By Arielle Atherley, policy associate
April marks Black Women’s History Month, National Minority Health Month, and Medicaid Awareness Month. Sitting neatly at the intersection of those issues is Black Maternal Health Week, which took place earlier this month. The first-ever national Black Maternal Health Week this month, founded and led by the Black Mamas Matter Alliance, sought to highlight the racial disparities that Black women continue to face in maternal health care. Challenges surrounding Black maternal health are often overlooked due to broader concerns about access to health care and the quality of health care in communities of color. But today, Black mothers disproportionately face poor maternal health outcomes as compared to their peers. We know that people of color are treated very differently when they enter the health care system – Black mothers are no exception to this experience.
All mothers deserve to be well-cared for before, during, and after the birth of their babies. But women of color, particularly low-income women of color, face a number of challenges in trying to afford adequate pre- and postnatal care for themselves and their babies. While some states and communities have taken steps locally to ensure that pregnant women receive the health care they need, Medicaid coverage continues to be a crucial source of pregnancy care for Black women, especially where large gaps in coverage remain. According to a new policy brief by The Leadership Conference Education Fund, Medicaid is the leading source of public financing for family planning services, accounting for 75 percent of all public funds spent on contraceptive services and paying for 45 percent of all births in the United States. Currently, 37 states provide the full Medicaid benefit package to pregnant women, ensuring that these women have comprehensive health insurance during their pregnancy. These resources are particularly essential for Black women aged 15-44, who represent 31 percent of all Medicaid enrollees. The importance of Medicaid to pregnant Black women makes it even more crucial that we protect these programs from any potential rollbacks. For many pregnant Black women, Medicaid coverage is key in allowing them to access health care, reduce financial instability, and bring safe and healthy babies into the world.
In 2018, the United States continues to have one of the worst maternal mortality rates in the developed world. Though global maternal death rates have dropped more than a third from 2000 to 2015, the rate in the United States has more than doubled since 1987. The Centers for Disease Control and Prevention (CDC) has noted that approximately 700 women in the United States die each year as a result of complications related to pregnancy or childbirth. However, the underlying racial disparities in this data are even more concerning. According to the CDC, Black mothers are three to four times more likely than White mothers to die from complications related to pregnancy or childbirth. CDC data from 2011 reports that Black women comprised 42.8 percent of deaths resulting from pregnancy or childbirth, whereas White women constituted 12.8 percent of this population. And Black infants in America are more than twice as likely to die as White infants, with 11.3 per 1,000 Black babies dying as compared to 4.9 per 1,000 White babies. This disparity is wider than it was in 1850, 15 years before the end of slavery.
The reasons behind the gap in maternal health rates have long been researched and debated, but are very much related to the broader challenges that people of color face when trying to access quality health care. For Black mothers in particular, a number of racial and cultural factors are at play. As noted in a recent New York Times story, “an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions…that lead directly to higher rates of infant and maternal death.” Black women also face longstanding racial bias in health care, which can include the dismissal of legitimate concerns and symptoms. Too often, Black women are subject to discrimination in the health care field, with 22 percent reporting discrimination when going to the doctor or clinic. Additionally, hospitals and clinics are often not held accountable for providing culturally and socially competent care for Black women.
Discrimination in health care takes many forms and occurs at every step in the health care system – from obtaining insurance coverage to receiving proper diagnosis and treatment. This discrimination seriously harms women, transgender patients, patients with disabilities, and patients who have language access issues, often causing them to pay more for health care and to risk receiving improper diagnoses and less effective treatments. Section 1557, the anti-discrimination provision of the Affordable Care Act, was an important step in prohibiting discrimination in health care. For Black women, who face additional barriers due to their intersectional identities, alleviating these challenges starts with changing attitudes about Black women and their bodies and, subsequently, shifting public policies and medical practice to incentivize patient-centered care that focuses on Black women’s individualized needs.
Take, for instance, the story of Serena Williams. You might know her as one of the world’s best tennis players and 23-time Grand Slam winner. But in September 2017 after giving birth to her first child, Alexis Olympia Ohanian, the athlete experienced a major postpartum health scare. As detailed in a January 2018 interview with Vogue magazine, Alexis was born by emergency C-section after Serena’s heart rate plummeted dangerously low during contractions. The next day, when Serena began to experience shortness of breath, she was dismissed by a nurse who assumed that her medicine was making her confused. Serena, who had experienced pulmonary embolisms as a result of blood clots in the past, knew that she needed a CT scan and a heparin drip. Instead, doctors proceeded to perform an ultrasound of her legs. After the ultrasound revealed nothing, they sent Serena for the CT scan where they discovered, as she had predicted, that several small blood clots had settled in her lungs.
This pushback and dismissal by medical staff happens all too frequently for women, disregarding the ways in which a woman knows her own body. In the case of Black women, these types of interactions are exacerbated by stereotypical beliefs about Black bodies. Most concerning is that this could happen to someone like Serena Williams, who is a wealthy, well-educated Black woman who, as a result of her professional athletic career, probably has a pretty good handle on issues related to her health. Nonetheless, her requests were not taken seriously by hospital staff when she knew something was wrong. One can only imagine how difficult it may be to navigate these types of interactions as a low-income woman with limited education and resources.
Though Black Maternal Health Week is officially over, there is plenty of work left to do. Black women and babies deserve the best possible health care to set them up for a life of success and long-term health. This means ensuring that Black mothers and babies can access the programs and services they need – whether it’s through private insurance, community operated clinics, or Medicaid assistance. This also means that we need to protect Medicaid, which can be a lifesaving resource for Black women. Most importantly, it is critical that we take the lead from organizations like the Black Mamas Matter Alliance that are fighting fiercely to ensure that Black mothers have the rights, respect, and resources to thrive throughout their pregnancies. Black women and babies are dying – it’s time we do something about it.
For more information on what you can do in support of Black maternal health, visit the Black Mamas Matter Alliance website.