The Maternal Health Crisis Facing Black Women

APPLE PODCASTS

GOOGLE PLAY

STITCHER

SPOTIFY

Women in the U.S. are more likely to die from pregnancy or childbirth related causes than women in other developed countries. Unfortunately, this is disproportionately felt by black women. Black women are more likely to die from childbirth or pregnancy related causes than white women by an outrageous 243 percent. Jamila Taylor, Senior Fellow with Center for American Progress sits down with us and explains that, without addressing the root causes and disparities between black women and non-Hispanic white women, black women will continue to die premature, preventable deaths.

Factors that contribute to African-Americans having higher rates of morbidity in other public health and medical areas are not able to explain the gap in maternal mortality between black women and non-Hispanic white women. Even when you count for socioeconomic status, physical health, income, and education levels between black and white women, black women see increased levels of maternal mortality. This clearly points to an issue rooted in social and structural inequality as well as racism.

Social and structural inequality and racism impacts black women’s lives, and ultimately, their maternal and general health.

Living in unhealthy environments compromises a black woman’s health which can then impact her maternal health prospects. For example, high levels of lead-contaminated water in Flint, Michigan, meant women (primarily women of color) saw increased levels of infant mortality and miscarriages.

It is also incredibly important to examine mental health outcomes. Black women, particularly single moms, have high rates of postpartum depression that tends to affect their livelihoods and that of their children. Black women carry a heavy load in their communities; they are faced with stress in the workplace and worries regarding the overall safety of their communities, which includes police violence. Communities of color can lack access to comprehensive health care and mental health care in general, which means black mothers will have difficulties accessing mental health services.

Women of color who live in low income areas are significantly more affected by these social and structural inequalities in a way that is harmful to their livelihoods. Structural racism is heavily impacting black women’s general health and reproductive health.

Policy must adjust accordingly; there needs to be comprehensive legislation that acknowledges structural racism as a factor in maternal health/mortality. Structural racism that contributes to maternal mortality includes issues of ensuring access to clean water, nutritious meals, mental health services, quality healthcare and safe communities.  It is also vital to continue to support the Affordable Care Act, Medicaid expansion, Title X, and women’s access to reproductive health initiatives, including abortion.  Only then can we begin to ensure black women can start to have healthy pregnancies and reproductive lives.

Links from this episode

Center for American Progress on Facebook
Center for American Progress on Twitter
Article: Black Women Disproportionately Suffer Complications of Pregnancy and Childbirth. Let’s Talk About It.
Article: Nothing Protects Black Women From Dying in Pregnancy and Childbirth
Article: Exploring African Americans’ High Maternal and Infant Death Rates
Article: Maternal Mortality and the Devaluation of Black Motherhood

Transcript

Jennie: Welcome to RePROs Fight Back, a podcast on all things repro. I'm your host, Jennie Wetter, and each episode I'll be taking you to the front lines of the escalating fight over our sexual and reproductive health and rights at home and abroad. Each episode I will be speaking with leaders who are fighting to protect our reproductive health and rights to ensure that no one's reproductive health depends on where they live. It's time for repros to fight back.

Read More

Jennie: Welcome to repros fight back. On this week's episode, we are going to discuss one of the largest racial disparities in women's health. A black woman is 22% more likely to die from heart disease than a white woman and 71% more likely to die from cervical cancer, but an outrageous 243% yes, 243% are more likely to die from pregnancy or childbirth related causes than a white woman. Helping me dig into this topic, I'm really excited to have Jamila Taylor, a senior fellow with the Center for American Progress here to talk to me today. Welcome Jamila.

Jamila: Thanks Jennie. I'm happy to be here.

Jennie: So let's start at the beginning and just kind of talk about the overall status of maternal health in the U.S. right.

Jamila: Um, so I think your, you know, introduction really sums it up. Um, right now, um, we are seeing some of the highest rates of maternal mortality that we've ever seen, particularly among black women. Um, we know that the disparities between black women and Non-Hispanic white women, um, are pretty stark. And so we're in a situation where, you know, if we don't start thinking about the root causes of this issue, that we're gonna continue to see, you know, black women dying, um, these premature, um, largely preventable deaths. When we think about that, we hear several different things that are hypothesized for causing this big gap.

Jennie: So let's kind of break them down and why they are or maybe aren't responsible for this gap.

Jamila: Right. And so I think, yeah, across the, the spectrum in terms of research that we see around health disparities, um, largely and I think public health spaces and also in, in, you know, some of the social science spaces, there is this look at, you know, sort of what are the behaviors that contribute to black Americans, you know, having higher rates of death, you know, and morbidity in certain areas. And so for instance, you know, if you look at, um, issues around obesity, we know there are large numbers of African American women who experience obesity, smoking in terms of heart disease, some of these other issues. But when it comes to maternal health issues, as well, we control for all of those things, you know, physical health, even socioeconomic status. We know that even black and white women who are equally healthy on equal footing, even in terms of like education, um, and income level, that black women are still more likely to die. And so I think as we digest the research around this issue, we have to acknowledge the fact that these other factors, these health risks that we see associated with mortality and morbidity do not help us answer questions. You know, in terms of why black women are more likely to die in pregnancy and childbirth.

Jennie: Yeah. And I think that was one of the really interesting things when I was reading the paper that CAP put out was seeing that black woman who is higher educated has worse health outcomes than a woman who, a white woman who did not have a high school education.

Jamila: Right. Absolutely. And when you look at, you know, those comparisons, you know, I think it points to the fact that we're looking at an issue that deals with social and structural inequality and racism. And so that's one of the things in terms of CAP’s approach, part of what we wanted to do with this paper was to delve deeper into the research. You know, looking at what we already know about poor pregnancy related outcomes, what leads to those? And how we compare, you know, non-Hispanic, white women to black women and we're looking at the research, it clearly shows that these higher rates of mortality are not due to any sort of behavioral or even, um, pre exposure to other social and environmental issues. And so it really comes down to, um, the racism piece here.

Jennie: So one of the things that really does get talked about and you see theorized a lot is that socioeconomic and poverty plays a big role, but this reshoot says it. Maybe that's not true or not solely responsible. Right?

Jamila: Absolutely. I mean, we know that generally we also see disparities in terms of poverty levels among black women. Black women are more likely to work in jobs that are low paying jobs. They are more likely to lack flexibility in the workplace. Um, and then a whole host of other sort of gender inequalities, um, and workplace issues that impact their livelihoods and then ultimately could impact their health. And when it comes to the income and education piece, it's really tricky because again, you know, we're saying that even among highly educated middle and upper income black women, they're still having these poor maternal health outcomes. Even when compared to white women that don't have, you know, higher education, um, or higher income levels, those women are still having pregnancies, you know, largely across the board. And so, so we can't simply answer I think or deal with this issue in a way where we're only focused on low income women. Um, the approach is going to have to be much broader than that. And I think even at CAP as we sort of think through what are the policy solutions, we know that things like access to quality health care is important. Or even like ensuring that all the low-income women that qualify for Medicaid have access to it. But the answer is not solely resting with health insurance coverage. So it's a very complex issue.

Jennie: Well, yeah, a lot of those women got left behind. And a lot of states that didn't expand their Medicaid programs under the Affordable Care Act.

Jamila: Absolutely. And look, I mean it will certainly help to have more states come on board and expand their Medicaid programs because you will have more women able to access services and healthcare under Medicaid, particularly women in middle income spectrums. And so, you know, insurance coverage is important, but again, it's not the end all be all. And now just add too, I mean another aspect of the story when it comes to maternal mortality is that we've seen some stories of women being elevated in the media, even Serena Williams and her own experience with her healthcare provider where she had a postpartum complication, um, had gone to her healthcare provider and initially was just told, oh, you know, I think you just need to rest. I'm sure there's no issue. And she pushed and eventually the issue was addressed. But not all women have that privilege to go to their provider and say, something isn't right. And we even saw that through the, um, ProPublica and NPR stories that were published had been published over the span of several months where they have highlighted, you know, everyday black women who had experienced complications, had gone to their providers telling them that something didn't feel right and oftentimes they're ignored. And so there was also an issue that we have to deal with in terms of providers implicit biases that may be relevant or present with providers and how they interact with black women. I think that's going to be an important aspect of any strategies to help save black women's lives.

Jennie: Yeah, that was another thing that really struck me when I was reading through the report was talking about how black women feel like they're not being heard when they talk to their providers. And I know you kind of see the research saying that women overall don't have their pain acknowledged when they visit the doctors, but this also seem to take it much further that black women in particular are not being heard.

Jamila: Yeah, absolutely. And it's something that we're hearing as a theme throughout the stories that are being elevated for women that have been affected by maternal health complications. Um, black women in particular. And so, um, I think we can't ignore that cause even if clearly these women have had access to the healthcare that they needed, um, and oftentimes they've had the income to support any services that they need in addition to what was covered in their insurance, so forth and so on. But, um, if they aren't being listened to or trusted by their providers, then that's costing them their lives.

Jennie: Yeah. And I think another area that, um, and this again I think can fall under like institutional racism is thinking about environmental factors and living in areas where there just aren't as healthy.

Jamila: Yeah, absolutely. We saw that with the Flint water crisis. You know, there were several reports that came out, um, that showed that there were increased rates of infant mortality for, particularly for black women, um, in the Flint area, who did have exposure to lead induced water. And as you said in terms of the structural racism piece, these are women, you know, that happened to live in a low-income area. They're largely women of color and it has impacted their, um, maternal health so, when we have any policies or programs that have a disproportionate impact on people of color in a way that is harmful and hurtful to their livelihoods that's what structural racism is.

Jennie: Yeah. And I think what was particularly egregious in Flint is you also saw an increase in miscarriages and that was only the ones they were able to measure, which-- was if it was after 20 weeks or so?-- they think that there's a lot more that happened because they happened before that, but aren't included in the counting.

Jamila: Right. Absolutely. And so even for, um, so yes, we have the issue around, um, you know, infant deaths and miscarriages. I think also they're going to be for children and women who have had exposure to lead water. Um, this is going to impact them throughout the span of their lifetime. So I think particularly for children they're going to have to be tested and researchers will have to keep an eye on them in terms of like the lasting effects of this. But again, it's just one example of where we see these environmental factors that impact maternal and infant health and child health issues in all, sort of within that, you know, rubric of structural racism.

Jennie: Yeah. And I think it really comes together with, you know, environmental justice and reproductive justice really kind of having these overlapping conversations that need to happen.

Jamila: Yes, absolutely. It's, it's intersecting, all of those things. I'll also add to that, another piece of this that CAP and to look at too is food insecurity, um, and how that may impact maternal and infant health outcomes as well. Um, so not only looking at where, you know, the sort of concentrations of people of color that are living in with high food insecurity, but also how policy changes and cuts to funding for programs like WIC and SNAP. You know, how those impact communities of color, particularly black families. And so we're going to look at that and see if there's a connection there too in terms of um, maternal health outcomes.

Jennie: So we talked about physical health not having also not being a major contributor to the gap. Um, one of the other areas that you guys looked at was mental health?

Jamila: Yeah, absolutely. And so mental health is, particularly maternal mental health is, you know, an important thing to examine when it comes to poor maternal health outcomes. I think in terms of how it impacts maternal mortality, I think the rates there aren't really high. But we know that black women, particularly black single moms have very higher rates of postpartum depression to the point where it not only affects their livelihoods but also the livelihoods or their children even throughout the early years of school and so forth and so on. So maternal mental health is an important issue that we need to address. I think, you know, it's a contributing factor for poor maternal health outcomes. And then also keeping in mind with the fact that communities of color lack access to, um, maternal mental health services. And so we need to do more to make sure that folks of color, low income communities have access to comprehensive mental health care. And that's another good thing about the ACA. It does support access to mental health services. It’s one of the essential health benefits of the ACA, so it's covered, it's free. And so really doing more, I think to also I think educate communities of color that that service is there and available to them. You know, if they are getting healthcare through the ACA instead of advertising it.

Jennie: Right.

Jamila: …De-Stigmatizing it, which I think, you know, will have to be done at the community level, but you know, we can do more to educate everyone in our communities about how important that is. I think also too, we're seeing mental health not addressed in communities of color is also a factor in like living in, you know, unsafe communities, you know, what we're seeing in terms of police violence. I mean you turn on the television and another unarmed black person has been killed by the police. I mean all of these things take their toll on our communities. And so we're really doing more to address trauma, um, and mental health issues as a key aspect of this. At the same time, I mean, we also know that black women also carry a lot on themselves, you know, in their communities. I'm a black woman and can tell you that we… not only are we sort of faced with, you know, stresses in the workplace, you happen to be a single mom that can be added stress. Um, and oftentimes we're putting other people ahead of ourselves. So the mental health piece is also key and because it oftentimes goes unchecked among women of color, we need to do more to, to raise the visibility of the issue and then also make sure that mental health screenings should be a part of any sort of postpartum support and health care services that women have as well.

Jennie: Absolutely. This really gets into a little bit of tearing apart what you mean when you say racism is the factor. Anything getting into that mental health conversation really kind of started it at of how um, violence in the community and all of these things and the women caring so much impacts their overall health before. And that is part of the racism and where you're talking about the gap.

Jamila: Yeah, absolutely. And you know, I think also too, there's sort of this perception that, I mean I think it's not just for black women, but I think women in general, like you have to be strong, you have to, you know, be there for everyone else. And I can't emphasize enough how that, you know, is hurting some women. And that's a lot of pressure to put on women so we definitely need to do more. And as you said, racism is a common thread throughout all of this. All of these issues that we're talking about today, you know, there are policies in place that are perpetuating these situations where, people of color are experiencing inequality. You know, it's something that has not been addressed over the span of many years and it's bleeding to death in these communities. I think maternal mortality is just one example, but we can also look at other, health conditions where across the board, black folks are more likely to die or have morbidity in these areas. And so, the common thread is racism and we have to get to the root causes to fully address them. And I hope that conversation seems to be moving ahead a little bit in the ways that it also seems to be getting worse.

Jennie: But like the conversations I think are being had more openly than they have in the past. And I know it seems like the white community is starting to engage a little more, which is good to see, hopefully in ways that are helpful but not always.

Jamila: Yes, I think we are right in an important moment. You know, and then that I have to give a nod to black women led organizations like Black Mamas Matter Alliance. Um, the National Birth Equity Collaborative, you know, in groups like that who are not only working I think at the community level to engage um, other black women and black women led organizations locally and at the state level. But also that work is trickling up nationally. I think what we've seen in terms of the piece from ProPublica as well as Serena Williams sharing her story, even if we look at, you know, the untimely death of Erica Garner, you know, these stories and the conversation is raised to a national level now. And so with that, we have the first ever black maternal health week coming up April 11th through the 17th. This is a week that is um, focused on amplifying the voices of black women in the maternal health and maternal mortality space and also lifting up black women led organizations that are really focused on addressing this issue. I also have a gift, have to give a nod to doulas and midwives who are working at the community level. I mean there are some really impressive programs that are happening largely on shoestring budgets. Um, you know, led by women of color who are trained doulas that have said, look, we want to do more to ensure that black women and women of color have positive birth experiences. And so they have created these programs, um, in models that are really helping save the lives of women of color. And not only are they working at the service level, but they're also patient advocates. And so there is a lot of important, exciting work happening in this space. Um, and we also need policy and programs to follow suit.

Jennie: Great. Well that leads us perfectly into what needs to be done to address that. So we talked a little bit about the community level, what at the policy level can be done?

Jamila: Well, I think at the policy level we have some low hanging fruit. You know, I think that we are in a place where we've seen all of these efforts to repeal and replace the ACA and through the work of activists, um, and advocates, we have been able to save the ACA. So I think we can applaud that. But that doesn't mean that it's not still under attack. I mean we, we still sort of see these efforts at the administrative level in particular to undermine, um, the ACA. So, you know, we need to keep working and making sure that we protect the ACA. I think Medicaid expansion is something that you also mentioned. Um, you know, I think these things are sort of the low hanging fruit but I mean we also need to think more about how we can get to those middle and upper income black women. And so though there will need to be more research and thinking about that. I think we also need to address, you know, some of the issues around structural racism that we talked about in terms of ensuring that families have access to whole foods and nutritious meals. Clean water is an issue. I can't even believe we have to talk about these things. One, it is 2018 but you know what, hunger is still a major issue in this country, particularly for children. And so that's an issue we have to address.I think we need comprehensive legislation that acknowledges that structural racism is a factor in maternal and infant mortality and then coming up with solutions that address key aspects of structural racism. You know, that we've talked about safe communities and policing and um, how that impacts folks comprehensive support in terms of mental health services, ensuring that health care is of quality. I think yeah, access is one issue, but we also need to make sure that women of color have access to quality health care. So I'm hoping that we see that. I think in order to have the, a comprehensive piece of legislation that we want passed, you know, it's going to take a while. But I think, you know, there are some things that we can sort of do, um, within the context of the current situation to help ensure better access to health care. Um, I also recognize that we're in the midst of fighting to ensure that reproductive rights are protected. We're seeing restrictions being tacked on to access to abortion at the states a very ferocious effort and federally and so, um, working together I think to do what we can to protect women's access to abortion is also a key piece of this. I mean, all of this is a thread that abortion is healthcare. It's a part of comprehensive healthcare that women need and, and it's an important aspect, I think to ensure that women have healthy pregnancies and healthy reproductive lives.

Jennie: Yeah. That brings me into something we also have, we haven't talked about on a podcast yet and we'll definitely have an episode covering it more in depth later, but talking about what's happening with Title X which is the only program, federal program with access to family planning for low income women.

Jamila: And it's really under, yeah, attack right now. Yeah, Title X is under attack. And so that's another, I think piece of the, of the policy puzzle here. You know, not only have we seen sort of protections for Title X providers that are also offering abortion services with private nonfederal funding be targeted by this administration. You know, this administration has been slow to roll out its grants for this year. And even in the grant notices they are really focusing on messages around abstinence and focusing on services, focusing on services moving away from evidence based interventions that we know work that we know help prevent pregnancy, which is really odd because at the same time they don't want women to have access to abortions, but they also don't want to help them prevent unwanted pregnancy. So that's kind of, that's a weird thing. Something I never understand with right conservatives in terms of these issues and also want to cut back on SNAP, but right in maternal health care and all of that, maternity, maternity care, all of those things which are key aspects to policies that help women thrive. And so I do think that, we have to keep a close eye on this, but also by to make sure that women have access to these services. Title X is just one piece of the pie in terms of access to contraception. You know, we're, we're seeing threats to Planned Parenthood at every turn. It’s an important front line provider that oftentimes is acting as the sole access point for healthcare for women of color, um, in low income communities. Um, and so if I'm a woman that lives in Southeast DC and Planned Parenthood is the only place that I have to go and for some reason I can't get health care there because that Planned Parenthood may not be accepting Medicaid or may not be able to support me through Title X grant funding, that's going to be an issue.

Jennie: And so all of these things start or create this perfect mix, um, where women's health care is being attacked at every turn and somehow like women's healthcare seems to be seen as not health care.

Jamila: I know, which is crazy, but I mean, again, you mentioned maternity care, you know, we also saw, you know, members of Congress trying to eliminate maternity care as one of the essential health benefits. So it's just, I don't understand it. I feel like it's… women's health is a piece of it, but I think even just broader in terms of like the attack and assault on women is really what we're seeing here. I think one of the things I read in at, which, I can't remember which article it was I read, but while I'm getting ready for this interview, it was talking about how even the healthcare system itself, it focuses when you're pregnant, it focuses on the fetus and not very much on the mother.

Jennie: Yeah, it's true. I mean that argument can also be made too on the baby once it's born.

Jamila: Um, that's, that's another thing that we've seen from research is that the response and sort of model of care from health care providers is really to focus on the infant once it’s born. And there are times where, you know, mom's health is ignored, or not addressed adequately. And so again, I think that's a fallacy because we're seeing women's deaths because of this.

Jennie: And we did focus a lot on maternal mortality. But that's not to say there, there are a lot of things that are bad up until that, right. There's a lot of maternal health risks that are not mortality that don't get talked about as much.

Jamila: Right, absolutely. We talked, yeah, maternal mental health was that, which I think, you know, again, could be in the prenatal period and in the postpartum period. And that's an important indicator there. Um, and then even with maternal health met only if we see it, um, maternal mental health issues in the prenatal period. It's, it could also impact mom keeping up with her prenatal care visits for nutrition and things like that. So there are some important things to address even with maternal depression and other anxiety issues and the prenatal period. But yeah, the environmental factors that we talked about, exposure to certain toxins like lead in the water is a key piece of that smoking and things like that. But again, we want moms to be healthy before they get pregnant or women should be healthy before they get pregnant. Excuse me. Um, so that's a key piece too. And that's something that we're also advocating for and pushing for in the context of the work. At the same time, it's a very complex issue when we talk about black women because even when we are healthy, you know, before pregnancy we're still 243 times more likely to experience maternal death as you had mentioned. So it's a very complex issue. And there are several parts of this that we have to focus on and address since this episode is going to be released during black maternal health week.

Jennie: I always like to end my podcast by talking about what can people do. So what can people do to support these issues?

Jamila: Well, I think, I think one thing or a few things that can be done, particularly during black maternal health week is to follow the Black Mamas Matter Alliance on Twitter. There's a thunderclap and you can also join for black maternal health weekend. We'll love folks to follow the handle and then join the Twitter, um, that thunderclap, which would be great. Thank you for posting to link. So that's an important piece. I think also, you know, we have been working with representative Alma Adams office to introduce a resolution that not only commemorates the first ever black maternal health week, but also lifts up the issue of maternal mortality among black women.

Jennie: Oh great!

Jamila: So it would be awesome for folks listening to the podcast to reach out to their representatives and ask them to cosponsor this resolution. Um, so that's a key thing that can be done.I think folks should continue to, you know, read up on this issue as you see sort of pieces come out or women's stories being shared, continued to read up on those and share them on your Twitter and Facebook so we can keep the drum beat going in terms of like addressing these issues. And last but not least, we have very important things coming up in November of, of this year and 2020. And so, you know, just for folks to think about these issues and sort of where they lie in the context of our elected leaders, or folks that are running for office, I think that's really important. We cannot afford to have another situation where we have people running this country that don't support women's health and rights. This is not only an issue that is both related to our health, but also our livelihoods. We are not healthy and thriving. We cannot go to work and, and feel happy and have good mental health. Um, so it really impacts all aspects of our lives and limit our important contributors to the productivity and the resilience at this country. And so we have to keep that in mind, that women matter in that we're active participants in politics and we should be accounted for and focused on, you know, when it comes to the policies and how our leaders were in the country.

Jennie: And women are the majority of voters.

Jamila: Yes. Yes, that's an important part too, women are the majority of voters. And then also since we're on the topic, we have a record number of women running for office. And so if you have amazing women running for office in your state, you know, support them. Um, and of course, reproductive health and rights should be a key part of that platform. And so to me, I feel like these issues shouldn't be partisan issues. You know, everyone has a mom or sister, some of us have daughters and women in our lives, everyone has women in their lives and these issues are important to all women regardless of their political affiliation or background.

Jennie: That’s a good place to stop. Jamila thank you so much for being here. I really loved it.

Jamila: Thank you so much, Jennie. This was great.

Jennie: For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at repros fight back. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

Take Action