Much has been written in the literature of public health about America’s shocking maternal mortality rate. Occasionally media reports the alarming rate when there is a hook. Advocates concerned with women and health illuminate the problem in reports and at conferences. But in light of the SCOTUS Dobbs decision on abortion, new urgency arose in addressing U.S. maternal mortality and its causes because of the link between reproductive rights and the persistence of inherent racial issues in women’s healthcare.
It is disturbing and illuminating to note the World Health Organization's maternal mortality rate rankings. The U.S. is 55th in the list of industrialized nations at nearly 24 deaths per 100,000 live births. A 2022 study found that women in this country face the highest rates of preventable problems and mortality when compared with women in 10 other wealthy nations, and that rate continues to go up. The race disparity in maternal mortality is additionally alarming. Black women die at a rate of 55.3 deaths per 100,000 live births, more than 50 percent higher than white women.
That’s one reason Rep. Alma Adams (D-NC) and several colleagues in the House introduced a bill earlier this year to specifically address the high rate of stillbirths, which Black women and other women of color are twice as likely to experience as white women. Targeted legislative like that is critical to changing the public health landscape when it comes to pregnancy outcomes and the health of women and children.
So are campaigns like the “Hear Her” initiative at the Centers for Disease Prevention and Control (CDC), designed to address the fact that women are often not heard, believed, or viewed as reliable when they present relevant histories or symptoms. That problem is worse for Black women too. Research shows that women of color are more likely to be described negatively in notes and reports and recent studies reveal that doctors are most likely to use “stigmatizing language” in their notes about patients of color, referring to them as “noncompliant, challenging or resisting,” as research at the University of Chicago revealed.
That’s why the all-out attempt to end abortion nationally, ignoring 50 years of precedent regarding a woman’s right to privacy, reproductive healthcare and choice was such a travesty, exacerbating the already shameful maternal morbidity and mortality data which serves as an indicator of continuing racism in this country.
Black women and their sisters of color are likely to suffer enormously from the consequences of state-ordered pregnancy in the states that cling to misogynistic, racist policies, and not only in terms of their health or possible survival. They will also be affected economically in dramatic ways. A Forbes report suggests they will be deprived of education that can lift them out of poverty, and they will be targets of aggressive invasions of privacy through data searches that enable the over-policing of their reproductive habits and practices. Depending on where they live, they may be subject to fertility and period-tracking apps used by police according to their zip code because they are deemed to reside in high .abortion areas.
In her monumental work resulting in the 1619 Project documenting the history of broad-reaching racism in this country, Nicole Hannah-Jones provides a historical perspective essential to understanding the confluence of maternal mortality, the abortion crisis we now face, and unrelenting racism. Her book provides vital context regarding the connection between those three issues.
The title of both the project and book derives from the origins of slavery in America, dating back to 1619 with much of the book’s relevance focusing on the period of Reconstruction following the Civil War, when a key question arose. What would white America do with black people post slavery? Where would formerly enslaved people fit in a paid workforce? How would former slaves be treated if they were free Americans? What would be done about their education or healthcare?
Southern Democrats resisted these considerations mightily, especially when reformers like Rebecca Lee Crumpler, the first black woman doctor in America, laid bare the burdens of being black in a country unwilling to facilitate freedom for former slaves.
Because of that resistance, the National Medical Association formed by black doctors in 1895 called for a national health care system - which went nowhere until the idea became a states’ rights issue during WWII when President Truman called for an expanded hospital system that predictably led to segregation and the denial of healthcare for black people. Later, insurance-based healthcare presented a further hurdle, while medical schools excluded black physicians and medicine became a for-profit, unregulated system. All of this has led to present-day lack of equitable, affordable, accessible healthcare if you are black or poor.
In the midterm election, five states had abortion on the ballot and in all five, voters supported the right to choose. Three of them guaranteed the right to abortion in their constitutions. That is a huge relief to women in the five states, but it remains to be seen how women of color will fare.
In Nicole Hannah-Jones’ words, “…arguments about socialized medicine, equity and human rights…echo down to the present day.” Her book reveals the connections that make women of color exceptionally vulnerable even in this moment, and reminds us that there is still work to be done.
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Elayne Clift writes about women, health, and social issues from Brattelboro, Vt.