Reproductive Justice for Black Mothers: The Preventing Maternal Deaths Act and the Work We Have Left to Do

By Meredith Reynolds

Associate Editor, Vol. 24

The Preventing Maternal Deaths Act was signed into law in December 2018.[1] This legislation has been years in the making[2] and part of a growing “birth equity movement” confronting how racism, poverty, and other social inequities are impacting mothers of color and their children.[3]

The Centers for Disease Control and Prevention (“CDC”) has tracked a significant increase in pregnancy-related deaths per 100,000 live births from 7.2 in 1987 to 18.0 in 2014 for all women in the United States.[4] This reality puts the United States at the bottom when comparing maternal health outcomes across high-income countries.[5] While there are many factors potentially contributing to this drastic rise, including changes in data collection over time and an increase in women with chronic health conditions, one fact is clear: mothers of color, and black mothers in particular, are the ones disproportionately losing their lives.[6] According to the CDC’s 2011-14 data, while the number of deaths per 100,000 live births for white women was 12.4, the number for black women was a staggering 40.0, and the average for women of other races was 17.8.[7] Even when controlling for variables like education and socioeconomic status, black women are more likely to die from pregnancy-related complications.[8]

Part of the problem is the fact that medical providers take black pain less seriously.[9] As pediatric nurse and Ferguson-based community activist Brittany Ferrell explains, “[j]ust like state violence is allowing black folks to be shot dead in the street, and no one’s being held accountable or even having to atone for the death of black bodies, the same thing is happening in these medical institutions.”[10] Another part of the problem is that experiences dealing with racism, accumulated over time, detrimentally impact one’s health, a concept researcher and University of Michigan School of Public Health professor Dr. Arline Geronimus has termed “weathering.”[11] The detrimental impacts of weathering in turn elevate risks during pregnancy.[12]

National attention on these issues has grown recently, thanks to efforts by many organizing groups, such as the National Birth Equity Collaborative, SisterSong, and Black Mamas Matter; Serena Williams’ and Beyoncé’s decisions to share their birth stories;[13] and, a prominent New York Times article last year detailing the crisis.[14] Racial disparities in maternal health outcomes, however, are not new. It is a crisis that has been “hiding in plain sight for the last 30 years.”[15] The United Nations Committee on the Elimination of Racial Discrimination (CERD) raised concerns to the United States back in 2008.[16] In 2012, Amnesty International described the preventable deaths occurring in this country as violations of several human rights, including the right to life, the right to be free from discrimination, and the right to the highest attainable standard of health.[17] Black women themselves have known this reality for years. Yet, the crisis has persisted.

The recent passage of the Preventing Maternal Deaths Act is encouraging. Its purported aims are “to eliminate disparities in maternal health outcomes for pregnancy-related and pregnancy-associated deaths [and] to identify solutions to improve healthcare quality and health outcomes for mothers, and for other purposes.”[18] The Act authorizes the Secretary of Health and Human Services to expand research and preventive activities, and it requires the creation of multidisciplinary maternal mortality review committees in each State and tribe to oversee the data collection and research.[19] These are important steps forward and achievements celebrated by the many women and infant health organizations who were instrumental in the bill’s passage.[20] Research and review, however, must be accompanied by immediate on-the-ground assistance for pregnant women and mothers, as well as ongoing development of innovative solutions.

We already know that the healthcare system is providing woefully inadequate services to black mothers. Implicit biases, in addition to instances of blatant racism, are rampant; and, as obstetrician-gynecologist Neel Shah admits, “[t]here is a very fine line between clinical intuition and unconscious bias.”[21] Thus, these racialized interactions and biases need to be clearly highlighted and addressed head-on. Funding needs to be allocated now to re-evaluate how medical conditions are assessed and treatment is provided, particularly for mothers of color. Additionally, funding should be set aside now to enable more widespread access to midwives and doulas. Research has already demonstrated that the support and advocacy of a doula leads to greater birth outcomes for women of color.[22]

More widespread efforts to achieve racial justice must continue as well: the promotion of doctors, nurses and doulas of color, the elimination of institutionalized racism and police brutality, and an elevated consciousness of the harms caused by daily microaggressions and discrimination. All of these issues are interrelated with reproductive justice for women of color.[23]

Most critically, we must start listening to black women.

[1] Preventing Maternal Deaths Act of 2018, H.R. 1318, 115th Cong. (2018) (enacted).

[2] Sharon Muza, Great News! Preventing Maternal Deaths Act Signed into Law!, DONA International (Dec. 24, 2018), https://www.dona.org/maternal-deaths-act/.

[3] See Rachel Jones, American Women Are Still Dying at Alarming Rates While Giving Birth, Nat’l Geographic (Dec. 13, 2018), https://www.nationalgeographic.com/culture/2018/12/maternal-mortality-usa-health-motherhood/.

[4] Pregnancy Mortality Surveillance System, Centers for Disease Control and Prevention (last reviewed Aug. 7, 2018), https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm.

[5] See Munira Z. Gunja et al., What Is the Status of Women’s Health and Health Care in the U.S. Compared to Ten Other Countries?, Commonwealth Fund (Dec. 19, 2018), https://www.commonwealthfund.org/publications/issue-briefs/2018/dec/womens-health-us-compared-ten-other-countries (finding that the United States ranked lowest out of eleven high-income countries in women’s health care and health status); see also Nina Martin & Renee Montagne, U.S. Has the Worst Rate of Maternal Deaths in the Developed World, NPR (May 12, 2017), https://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world (reporting similar findings from a joint study by ProPublica and NPR).

[6] Pregnancy Mortality Surveillance System, supra note 4.

[7] Id.

[8] Black Mammas Matter Alliance & Center for Reproductive Rights, Research Overview of Maternal Mortality and Morbidity in the United States, in Black Mammas Matter: Advancing the Human Right to Safe and Respectful Maternal Health Care 21 (2018), available at https://www.reproductiverights.org/sites/crr.civicactions.net/files/documents/USPA_BMMA_Toolkit_Booklet-Final-Update_Web-Pages.pdf.

[9] Id. at 26 (“Studies show that Black patients are treated differently than White patients with the same symptoms, receiving fewer diagnostic and therapeutic interventions, and even less pain medication.”).

[10] Jones, supra note 3.

[11] Amy Roeder, America is Failing Its Black Mothers, Harv. Pub. Health (Winter 2019), https://www.hsph.harvard.edu/magazine/magazine_article/america-is-failing-its-black-mothers/ (“[F]or people who face chronic threats and hardships—like struggling to make ends meet on a minimum wage job or witnessing racialized police brutality—the fight-or-flight response may never abate. ‘It’s like facing tigers coming from several directions every day,’ Geronimus says, and the damage is compounded over time.”); see also David R. Williams, How Racism Makes Us Sick, TEDMED Talks (2016), https://www.tedmed.com/talks/show?id=621421.

[12] See Roeder, supra note 11 (“These [biological responses to physiological stresses] siphon energy from other bodily systems that aren’t enlisted in the fight-or-flight response, including those that support healthy pregnancies.”).

[13] Serena Williams, Serena Williams: What My Life-threatening Experience Taught Me About Giving Birth, CNN (Feb. 20, 2018), https://www.cnn.com/2018/02/20/opinions/protect-mother-pregnancy-williams-opinion/index.html; Beyoncé Knowles, Beyoncé in Her Own Words: Her Life, Her Body, Her Heritage, Vogue (Aug. 6, 2018), https://www.vogue.com/article/beyonce-september-issue-2018.

[14] Linda Villarosa, Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis, N.Y. Times (Apr. 11, 2018), https://www.nytimes.com/2018/04/11/magazine/black-mothers-babies-death-maternal-mortality.html.

[15] Roeder, supra note 11.

[16] Id.

[17] Id.

[18] Preventing Maternal Deaths Act of 2018, H.R. 1318, 115th Cong. (2018) (enacted).

[19] 42 U.S.C. § 247b–12.

[20] Muza, supra note 2.

[21] Roeder, supra note 11.

[22] See generally Kenneth J. Gruber et al., Impact of Doulas on Healthy Birth Outcomes, 22 J. Perinatal Educ. 49 (2013) (finding that doula-assisted mothers were more likely to have healthy babies and less likely to face birth complications in a study comparing two groups of predominantly African American mothers).

[23] The term “reproductive justice” was first coined in 1994 by a group who referred to itself as Women of African Descent for Reproductive Justice. This group recognized that a broad and intersectional framework was necessary to effectively address the reproductive health challenges women of color face. See Reproductive Justice, SisterSong (last visited Mar. 17, 2019), https://www.sistersong.net/reproductive-justice (providing further information on what reproductive justice and how we can work to achieve it).