National Partnership for Women & Families analysis reveals that nearly two-thirds (62 percent) of Black women who have given birth in the last 12 months are employed.Amanishakete Ani. “C-Section and Racism: ‘Cutting’ to the Heart of the Issue for Black Women and Families” Journal of African American Studies, December 2015, https://www.jstor.org/stable/44508234 Even when they are employed, Black women face a wage gap: Black women are only paid 66 cents for every dollar earned by white, non-Hispanic men.People are identified as having a disability in this analysis if they responded that they have difficulty in one or more of the following realms: vision, hearing, cognitive, ambulatory, self care, and independent living. This is a limited definition of disability that excludes a portion of disabled people. For more information on how disability is measured in the American Community Survey, please see: United States Census Bureau. “How Disability Data are Collected from The American Community Survey,” https://www.census.gov/topics/health/disability/guidance/data-collection-acs.html This gap is particularly large after giving birth.
- A National Partnership for Women & Families analysis shows that Black women who are employed the year after they have given birth are paid 50 cents for every dollar paid to white, non-Hispanic men of the same age group.Note: Figures compare median earnings for all workers with positive earnings age 16-50.
- Congress must address this disparity by strengthening equal-pay legislation and raising the national minimum wage to at least $17 an hour.
Collect Intersectional Data, Especially for Disabled Black Birthing People
- Black disabled people are more likely to experience adverse birth outcomes than nondisabled or non-Black people.Caroline Signore, Maurice Davis, Candace M. Tingen, and Alison N. Cernich. “The Intersection of Disability and Pregnancy: Risks for Maternal Morbidity and Mortality,” Journal of Women’s Health, February 2, 2021, https://doi.org/10.1089/jwh.2020.8864
- Pregnant women with disabilities have a much higher risk for severe pregnancy- and birth-related complications and death than other pregnant women.U.S. National Institutes of Health. “NIH Study Suggests Women with Disabilities Have Higher Risk of Birth Complications and Death,” December 15, 2021, https://www.nih.gov/news-events/news-releases/nih-study-suggests-women-disabilities-have-higher-risk-birth-complications-death
- We need additional research and data on the intersection of disability, gender, race, and other identities, in order to improve policies for Black, disabled birthing people.
- Decision makers must commit to collecting standardized data on disability status, in addition to disaggregated race/ethnicity (with subgroups) and sexual orientation and gender identity data, as well as how these identities interact with each other, so that we can understand and solve for inequalities and their root causes.
This issue brief was made possible thanks to the generous support of the Skyline Foundation.
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