Bonus Pod: BMHW22- The Current Status of Black Maternal Health in the U.S.

It’s officially Black Maternal Health Week 2022! Dr. Jamila Taylor, Director of Healthcare Reform and Senior Fellow at the Century Foundation, sits down to talk with us about the current status of Black maternal health in the U.S., as well as what access to abortion, pregnancy and delivery care, and COVID-19 services look like for Black pregnant people and other people of color in this country.

 Even though the United States spends more per capita on health care than any other country, the maternal mortality rate is steadily worsening. Just last month, the Centers for Disease Control and Prevention released new data showing that Black women are three times more likely to die from maternal health issues and maternal morbidity than white women. These rates have steadily increased due to the COVID-19 pandemic. Social and structural inequality as well as racism in the healthcare system continue to contribute to the poor health outcomes of Black women. Racism in healthcare can result in physical and mental health impacts, weathering (wear and tear on the body), and increased likelihood of experiencing complications during the pregnancy and birthing process.  

The COVID-19 pandemic has laid bare the ways in which marginalized communities continue to be further marginalized when it comes to healthcare access. The pandemic’s restrictions on those allowed inside hospitals and clinics impacted Black birthing people’s abilities to bring along companions into medical settings, like a friend, family member, or doula to serve as an additional patient advocate.

Already, the U.S. is experiencing a maternal mortality and morbidity crisis, but tacking on extreme attacks to abortion care will worsen health outcomes. A possible overturning of Roe v. Wade by the Supreme Court in June will leave the United States woefully unprepared for a worsening maternal mortality crisis, exacerbated by a lack of access to abortion care for millions. States that are most likely to pass the most draconian abortion restrictions are the states with the highest maternal mortality rates, mostly concentrated in the American south. 

The Momnibus package, which has been led by Congresswoman Lauren Underwood and Congresswoman Alma Adams, is a package of 12 bills that address almost every dimension of the Black maternal health crisis. This package of legislation addresses a variety of intersectional Black maternal health concerns, including the social determinants of health, vaccinations, climate, housing, insurance coverage and more. Passage of the Momnibus would make a momentous difference in addressing the U.S. Black maternal health crisis.

Links from this episode

The Century Foundation on Twitter
The Century Foundation on Facebook
The Maternal Health Crisis Facing Black Women
Information on the Momnibus
Information on the Build Back Better Act

Transcript

Jennie: Welcome to rePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jennie: Welcome to this week's episode of rePROs Fight Back. I'm your host, Jennie Wetter, and my pronouns are she/her. So y'all, you would think that since it has only been a week since we have talked, I'd be like, you know what? Nothing has changed. You know, nothing really to add… but y'all so much stuff has happened in the last week. And again, unfortunately, most of it is trash, terrible things. The unle assaults on abortion rights and trans rights and Rams youth is just unending, right? Like still happening. So many things happening at the state level. I don't wanna focus on any of it. Y'all I don't wanna talk about it right now. Like I am recording this, um, the day that Justice Ketanji Brown Jackson was confirmed. So I wanna sit in that joy. So let's just do that, right? Let's just focus on the joy of the Senate confirming the first Black woman as a Supreme Court justice. Y'all, this is historic. It is so wonderful. I am so excited to see that we are going to have this wonderful, wonderful Black woman on the Supreme Court. I just… y'all. I'm just so happy. Uh, it is just a historic moment and there's just so much to celebrate right now. I also found interesting and it's really weird that it like really hit me so strongly when I read it. Because if you think about it for like a second, you're like, well, duh, that's obviously the case, but still, I don't know. It just like took me aback for a second and that this is going to be the first time in the Supreme Court's 230 year history that it, there will not be a white male majority on the Supreme Court that I, I don't know why it bowled me over so much when I read it, because I mean, if you think about it for a second, like that's obviously true, right? For so much of the history, it was just all white men. So yeah. Now would be the first that we're not seeing a white male majority obviously, but I still find it just so striking and just thinking of all of these other experiences and voices that are being brought to the Court to make sure that we're getting hopefully closer to a more just world and having the first Black woman on the Supreme Court is for sure a step in the right direction to get to a more just world. And I am just so ecstatic and just sitting in the joy today of soon to be Justice Ketanji Brown Jackson being the first Black woman on the Supreme Court. I just it's so exciting.

Jennie: And you know, so often we talk about living through history because it was like all of these terrible things, right? The pandemic or the, the previous administration and all of the many things that happened then. And like, man, I don't wanna live through history anymore. This, this is history. I want to remember. Right? I want to remember the first Black woman being confirmed to the Supreme Court. So congratulations, Justice Jackson. I cannot wait to see what you bring to the Court. I wait to see the opinions you write, or maybe right now more with the heavy conservative majority, the, the descents you write. I just, I I'm so excited. And so let's, let's take this time to celebrate the huge victory, right? It's a huge victory before we start stressing about all of those other things I mentioned at the beginning about this unrelenting assault on abortion rights. Like let's sit in the joy for a little while. I feel like right now working in repro, joy has been a little few and far between to sit in. So I am definitely going to enjoy at least taking this weekend and next week to just sit in the joy of we're going to have the first Black woman on the Supreme Court. And I am so excited. So with that, let's turn to this week's episode. So this week is Black Maternal Health Week. And so I couldn't think of a person that I would rather have talked to then Dr. Jamila Taylor at the Century Foundation. Jamila is so wonderful. She was one of the first people I talked to when I was talking about the idea of starting this podcast and was starting to just get temperature read, uh, from friends and colleagues. And I still had a lot of doubt if it, it was the right move for me, I, you know, I wasn't sure that I was the person to do it, that I should do it. That a podcast was a good idea. And I just remembered Jamila being a really big cheerleader, like right from the beginning and thinking it was an amazing idea and it really made a difference, right? To have somebody I respected so much be a cheerleader for me. So I just, since Jamila's probably listening, thank you, Jamila. I am so grateful that she has been on the podcast a couple times, and I'm very excited to have her back today to talk about Black maternal health. So with that, let's turn to my interview with Dr. Jamila Taylor.

Jennie: Hi Jamila. Thank you so much for being here today!

Dr. Jamila Taylor: Hi Jennie. Thank you so much for having me.

Jennie: So before we get started, do you wanna do a quick introduction of yourself and include your pronouns?

Dr. Jamila Taylor: Sure. Thank you to everyone for tuning in today. I'm Dr. Jamila Taylor. I serve as Director of Healthcare Reform and Senior Fellow at the Century Foundation, a 100 plus year old think tank with offices in Washington, DC and in New York; healthcare policy is one of our focus areas. We also work on issues around the economy and jobs, international policy, as well as education issues. I've been working in the reproductive rights and justice space for over two decades now. And one of the issues that is near and dear to my heart in that context is maternal health. So really excited that Jennie has invited me here today to talk about the issue. Before I started working in advocacy and policy, I did a long stint on Capitol Hill working for Congressman Bobby Scott of Virginia. And I've also held a number of positions in advocacy organizations, both in the reproductive rights and justice space, as well as healthcare and HIV/AIDS.

Jennie: I am so excited to have you here, well, one, I'm always excited to have have you on. But two, if we're gonna talk about Black Maternal Health Week, like I couldn't think of a better person to talk to than you. So thank you for being here.

Dr. Jamila Taylor: Great. I'm happy to be here.

Jennie: So maybe we'll just start at the beginning and like, what is the status of Black maternal health right now?

Dr. Jamila Taylor: Yeah, well, you know, I hate to sort of start off the conversation, you know, with some sobering statistics, but to be honest, you know, the status of Black maternal health right now is that the maternal mortality crisis in this country is getting worse. You know, just last month, the Centers for Disease Control and Prevention issued some new statistics on, you know, sort of where we are. And in terms of the maternal mortality rates in this country, Black women are about three times as likely to die of maternal health issues. Maternal morbidity, you know, the rates between Black and white women are, are much more higher. And we also know that over the last year or so that we've seen the rates increase largely due to the COVID 19 pandemic. You know, prior to this past, you know, update in terms of the stats, we didn't have much data, um, available on Hispanic women. And we saw that their mortality rates actually raised by 44% in one year-- again, were looking at these stats and recognizing that the COVID 19 pandemic has had a huge impact on this increase that we're seeing. So in a nutshell, the maternal mortality crisis in this country is worsening,

Jennie: Which I mean, that is just devastating, cuz it was already terrible and already a crisis before it got worse.

Dr. Jamila Taylor: That is absolutely true. You know, and the thing that makes it, I think super shameful, I mean it's already shameful, but the fact that, you know, as a country, you know, we spend more per capita on healthcare than any other country, you know, and we also have the worst maternal mortality rates than any other similarly developed country. And so this is an issue that, you know, quite frankly, we have the tools to address. And I know we'll talk about that more in the program today. And a lot of it really comes down to, you know, how are we treating, you know, particularly Black women and other women of color in the healthcare system. Based on the research that TCF has done-- my organization-- as well as a host of others, we know that racism is actually a root cause of, you know, why we're seeing such high maternal mortality and morbidity rates among Black women and other women of color. And so we'll have to root that out, you know, if we really want to address this issue adequately, but there are also a host of other things that we'll also it talk about in the program today.

Jennie: Yeah. And that really gets to you, I was gonna ask, cause we had, I think the first time you're on, we had this conversation of like what is causing the Black maternal mortality rate to be so much higher? And I think that's a really important point cuz I think a lot of people see that it's higher for Black women and assume it's a race-based issue and not a racism issue. Do we wanna expand on that a little bit?

Dr. Jamila Taylor: Sure, absolutely. You know, I think it's, it's easy for folks to sort of point to race as a factor and an issue like this. Right? Because then it would be easier for us to sort of unpack, you know, the issue. But quite frankly, you know, research shows that racism and the experience of racism has an impact on Black health to the point that it causes, you know, our defenses to be lowered. It causes us to have both mental and physical and emotional health challenges. It causes a wear and tear on the body, you know, a concept also known weathering. And again, all of these things are, are well documented. And so we know that because of those things, you know, it, when a Black woman presents with a pregnancy, it does cause her to, to have her defenses reduced. And, and that means that she's more likely to experience complications and the pregnancy and birthing process. I think another aspect of this, which also fits within the conversation about racism is the fact that we're also more likely to experience racist experiences at the hands of our providers. Right? And you know, there's a lot of conversation, I think in the public health field, I think more recently we're seeing it more of those conversations. A lot of that in the backdrop of COVID, there's more of a conversation about how do we address racism among healthcare providers within the healthcare system? You know, some of those conversations have focused on, you know, increasing access to, you know, implicit bias training for providers, making sure that everyone in both the front and back office are adequately trained in to address implicit bias, but also too, a part of that is making sure that we develop and implement antiracist health policy. And so that means we wanna make sure that everyone has access to affordable and quality health insurance coverage, and care. It means that, you know, the services that we need to access pregnancy related care is affordable to everyone. It means that we need to make sure that maternity care wards are available in all neighborhoods. So everyone has access to them. And so it really is a multifactorial approach. But again, racism is at the root of all of these things.

Jennie: I mean, I kind of feel like that's a universal statement.

Dr. Jamila Taylor: I think so too. I think you're right. I think, look, if we were having a conversation today about, you know, heart disease or, you know, again, I mentioned COVID 19, I think, you know, we're, we'll see some of the same, I think, trends when it comes to health and health concerns for, for people of color in this country. And again, you know, because we experience those, those racist, we have those racist experiences does cause our defenses to be lowered and cause us to have poorer health outcomes. But again, these aren't things that we cannot address, um, both through public policy and our approaches to public health.

Jennie: So I think the conversation about Black maternal mortality has just been progressively getting louder and louder and louder for the last quite a few years. But I think one of the points that it really brought kind of this, uh, explosion of people, a broader audience, understanding racial disparities was COVID right? You, you started to see a much larger conversation happening around it. And unfortunately, you're still seeing that, how that's impacting maternal health, but I think it was good to see it grow broader. You're still seeing these huge impacts of how COVID then is impacting Black maternal health.

Dr. Jamila Taylor: Yes we are. And you know, I think the thing with COVID is, you know, I think it's important to start with the simple fact that, you know, COVID 19 has had a disproportionate impact on people of color in this country, particularly Black and Latino populations. And that also has meant that pregnant people that are part of those populations have also been disproportionately impacted by COVID. And what we know is that, you know, when a pregnant person presents with COVID, it could cause complications in, in their pregnancy and a childbirth, you know, it could cause preterm birth, a low birth weight, you know, in infants and really cause the pregnant person to, to be ill. And so that has had an impact on, you know, how we've seen our, you know, maternal mortality rates go up particularly among Black and Hispanic women in the last year or so. And so I think when we saw these new COVID 19 rates, as well as the maternal mortality rates be released and sort of look at them side by side, it was clear that COVID 19 has had an impact. I think another thing I'll add too, is that early on in the pandemic, we did see, you know, a number of hospital systems implement policies to basically say that pregnant people could not have a loved one or companion, you know, coming into the hospital with them, whether they were coming in for appointments or even in the birthing process. And whereas we understand that the systems we're thinking about the health and wellbeing of, of other patients and, and workers in the hospitals, a situation like this did have an impact on Black and other birthing people of color… the fact that it's so important for us to, you know, and I'm a Black woman, so I can say us, um, it's so important for us to have a companion or advocate with us in the birthing process, and a lot of that is due to the fact that one, what I mentioned earlier about the likelihood of experiencing racism within the healthcare system, and also just having someone there to be your advocate, you know, ideally a doula, you know, a, a person that serves as an advocate for pregnant women and their families, you know, either in hospital settings or even outside of hospital settings is really important. And so those policies, whereas again, they were put in place to, to help protect others from COVID 19, it did have an impact on Black and brown birthing people. And so, you know, birth justice advocates swooped in there to do what we could in order to help to lift some of those restrictions. And part of, of our thinking behind that, and part of our approach was to share what we know about research and the importance of having a doula or support person in the, in there with the birthing process for families.

Jennie: Yeah. I mean, the data was pretty clear that that makes a huge difference and yeah, so, so good to see that that's really been lifted in a lot of places and hopefully stays that way if we have, you know, more waves of COVID.

Dr. Jamila Taylor: I hope so. You know, I mean another part of it too, is that, you know, the same communities that have been disproportionately impacted by COVID are also, it's also been harder for them to access treatment and, and as well as the vaccines and, and that has also been a case for pregnant people. And so I think as we sort of move into, you know, the next phase of, you know, how we're addressing COVID and how we're approaching it from a, a public health perspective, it's still gonna be essential to make sure that, you know, that care and treatment and the vaccines remain available to everyone, particularly to, you know, communities of color and pregnant people. And so that's gonna have to be centered in, in whatever strategies we move forward with. And I know that the Biden-Harris administration is trying to do that, but they will also need the support of Congress to fill the gaps with the funding that we continue to need to adequately address COVID 19. And in turn some other health concerns, including the maternal health crisis.

Jennie: So another area, uh, where people of color particularly Black women are disproportionately impacted is with abortion access and abortion restrictions. And I think, you know, we try to talk about it on the podcast, how that is interrelated to maternal health and how they play together. But I think it's always important to have that conversation of like the intersection of restricting access, especially in a possibly post-Roe world soon. Like how is that gonna interplay with Black maternal health?

Dr. Jamila Taylor: Yeah, absolutely. And, you know, I'll start off by saying, you know, anyone who is working in the reproductive justice space, who both cares about maternal health and the gains that we're trying to make in that space are critically concerned about, you know, the direction that we're going in when it comes to protecting, you know, the access to and right to abortion. I think we see these issues sort of intersect when, you know, the fact that we're already experiencing a maternal mortality and morbidity crisis and this country when it comes to Black and brown women. And if you tack onto that, you know, restrictions on abortion care or the fact that abortion may be out of reach for millions of, of women, you know, that is only going to worsen are already bad maternal mortality crisis, right? For women that would let like to have an abortion that would like to choose to have an abortion, because it just may not be the right time for them to get pregnant and, and have a child, you know, having access to abortion is essential and it's healthcare. It should be available to, to all people who need it. And so I think that we are rightfully so alarmed about what could happen if we see Roe overturn. And quite frankly, I just don't think that as a country, we're prepared to deal with a worsening, you know, maternal mortality crisis that is gonna be compounded by a lack of access to abortion care for millions of women. I'll also say too, that there are other factors at play here, right? So we're not only talking about access to vital healthcare services. We're talking about the intermix of other oppressions that Black and brown women experience, whether it's, you know, housing insecurity, the likelihood of experiencing violence in our neighborhoods, not having access to transportation or adequate nutrition. All of those things are really what reproductive justice is about. You know, when we use that framing, it's really to sort of to focus on the intersecting oppressions that have a disproportionate impact on people of color in this country and having access to quality affordable maternity care, as well as abortion care are, are key to a person's reproductive life. And we are rightfully really scared about this. And, and I think still thinking about how to adequately approach it to be quite honest, but I think it's important to lift up these intersections, you know, particularly for those that care about maternal health and that are advocating for increased investments in maternity care and, and other supports for, for pregnant people, abortion should also be a part of what you're advocating for, if you care about maternal health.

Jennie: Yeah. And I think one of, of the things that is always really striking is seeing the states that are the most likely to ban abortion or the states that have already really restricted access are states that have a real maternal health crisis happening in them. Not that the maternal health crisis isn’t nationwide, but those are definitely some of the worse states for it. And so it something that I, that I worry about as well.

Dr. Jamila Taylor: Yeah, absolutely. So the states that are, are more likely to pass the most draconian abortion restrictions are also states that have poor maternal health outcomes. These are states that have the highest maternal and infant mortality rates to be quite honest, you know, most of them are concentrated in the South, which is also a place that, you know, tends to be a hotbed for a number of public health concerns, as well as a part of the country where almost, I think almost half of African Americans live in the South. And so there are so many different pieces to this. And again, I think the conversation that we're having today and sort of showing the intersectionality in not only access to abortion maternity care, but also these other sorts of social determinants of health, you know, as well and how they sort of interface and connect in a person's life to, to really sort of give us a picture of their overall wellbeing.

Jennie: Okay. That's enough focusing on the problem because it is a big problem. Let's start, let's turn to solutions. So what can be done to improve Black maternal health?

Dr. Jamila Taylor: Well, there's a lot that can be done. I mean, first and foremost, we cannot have this conversation without talking about the landmark legislative package, the Black Maternal Health Momnibus, which was led and introduced by our fierce, fierce, fierce fierce leader, Congresswoman Lauren Underwood, as well as Rep. Alma Adams and others in the Black Maternal Health Caucus. You know, the Black Maternal Health Momnibus is a comprehensive package of 12 bills that address almost every dimension of the Black maternal health crisis, including issues around climate and maternal health, maternal vaccinations, the social determinants of health, supporting incarcerated moms with the care and support that they need as well as a whole host of other issues. And, you know, we have been lucky this year, you know, we've seen some of those investments actually be included in the, the Build Back Better Act version that was passed in the, in the House of Representatives early this year. And recognizing that things are, are sort of gridlocked right now when it comes to Build Back Better. But, you know, as Congress considers to think about what’s gonna happen with that package and, you know, the, any other iterations that it could take, we're really hoping that the maternal health investments are maintained in that package. I think another key piece to mention too, is, is insurance coverage…right now the Medicaid program, which funds, you know, about half of all births in this country, unfortunately the program drops pregnant people off of coverage just 60 days after giving birth. And that does not make sense, particularly in a pandemic as well as you know, in a country that's grappling with a maternal mortality crisis. And so we've also been advocating for a full year of postpartum extension under the Medicaid program. And so there are investments included in the Build Back Better Act to support this as well as standalone bills like the MAMAs Act and others that, um, would also support this coverage. And then I'll also say that some states have started to, you know, submit Section 1115 waivers, which are, you know, demonstration projects submitted to, you know, the federal government to expand or extend coverage under the Medicaid program. So a couple of states have been improved for those 1115 waivers for extensions, but you know, what we're trying to do with having these fixes as part of Build Back Better is that we want this to be mandatory and permanent so that everyone and in every state has this coverage. And so those are just some of the things that advocates have been cooking up over the past few years to address this crisis, but there's obviously always gonna be more work to be done, but if we can just get these things over the finish line, I think that's gonna be revolutionary. And we think about where we are, right, where we need to go in terms of addressing this crisis once and all

Jennie: It's been really exciting to see one the administration's commitment on this issue. And two to see how far the Momnibus came this year. It, it was really exciting to, to see it advance so far and to get a lot of it into the Build Back Better that was pass through the House. I'm hoping that you guys get it across the finish line, but yeah, it, some of these things, they take so much time to get going, but I feel like this has really good momentum behind it.

Dr. Jamila Taylor: I like to think so. And then I think another thing to add to there's been so much conversation about, you know, sort of Build Back Better…And I think I'll say too, you know, with the investments that are included in the package, that focus on the Momnibus as well as the postpartum coverage extension. We're talking about a total of about 3 billion and compared to some of the other investments that are included, this is not huge. Um, you know, when you think about the return of investment as well, you know, the Century Foundation has done research to look at how many women would be impacted with the postpartum coverage extension and based on our estimates over a million women be able access coverage for a full year after giving birth. If the Build Back Better act provisions were to, to pass and move forward and signed into law. And so that would be huge, you know, for our women who are in desperate need to have that coverage continue, especially in such a sensitive period, you know, after giving birth. And we also know too that it not only impacts their mental, emotional, and physical health, but also the health of their infants as well.

Jennie: I mean, that's just life saving care and life changing care.

Dr. Jamila Taylor: Absolutely. Absolutely.

Jennie: Okay. So we always like to have, what can our audience do? I always like to end with that because sometimes all of the stuff can feel so paralyzing. There are so many things happening. So what actions can our audience take to help in this area?

Dr. Jamila Taylor: Well, first off, I mean, I think that, you know, for those that are listening in, we've talked about so many issues know during this conversation, not only Black maternal health, but also access to abortion and, some of the other issues that are so critical and important when we look at the intersectional nature of, you know, a pregnant person's life. So I think if you wanna be supportive, I think the first is to, you know, call your members of Congress and encourage them to co-sponsor the Black Maternal Health Momnibus, if they are not already on that; also issue your support of the Build Back Better act, the maternal health investments that were included there. And then I think also too, you know, we can't do this work without also again, supporting and ensuring access to abortion care. And so I think keeping your ears to the ground, supporting abortion funds in your states to make sure that they have the funding, they need to support pregnant people. Um, and then also weighing in both in, in state legislatures, as well as at the federal level about your support for abortion care, but at the federal level there are amazing bills that have been introduced to support abortion, like the EACH Woman Act as well as the Women's Health Protection Act, you know, so reach out to your members of Congress and issue your support for that. But there's plenty of, of work to go around in plenty of ways that you can engage and stay looped in with the work that the broader reproductive rights and justice community is doing on these issues.

Jennie: Well, it's really thank you so much for being here as always. It was a real pleasure talking to you.

Dr. Jamila Taylor: Thank you so much for having me, Jennie, it's always great to be here and speaking to an old friend and continue with the great work that you're doing with the podcast and all the other things.

Jennie: Aw, thank you.

Dr. Jamila Taylor: You're welcome.

Jennie: Okay. Y'all I hope you enjoyed my conversation with Jamila. I had a wonderful time talking to her. It was great to catch up with her and get to talk about all things Black maternal health. I hope you all enjoyed the episode. We'll be back with a regular episode next week.

Jennie: Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. 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, or on Instagram at reprosfb. 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.

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