The Abortion and Maternal Health Landscape is Different for Black Women. That Needs to Change.

The United States is an extremely unstable landscape when it comes to being pregnant and giving birth. Black women, in accessing abortion care, tend to face more geographic, transportation, infrastructure, and economic barriers. And Black women are three to four times more likely to die from causes related to childbirth and pregnancy. Jessica Pinckney with In Our Own Voice talks to us about the abortion access and maternal health crisis that Black women face on a daily basis in the United States.

About four million people give birth in the U.S. every year, and 700 people die from pregnancy and birth. An additional 50,000 experience an additional pregnancy complication that is so severe that they nearly die. Three out of five of the previously-mentioned pregnancy related deaths could have been prevented. Yet, these pregnancy and birth related injuries and deaths are disproportionately felt among Black women—in fact, Black women are three to four times more likely to experience a pregnancy-related death than a white woman. Black women are more likely to be exposed to negative social determinants of health, like income inequality or societal discrimination. Black women experience bias from medical providers, and have been historically exploited through scientific research and experimentation by U.S. healthcare providers. These historical and modern plights that Black women have faced when accessing healthcare are shrouded in racism.

It isn’t just maternal health that’s alarming—access to abortion for black women is also falling behind. In the last year alone, the United States has passed 5 bans on abortion after 6 weeks gestation. This legislation is compounded by the Trump administration’s gag rule on Title X, efforts to prohibit Planned Parenthood from receiving Medicaid reimbursements, and the Hyde Amendment. Black women are more likely to have to jump through logistical hurdles—like those related to transportation and infrastructure— in order to access abortion care. This has a major impact on Black women’s economic security, particularly in the south. It is important to note that the same states that have introduced the most extreme abortion bans are the states in which levels of maternal mortality are highest.

Black women are disproportionately impacted by the Hyde Amendment. The Hyde Amendment makes it so that low-income and black women that are accessing healthcare coverage through Medicaid don’t have the same rights as other women who can finance an abortion out-of-pocket or through private health insurance. 31% of Black women and 27% of Latina women of reproductive age are enrolled in Medicaid, compared to just 15% of white women. This amendment also detrimentally impacts other marginalized communities, like the LGBTQ+ communities.

When women are denied an abortion and then give birth, they report worse health outcomes up to five years later as compared to women who received an abortion. Those who are denied an abortion are more likely to delay prenatal care, which often leads to higher incidences of maternal health problems. This coupled with pre-existing limitations on quality health care means Black women can face serious medical complications and negative social outcomes when denied an abortion.

Links from this episode

In Our Own Voice
In Our Own Voice Twitter
The Maternal Health Crisis Facing Black Women podcast episode
Article from CAP: Black Women Disproportionately Suffer Complications of Pregnancy and Childbirth. Let’s Talk About it.
Black Mamas Matter Alliance

Transcript

Jennie: Welcome to rePROs Fight Back a podcast on all things repro. I'm your host Jennie Wetter. In 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.

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Jennie: Hi everyone. Welcome to RePROs Fight Back. I'm your host, Jennie Wetter. Recently you may have noticed I've been trying to do a more personal intro to the show instead of just jumping right into the interview. So that's something new. I'm trying. Let me know if you like it or if you hate it. So when I was thinking about what I wanted to do this week, I had all of these ideas going through my head and I kept being like, they're not going to want to hear that. I'm not an expert in that. Like why do they care what I have to say? That really led me to think about imposter syndrome. And you know, it's something that a lot of women in particular struggle with. I think everybody kind of struggles with it to degree, but in particular, I think a lot of women struggle with it and it's not something that gets talked about a ton. I know I fight it a lot when someone is talking about, you know, well you're an expert on this. I have to just like cringe. Like what? I'm not an expert. I don't know what you're talking about. Like yeah I work in this issue but I'm would not consider m self an expert. Did you see all of these badass people I work with? They're amazing. Like all the guests on my podcast, they are amazing. I'm not that person. And there's just always that little voice in the back of my head that I always questions it. Like it's always like, well, you know, you're just not as good. I don't know what you're doing. And so I think that just leads me to one of my goals this year. I don't know that I would say it's like a new year's resolution… cause again, I talked about how I tried to keep those light and fun. But one of the things that I've really been trying to work on and I want to continue to work on this year, it's shutting up that bitch in the back of my head who is always questioning me and always saying that I don't know what I'm talking about and I don't know what I'm doing. And it's time to not listen to her. She's not in charge. I'm in charge. I know what I'm doing and someday I will completely believe that. So here's to all of us telling that little voice in the back of our head that she, that voice is not in charge, that we are smart and we know what we're doing. And you know, sometimes we don't and it's okay, but you can't let that voice in the back of your head rule everything. And I have been listening to her way more than I should and I really need to stop. So I hope that helps put voice to some things that people, other people may be struggling with. I know, you know, until you start hearing the conversation out loud, you assume it's just you and that voice is just, yeah, no, you don't know what you're doing. But when you hear that people you respect have that same voice and you're like, “Oh no, we're all in this together” and if we heard a friend saying that about themselves, if we heard them say that they didn't know what they were doing, or they weren't an expert in their given field, we would never tolerate it from them, right? We would tell them, stop them right there and say, “what are you talking about? Obviously you know what you're doing and obviously you're an expert.” So why do we tolerate it from ourselves? Why do we listen to that voice? So here's to stop listening to that voice that is putting that doubt in our heads. It is not worth it. It's time to talk about imposter syndrome because that will help make it stop. Okay, with that, let's turn to the podcast and the interview. I'm really excited for y'all to hear this week's interview. I got to talk to the amazing Jessica Pinckney again with In Our Own Voice and we talked about the crisis around maternal mortality and abortion access and how it has a disproportionate effect on Black women. And it is a really important conversation and I can't wait for y'all to hear it. So with that on to the interview, hi Jessica, thanks so much for being here.

Jessica: Thanks for having me back. I'm excited to be here.

Jennie: I’m so excited and I'm just really excited to be talking about this topic again, it's been awhile since I've talked about Black women in maternal health and that's a shame. So I'm so excited that we're doing it again.

Jessica: Well, it's a definitely a very important topic that's been getting a lot of attention in the public narrative and so excited to make some important connections today.

Jennie: So maybe we should start at the very beginning and kind of talk about what does maternal health and maternal mortality look like right now in the US?

Jessica: Sure. So right now about 4 million people give birth each year and unfortunately about 700 women die every year from pregnancy and birth and an additional 50,000 experienced some type of pregnancy complication so severe that they nearly die. And in addition to that, three out of five pregnancy related deaths could have been prevented. So what we see right is a really unstable landscape for giving birth. A lot of the complications that individuals who become pregnant see in pregnancy could be avoided with changes to our healthcare system with changes in culture and society. And so this is an issue that has been getting more and more attention specifically as it relates to Black women who are even more significantly impacted.

Jennie: Yeah, and I think it's also worth noting just putting it in a global perspective that the US is one of the very few, if not the only place where the maternal mortality rate is been going up versus going down.

Jessica: Right. And that's, I think it's really important to note. It is incredibly important to note and it's really due to issues that arise in our health care system. We have really high costs. There are gaps in insurance coverage, there's lack of access, particularly quality access and community centered care. There's a failure to integrate patients decisions into the delivery of care. And then there's social determinants of health that are really important to lift up. There's a lack of safe housing. There's a lack of nutritious food. A lot of folks don't have adequate or reliable transportation. Pregnancies can be impacted by proximity to environmental toxins, so on and so forth. So you're absolutely correct. Are maternal mortality rate has been rising even as an incredibly developed country and a lot of it is systemic and can be addressed, but really requires holistic thinking about this issue.

Jennie: So you know, it's also, you mentioned really important to note that this has had a disproportionate effect among Black people. I think it's not always in an obvious way. And I think people think it's because of you know, a lack of access to care or because they are poor. But it's not that simple, right? It's really not.

Jessica: Black women are three to four times more likely to experience a pregnancy related death than a white woman. This is a statistic we hear quite often, but I think it's really important to repeat and repeat and repeat because it's horrifying. It's absolutely horrifying. As a Black woman of childbearing age who talks about this day in and day out, it's certainly impacts me thinking about it. Yeah, it's incredibly scary when you think about starting a family, Black women are more likely to be exposed to negative social determinants of health. Like I was just talking about. We're impacted by income inequality, societal discrimination. There's a history of scientific research and experimentation exploiting Black women. There's significant provider bias, so these issues all certainly impact Black women and really that's at its core racism. Black maternal mortality really knows no economic geographical, so on and so forth. Boundaries, right? I think the case you often hear about is Serena Williams who has tons of access in terms of money, access to the best providers, not only in the country, but the world she's married to someone who presents as white and is in a heterosexual relationship. All of these things that really relate to privilege and yet when giving birth to her first child was unable to get providers to listen to her and almost died following childbirth. And so this is really an issue that does not care if you're wealthy or poor, does not care if you live in Southern California or Wichita, Kansas. And it's something that…I think it's complicated for people to address because it's not one quick simple fix. We have to address the pay gap that impacts Black women. Black women are typically paid 61 cents for every dollar a white non-Hispanic man is paid, which you know, low wages mean that Black women and our families have less money to support ourselves. We have to choose between essential resources like housing or childcare or healthcare or more likely to be uninsured and face greater financial barriers to access the care we need. We're less likely to access prenatal care because of some of those issues. And then there's just a really strong provider bias that exists in our healthcare system where providers are not listening to Black women who should know their bodies best. And so we're not being heard. You know, I think a lot of Black women have a real distrust of the healthcare system because we've been tested on and experimented on an had our bodies used for science for decades. And so there's just a natural mistrust that also exists there. And so there are a lot of barriers to address to improve the maternal health outcomes, particularly for Black women. And like I said, I think we really need to take a holistic approach to be able to do that.

Jennie: Yeah. And everybody always wants, you know, if I just do this one simple magic thing, everything will be better. And you know, if they can just address this one thing and not want to address the entire system.

Jessica: Right. And you and I have talked previously about intersectionality and Black women. When we're thinking about starting families, when we already have families and we're thinking about growing our families, we're showing up in our communities and in our healthcare system, both as a woman and a Black woman, as mothers, as wives, as partners, so on and so forth. And so there are various impacts on our life and we have to address all of those. Just there's not one little band aid that's going to fix this, this broader issue. It has been nice to see it become not just part of the general conversation now, but starting to see bills being introduced that are looking at ways to address this crisis.

Jennie: I mean we don't need to dig into them cause I definitely didn't warn Jessica, but just, it's nice to see that Congress is maybe starting to at least talk about it and maybe try to make action happen.

Jessica: Yeah. I always joke that there are so many, yeah, maternal health bill is out there right now In Our Own Voice is always really supportive of the bills that are addressing implicit bias that exists in the healthcare system specifically because we know that racism really is at the core of this issue. And so it's really important that that be part of any solution to the maternal health crisis. But yeah, there's a lot of legislation out there. It's great to see Congress having this conversation and we hope that they'll start taking action.

Jennie: Yeah. And if you all want a deeper dive on how it really, racism is the bottom line on black maternal health. I did a great interview a while ago now with Jameela Taylor when she was at the Center for American Progress talking about the research they did where it showed that the bottom line is racism and there's a great paper that they have as well that you can check out or you can listen to that old episode if you feel like you really need a lot more on it. And Black Mamas Matter Alliance is also a great resource. They do a ton of research and really just lift up the impact that the maternal mortality crisis has on black women as a whole. And I know Jameela is very involved with Black Mamas Matter as well. Yes. So turning from maternal health, although that's not completely unrelated as we'll talk about, is talking about abortion access and all of the barriers to abortion access we're seeing right now.

Jessica: Yeah. This is a terribly alarming time for abortion access. In the last year alone, we've seen five bans on abortion, six weeks alone, Alabama. Just passed this last year, a ban criminalizing abortion at any stage of pregnancy and we've just been seeing abortion access really be attacked from left and right. We know that about one in four women will have an abortion by the age of 45 so this is an issue that really does impact all of us. And you know, I think it's really important to understand what's happening in the states even if it's not the state that you're from because it certainly as things move through the courts and as we see the impact that this has on legislative and administrative activity at the federal level, you know, we all are impacted no matter where you are.

Jennie: Well and you definitely see like one state introduces it and then it just like sweeps through like all of these anti-choice bills.

Jessica: Yes. I just did a very hard eye roll. Um, yeah…

Jennie:… there's a lot of copying and pasting that happens with these bills and there's a lot of identical legislation that we're helping make it worse.

Jessica: Yes, exactly. Exactly. And I think also these bans are really compounded by the Trump administrations rule on Title X which prohibits Title X recipients from referring patients for abortion care. There's also the ongoing efforts to prohibit Planned Parenthood from Medicaid reimbursement that we see popping up. And there's just a multitude of laws that really ignore evidence and science and mandate how healthcare providers practice medicine and do their jobs. And then on top of that, there's the Hyde amendment. So we really see barriers to abortion access hitting us left and right.

Jennie: Yeah. And unfortunately this is another area where you were seeing Black people much more impacted than white people.

Jessica: Yup. A Black woman in accessing abortion care tend to face more geographic transportation, infrastructure, economic barriers, and it further increases economic disparities and has a major impact on folks, particularly in the South. We know that the southern states have large populations of, of Black women, and so there's a real connection to, we see a lot of these abortion bans being implemented or introduced and where there are large populations of communities of color, particularly Black women.

Jennie: Yeah, we can definitely see this. So for the last six or seven years, Population Institute has done a report card on reproductive health and rights and you just see on the report card the whole like southern US is bright red because are all failing on reproductive health and rights.

Jessica: Yeah, and I think there's a real connection where the South fails with reproductive health and rights and the maternal health crisis that we see. Right? Because the same states that have introduced the most severe abortion bans are the same states that have the highest maternal mortality rates in the country. So there is a real connection between these issues and unfortunately folks who are living in that region tend to bear the biggest brunt. But I would be remiss, I just think it's important to also know that there are huge gaps in abortion access all across the country. And we really see, particularly with abortion coverage bans, folks who are on Medicaid who are in the children's health insurance program, who are in federal prisons, who are in the military, who are part of the native population who are living on tribal land… So on and so forth being incredibly impacted at a federal level. So with the introduction of the Hyde amendment in the late seventies and the expansion of similar coverage bands over the last few decades, that has really impacted the landscape in addition to the bands we see at the state level in addition to changes to Medicaid and Medicare that really make it impossible for our folks to access the care they need and deserve.

Jennie: Okay. Cause I was just going to ask you about Hyde so I can talk about Hyde all day. Um, so you did kind of a touch real quick on what it is, but again, that's another way where it disproportionately, you're seeing Black women impacted.

Jessica: Right. And you know, I always like to lift up that when Henry Hyde introduced the Hyde amendment, so the 1977 HHS appropriations bill, he was really explicit about what he was trying to do. He said that his intent was to harm low income women. And if he could have found a way to do it, he would have banned abortion writ large. But this was the only way he could go about it. And so he was very up front about penalizing low income people. And we've seen over the last 40 years that the law has dramatically limited coverage of abortion and created a huge barrier for poor and low-income women, not only under the Medicaid program, but across the federal government. And this just means that low- income women who access their health care through Medicaid don't have the same as other women who can finance an abortion out of pocket or through their private health insurance. And as it relates to Black women, 31% of Black women and 27% of Latino women of reproductive age are enrolled in Medicaid compared to about 15% of their white female counterparts. So we see that this disproportionately impacts women of color. It also disproportionately impacts the LGBTQ community who do in fact need to access abortion care. 20% of LGBTQ people are on Medicaid compared to 13% of non-LGBTQ people. So we see this impacting communities that have already been historically marginalized in a really detrimental way. While states can use their own funds to extend abortion coverage to those who are on Medicaid currently only 17 states do, which means more than half of reproductive age women live in states that restrict abortion coverage. So that's about 8 million women, it's vast.

Jennie: Yeah. And I think, you know, it seems obvious to you and me the ways that these two things are related, right? The maternal health crisis and the abortion access crisis. Then maybe we should spell it out. Like how are they interrelated? Jessica: Right. Well as I was saying before, the states that have the worst abortion bans on the books that have the worst access to healthcare at large are also the states that have the highest maternal mortality rates. And there's no way that those two issues are not intertwined. When women are denied an abortion and then give birth, they report worse health outcomes up to five years later as compared to women who received their abortion. Those who are denied an abortion are more likely to delay prenatal care, which often leads to higher incidences of maternity related health problems. And there can also be a limitation or multiple limitations on the ability to access quality health care period. So, you know, I think we see when folks are denied there abortion, it impacts when, if, how they will receive pregnancy-related care. And women who are denied abortion care, they're also more likely to experience eclampsia, death, other serious medical complications during the end of their pregnancy, often related to not being able to get the quality care they need it at the beginning of their pregnancy. So this is a huge problem and it's certainly related. We're talking about the full range of someone's pregnancy, whether they choose to terminate it or not, and there's no way not to link these issues together.

Jennie: Absolutely. And I think it's also worth noting, yeah. You know, the studies had shown that women are also worse off economically if they are not able to get an abortion that they would like to have.

Jessica: Absolutely. Yeah. There's a ton of both data and anecdotes about that and it's just really awful to hear.

Jennie: Yeah. Because we're, the healthcare system is directly impacting people's long-term livelihood and so there's no way to talk about these issues without talking about them together. I think it should obviously be very clear now since both the maternal health crisis and the abortion access crisis, both in packed women of color, particularly Black women, most so obviously the two of them together is having a real detrimental impact on Black women.

Jessica: Absolutely, absolutely. I think, you know, there's a huge impact, particularly, on economic security for Black women. Access to abortion is linked to greater workforce participation, higher lifetime earnings. And those who are denied an abortion are more than three times greater odds of being unemployed. Women who were able to have an abortion were six times more likely to have positive life plans related to education and employment. So restrictions and bans on abortion care certainly fall disproportionately on Black women and exacerbate our health disparities. But they also exacerbate our ability to live, you know, whole and free lives. And I think more fundamentally, policies that undermine access to abortion care and quality maternal health care are rooted in this persistent structural racism and sexism that we have been talking about today. And then there's the real distrust of the healthcare system and providers that make Black women reluctant to seek care and the system and the providers in it. As a result of that, racism often don't trust Black women about what we say we want or need in terms of our, our bodies and our care. And that really spans from the denial of abortion care. So the minimizing and ignoring of our pain during maternity care and childbirth.

Jennie: So this all feels pretty bleak right now. Um, so maybe let's talk about what can be done.

Jessica: Yeah, I think as I've said today, you know, we really need a multifaceted cross issue, holistic approach to addressing this issue. We need expansion and maintenance of health coverage that's high quality, that's affordable, that's comprehensive, that includes the full range of reproductive care, behavioral health, preventative care, long-term services, community based services. We need to expand access to quality, patient centered and comprehensive reproductive health care that absolutely includes abortion care, federal and state level restrictions need to be repealed and as well as laws that erect burdensome and unnecessary barriers to accessing timely and high quality care. And we need to expand access to contraception and related counseling and strengthen the Title X family planning program. We certainly need to see patient-centered and culturally sensitive care that you know, really relates to the patient at hand and is respectful and eradicates cultural bias and discrimination that we see in medical practice. It's really important that we have policies, solutions that increase provider diversity in maternity and reproductive health care and that hold providers and hospital systems and healthcare systems accountable for failure to provide unbiased quality healthcare. We need to address the social determinants of health that are disproportionately impacting Black women. So we have to talk about chronic stress of poverty and racism and how that is shown to harm our bodies. Weathering is a real thing. So we need to address social factors and modify them to improve health outcomes through policies that often have nothing to do with healthcare itself, right? We need to look at economic equality. We need to raise incomes and great policy solutions that will help build wealth. We need to provide families access to clean, safe, affordable housing to clean, safe water. We need to improve the quality of our education system. We need to prioritize public transportation, including transportation for medical appointments. We need to increase access and availability of healthy and affordable food. The list really goes on of the various approaches we can take to address this issue. So obviously common sense for so many of them. Right, right. And yeah, I mean, uh, you know, we talked a little bit about the maternal health bills that exist in Congress right now and those are wonderful and would expand doula care after birth would mandate implicit bias training for providers, so on and so forth. But you know, we really do need to also look at some of the intersectional policies that can improve not only Black women's lives, but other groups that have traditionally then marginalized. And this really impacts, you know, our chronic stress, historical trauma, so on and so forth. And so we need adjustments and adaptations to our healthcare system, but we also need to look at our society and our culture as a whole and see what we can do to better individual's lives day in and day out so that they can access the quality healthcare that they need and deserve. Jennie: So that's a long list, really important list. And that was only half of it. So what can listeners do? What actions can listeners take to help?

Jessica: I've got a whole list.

Jennie: I will make sure to include links to as many things as we can.

Jessica: Wonderful. There is a great policy report that In Our Own Voice and the National Partnership for Women and Families released last year on maternal health and abortion restrictions and the intersections of the two items are the two issues and so you can find that policy brief at blackwomensrj.org and you can dive a little bit deeper into understanding how these issues can't be siloed and why we need to talk about them together more often. I cannot go without encouraging folks to vote, vote early, vote often. In Our Own Voice is really excited to be relaunching and pushing out our I Am A Voter campaign in 2020 which is an issue focused campaign, talking about the issues that matter and impact Black women. When we go to the polls, one of what are both of which are maternal health and abortion access. And so, you know, in order to see the policy changes that we want to see both at the federal and state level, we need to ensure that our legislators understand these issues and hear us. And one of the ways they hear us is at the polls. Another way that they hear us is by you calling them. Um, so I encourage you to call your congressmen and women, call your senators and urge them to make the connection between abortion access and maternal health. There are plenty of resources that we've already mentioned that are out there to help make this connection for your members. And I, you know, I encourage you to ask them if they support and sponsor the Each Woman Act, which addresses the Hyde amendment as well as the Women's Health Protection Act, which addresses some of the medically unnecessary restrictions we see popping up in the states. A few of the maternal health bills that are, are really powerful are the Maternal Care Act, the MOMMIES Act and the MAMAS Act. And so urge your senators to do their research, urge your congressmen and women to do their research on those bills and make sure that they're supporting them and lifting up these issues in their community as they matter to you.

Jennie: Well, great. Jessica, thank you so much for doing this.

Jessica: Thank you so much for having me. It's always a pleasure.

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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