Why the U.S. must urgently address maternal health disparities for Black women


It is no secret that the U.S. lags greatly behind other developed nations in maternal health outcomes. When we hear the stories of women like Shalon Irving, who died three weeks after giving birth and whose pleas for help prior to her death were all but ignored, or the story of Kira Johnson, who was left hemorrhaging for ten hours in the hospital after what was supposed to be a routine c-section, it is hard not to see how real and evident this disparity is.

In 2021 alone, 32.9 per 100,000 women died in the United States during pregnancy or within a 42-day window afterward. When stratified by race, this rate increased to 69.9 per 100,000 for Black women of all education levels. This fact is evident with Shalon Irving, who had a PhD in epidemiology, and Kira Johnson, who had a pilot license and spoke five languages. Black women of all socioeconomic classes more often reported that they felt disrespected or mistreated during labor, felt pressured to undergo a c-section, or felt as though they were stripped of their personal autonomy during the birthing process.

But this data is far from breaking news. We have known for at least a century that pregnancy is far more lethal for Black mothers. Data stretching back to 1917 has shown that Black women have consistently been more likely to suffer from complications of pregnancy, including death.

With the explosion of the racial justice movement of 2020, Black women and their families have felt more empowered to share their encounters with the health care system during pregnancy. In the last four years, there have been countless articles, interviews, and videos detailing harrowing anecdotes of Black pregnant women being ignored, mistreated, and dying from preventable causes. Between the accounts of Shalon Irving, Kira Johnson, and countless others, the Black maternal mortality disparity has been well-established as having a substantial impact on Black women in the United States. So why do we seldom hear about what is being done to improve this disparity despite hearing so often of its effects?

In 2021, Representative Lauren Underwood and Senator Cory Booker introduced the Black Maternal Health Momnibus bill into Congress. The bill proposed the investment of funds into overcoming social determinants of health, improving health care access to underserved communities, and promoting community organizations that invest in maternal health outcomes. The bill also included a provision to grow and diversify the perinatal workforce to provide “culturally congruent maternity care and support.” However, in the three years since the bill was introduced, it still has not passed, even with reintroduction in 2023. This, coupled with recent attacks by lawmakers on diversity, equity, and inclusion efforts to include more underrepresented groups in medicine, shows that the federal government as a whole has not been able to take the steps needed to improve this disparity.

What is needed is clear: Federal government action directed toward culturally competent care and improvement of access to resources. This includes training health care professionals to adequately address preconceived biases, investment toward the recruitment of underrepresented groups in medicine and community health organizations that target Black health disparities, and overall expansion of access to health care services in both the prepartum and postpartum stages. While the movement to change is slow, it is not non-existent. Federal expansion of Medicaid in some states has allowed for longer postpartum coverage, but this coverage only protects mothers in states that accepted the expansion. Additionally, no further legislation has been passed to target the Black maternal health crisis since 2020 directly.

Congress needs to act swiftly and directly. There is no reason that a country as heavily resourced as the United States should continue to have such a wide discrepancy in maternal health outcomes. We have heard the stories of preventable Black deaths; we have listened to the cries of mothers and their families. What we need now is definitive action, and it is up to the federal government to finally do so.

Congress needs to act swiftly and directly.

There is no reason that a country as heavily resourced as the United States should continue to have such a wide discrepancy in maternal health outcomes. We have heard the stories of preventable Black deaths; we have listened to the cries of mothers and their families. What we need now is definitive action and it is up to the federal government to finally do so.

Isabelle Akinyemiju is a medical student.


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