It’s an all-too-common story that spans generations, passed down from mother to daughter. A pregnancy complication gone unseen, a Black mother-to-be gone unheard, and an unnervingly near-death miss. The reality of pregnant Black women in America is a risky one.
Here’s the problem by the numbers:
The U.S. has the highest maternal mortality ratio in the developed world and is one of only 13 countries where maternal mortality is rising (Center for Reproductive Rights)
Black, American Indian, and Alaska Native women are two to three times more likely to die from pregnancy-related causes than white women (CDC)
For women over the age of 30, pregnancy-related mortality ratios for black and American Indian/Alaska Native (AI/AN) women was four to five times higher than it was for white women (2007-2016 CDC data)
The PRMR for black women with at least a college degree was 5.2 times that of their white counterparts (CDC)
How can we explain this disparity?
“It’s racial,” Jennifer Jacoby, federal policy counsel for the Center for Reproductive Rights, told The Whipp.
For Jacoby, who has testified as an expert witness on the issue in front of the U.S. Commission on Civil Rights to support legislation addressing Black maternal health disparities, it’s also personal. Not only has she worked on federal maternal health policy, she’s seen the problem up close—twice. More than 30 years ago, Jacoby’s mother, who is Black, nearly lost her life to preeclampsia when her symptoms went unnoticed during her pregnancy with Jennifer. When pregnant with her own daughter, Jacoby also experienced serious untreated and undiagnosed complications.
“I bore my mother’s symptoms, which also went undetected,” Jacoby said in her testimony. “I was told to go home. I fought to be admitted to the hospital early. I was blamed for my condition. I had a caesarean section that most likely could have been prevented. For days, my mother watched helplessly by my side as history repeated itself.”
Even with expert knowledge of the problem, both professionally and personally, Jacoby faced the issue first-hand.
“We advocated for ourselves, had access to top doctors, good insurance, and sufficient means. But our circumstances were no match for racial bias,” she said.
The maternal health crisis has received new momentum over the past few years as a new wave of minority women were ushered into Congress and brought intense focus on solutions with them. In 2019, Congresswomen Alma Adams (NC-12) and Lauren Underwood (IL-14) launched the first-ever Black Maternal Health Caucus to address the racial maternal health disparities. The caucus has become one of the largest bipartisan efforts, with more than 100 members as of 2020, including Vice President Kamala Harris when she was a senator.
In 2020, the Caucus presented the first round of solutions to the health crisis: The Black Maternal Health Momnibus Act. Now in its new, 2021 form, the Momnibus Act contains 12 pieces of legislation that will improve every aspect of the maternal health crisis, from funding community-based organizations, studying the health risks for pregnant and postpartum veterans, improving data collection and quality measures, investing in digital tools, supporting maternal mental health, addressing social determinants of health and more.
The 2021 bill package also includes two new pieces of legislation—Investing in community-based initiatives to reduce levels of and exposure to climate change-related risks for moms and babies and addressing Covid-19 needs. More than 190 organizations—including the Center for Reproductive Rights, which also played a role in advising some of the legislation—have endorsed the Momnibus.
(See more about each piece of legislation in the Momnibus Act here.)
One of the most important solutions touted by advocates is extending Medicaid coverage to 12 months after giving birth. Currently, women who become eligible for Medicaid—the federal government’s health insurance program for people under a certain income level—due to pregnancy are only covered up to 60 days after giving birth.
Extending coverage to 12 months would address one of the largest coverage gaps. It is widely supported, and more than a dozen states have either taken steps or are considering expanding Medicaid in this way themselves.
“More than half of pregnancy-related deaths occur after delivery: 40[%] occur 1 to 42 days postpartum and 11.7[%] from 43 to 365 days postpartum nationally, with even higher rates in some states,” according to the Commonwealth Fund.
While the Momnibus bill does not contain legislation to extend Medicaid benefits, a handful other bills have been introduced over the past two years to specifically do just that. And the effect would impact thousands—nearly 45% of all births in the U.S. are financed through Medicaid, according to the Kaiser Family Foundation.
“[The cutoff] is a death sentence for a lot of moms, and it’s an easy fix,” Jacoby told The Whipp.
Getting it done
With renewed energy on legislative solutions, the maternal health crisis may finally soon see some fixes. However, it’s also important to understand racial discrimination across the entire life course as these solutions are being considered, because racial bias and discrimination does not start when women become pregnant. For example, one recent study found that racism earlier in life actually has an impact on pre-term labor risk among Black women. Pre-term labor is the leading cause of pre-term deliveries, which carry significant risks including infant mortality.
During adolescence, each unit of direct racial discrimination correlated to a 48% increase in pre-term labor odds, and 45% when the discrimination was in childhood, the study found. Surprisingly, the study found no association between racial discrimination in adulthood and pre-term labor.
“Stress from racism has very real consequences for the health of Black mothers and their babies. Interpersonal racial discrimination is not just a matter of, ‘hurt feelings,’” Katie Daniels, PhD, assistant professor in the Department of Sociology at California State Polytechnic University and one of the study authors, told The Whipp. “Repeated discrimination over the life course is like a wound that is constantly being opened, never healing, becoming life threatening for a mother and their baby.”
Daniels also supports funding to examine the impact of racial discrimination on health, better education in medical schools on ways to improve racial discrimination in health care and better access to more pregnancy care services for Black women. Representation in the field matters, too.
It seems that if it can happen to Jacoby—who not only had the personal experience after her mother’s complications, but also the expertise as one of the most knowledgeable people on this issue—it can happen to any minority pregnant person. The issue has even touched the best tennis player of all time, Serena Williams, who experienced clots the day after delivering her daughter via emergency C-section and had to fight to be heard and examined.
As for what happens next with the Momnibus Act?
“There is a lot of hope right now,” Jacoby told The Whipp.