This Mother’s Day, Reproductive Justice for All American Women

This Mother’s Day, it’s time we own up: we do not have reproductive justice in America.

Just in time to celebrate all moms, the Center for Disease Control has issued a new study confirming shocking racial disparities in maternal mortality in the United States, with African American women dying in childbirth at 3–4 times the rate of white women. In New York City, Washington, DC, New Jersey, and states resisting Medicaid expansion, the disparity is at least twice that.

The United States is one of only 13 countries — — and the only advanced industrialized nation — where maternal mortality is actually going up. Forty-fifth in the world in grappling with maternal mortality, the U.S. now ranks behind Libya, Kazakhstan, and nearly every country in the war-ravaged former Yugoslavia.

All of this despite the U.S. spending more on health care per capita than any other nation.

What’s going on?

A number of factors have contributed to this shameful positioning; first and foremost is racism.

Whether its expression is veiled, muted, or simply denied, racism’s impact is nevertheless felt in the implicit bias many caregivers and institutions hold toward women of color, whose health issues too often go unheeded and unaddressed. Women themselves often internalize the toxic physiological stress issuing from racism, which can result in hypertension, pre-eclampsia, and elevated rates of infant and maternal death. This impact of toxic stress relating to racism is constant regardless of income and educational levels.

Neck and neck with racism, of course, is the sexism that still prevails in so many institutional settings — the unfortunate but very real predisposition among countless caregivers not to take seriously what women tell you they feel and need.

For black women, that’s a double whammy. “Basically, black women are undervalued,” Dr. Ana Langer, Director of the Women and Health Initiative at the Harvard T.H. Chan School of Public Health, told the American Heart Association. “They are not monitored as carefully as white women are. When they do present with symptoms, they are often dismissed.”

With the racism and sexism come a stunning ignorance of the ways in which specific medical conditions and symptoms of distress may present quite differently for women of color. The shocking near-death childbirth experiences of patients as revered as Serena Williams and Beyoncé can be attributed to such ignorance, raising a long-overdue alarm among maternity wards nationwide.

A day after giving birth to Alexis Olympia by cesarean section, athletic luminary Serena Williams experienced a pulmonary embolism — a blood clot blocking an artery in her lung that was part of Ms. Williams’ medical history and that is also a common post-cesarean section complication. Struggling for breath, Serena recognized her symptoms and asked for help. Her concerns were initially dismissed, wasting precious time before she was finally diagnosed and treated. Even then, Williams’s challenges continued, resulting in an abdominal hematoma that required further surgery and kept her in bed for the first six weeks of her daughter’s life.

Beyoncé experienced extreme swelling while pregnant with twin boys, often a telltale sign of toxemia or pre-eclampsia. This vibrant creative artist was kept on bedrest for a month before she had an emergency c-section, after which she and her twins spent weeks in the hospital. A condition 60 percent more likely to appear among African American women, pre-eclampsia can lead to post-natal heart disease, a leading cause of maternal death.

Other common conditions that predispose pregnant women of color to adverse health outcomes, in addition to hypertensive heart disease, include diabetes, obesity, and a strong but under-reported correlation between maternal mortality and women of color who are victims of sexual violence. By next Mother’s Day, we need this devastating linkage to be widely acknowledged, studied, understood, and believed.

Another key factor in the disproportionate lethality of motherhood for women of color is the all-too-common lack of access to care. Whether because they are poor, uninsured, in remote regions lacking health facilities, or otherwise marginalized, far too many pregnant women of color in America, including Native American women, lack ready access to vital health information, proper prenatal care, and adequate, informed institutional care while in labor, delivery, and after giving birth. The current administration and many state legislatures are actively choking off this already limited access to care for poor women; undocumented women face the additional fearful quandary, in this febrile anti-immigrant moment, of whether or not to seek care at all.

Still, there is some good news: for one thing, leading medical associations have come together in groups such as the Council on Patient Safety in Women’s Health Care, to improve outcomes by providing invaluable information regarding best practices regarding pregnancy, childbirth, and post-partum.

Civil society, too, has organized itself to raise awareness of these lethal disparities, through organizations such as the Black Mamas Matter Alliance, the MomsRising network, and the March of Dimes. These non-profits and their partners have been working hard to make more mothers aware of the importance of pre- and postnatal visits and of screening for hypertension and depression, and to raise the alarm about what is not being done on the institutional, local, state, and national levels.

Perhaps in response, local government is seeing some action. Nearly 30 states and Washington, DC, have now established Maternal Mortality Review Committees to examine each maternal death, and just this past week, Ohio legislators established an Ohio Black Maternal Health Caucus to address their state’s current crisis. And New York City has launched a comprehensive five-year plan to reduce maternal mortality and dangerous complications of childbirth among women of color, with a focus on the highest-risk neighborhoods.

This increasing awareness and mobilization has been given even greater prominence by the many powerful women of color now serving in the House of Representatives, who have roused the often stuporous Congress to action, with the creation late last month of a Black Maternal Health Caucus and the introduction, just in time for Mother’s Day, of bicameral legislation that would expand Medicaid to broaden women’s access to primary care, pre- to post-natal services, and midwife, doula, and postnatal care.

It’s about time.

May this new awareness, activism, and the plethora of compelling new research, policy, and legislative initiatives make this Mother’s Day a turning point in advancing reproductive justice for all women in America, now.

Our mothers and babies and families and communities cannot wait any longer.