Post Roe, America must end its staggering maternal health crisis

When a child is born, medical providers quickly calculate the Apgar score. Using a 0-10 scale, numbers are assigned to gauge the baby’s breathing, pulse rate and other vitals. A score below 7 is a sign of potential distress that may require emergency care. 

If there was an Apgar score for maternal health, our nation wouldn’t come close to a 7. 

Nearly 1,200 women in the United States — almost 60 percent of whom were women of color — died in 2021 from complications due to pregnancy and childbirth. Given the lack of data for transgender and other birthing people, this is likely an undercount. COVID-19 exacerbated this tragedy and the Supreme Court’s recent abortion decision is expected to worsen it. 

When Congress reconvenes next week, expanding care before, during and after pregnancy must be an immediate priority. Otherwise, the United States risks permanently cementing its status as one of the most dangerous nations in which to give birth — and, in many respects, one of the least supportive for raising children.   

As two Black women, the dismal state of America’s maternal health system is personal to us. Consider the diverse array of people treated so poorly by it: 

• Compared to white women, Black women are almost twice as likely to lack health insurance, twice as likely to have unexpected and serious problems with labor and delivery, and three times as likely to die from pregnancy-related issues. 
• The maternal death rate among Latinas — nearly 20 percent of whom are uninsured — has more than doubled since 2018. 
• Indigenous women, particularly those in rural areas, are at heightened risk of life-threatening complications during or following childbirth. 
• Undocumented women and incarcerated women are less likely to receive prenatal and postnatal care. 
• People experiencing intimate partner violence during pregnancy are at higher risk for unsafe birth outcomes. 
• More than half (51 percent) of LGBTQ+ birthing people reported bias or discrimination affecting pregnancy, birth and postpartum care, compared to 35 percent of cisgender, heterosexual people. 

The United States spent $4.3 trillion on healthcare in 2021. Our maternal health crisis is not due to a lack of resources, but an ongoing failure to properly and equitably allocate them. More than 2 million women of childbearing age across 1,100 counties live in maternity care deserts lacking birth centers, hospitals providing obstetric care, OB/GYNs, or certified nurse midwives. One in 6 Black babies is born in areas with no or limited maternity care services. 

Women of color are severely underrepresented in the healthcare system — Black women account for less than 3 percent of physicians in the United States — and racism results in poorer treatment and worse health outcomes for Black, Indigenous, and patients of color, regardless of factors such as income and education. One-third of transgender people report experiencing discrimination in healthcare settings; many avoid medical care as a result.  

Following the Supreme Court’s egregious ruling in Dobbs v. Jackson Women’s Health, at least 15 states have total or near-total abortion bans. Disproportionately high numbers of Black women living in these states are projected to die from unwanted or unintended pregnancies; a national abortion ban would lead to a 21 percent increase in pregnancy-related deaths among all women, but a 33 percent increase for Black women. 

We believe strongly that reproductive justice — the ability to make choices about our bodies and whether and when to have children, and the ability to parent children in a safe and secure community — is a fundamental human right. Too many people, however, are denied that right. 

As birth justice advocates, the SisterSong Women of Color Reproductive Justice Collective is proud to work with partners such as the Black Mamas Matter Alliance to offer healthcare assistance. SisterSong’s Birth Justice Care Fund provides essential baby equipment and supplies to BIPOC birthing people and funds birth workers of color to provide critical services. 

At the national level, the COVID-19 public health emergency maintains continuous health coverage for Medicaid participants. The Biden administration’s most recent extension of the emergency maintains that coverage through January. That’s important because Medicaid pays for 65 percent of births to Black mothers and is associated with a number of health benefits, including improved preconception health indicators and reduced maternal death rates.

But nonprofit sector initiatives and temporary executive branch actions are not enough. 

When Congress reconvenes, expanding Medicaid coverage should be a top priority. Eleven states have not expanded their Medicaid programs under the Affordable Care Act, effectively denying health insurance coverage to more than 800,000 women of childbearing age. These states are among those with worse maternal health outcomes and where abortions are already or soon will be banned. Congress should expand Medicaid coverage and make federal funds permanently available to every state that does so to one year postpartum. 

Congress should also swiftly enact the Black Maternal Health Momnibus Act, which contains more than $1 billion for expanding the perinatal workforce, strengthening maternal health equity programs and research initiatives, and improving telehealth services. The bill also makes significant investments in other areas directly connected to maternal health, such as housing, nutrition and transportation. More than 80 percent of pregnancy-related deaths in the United States are preventable; these investments are necessary to make that happen. 

We also note that maternal and child health goes well beyond conception, delivery and postpartum care. It includes jobs that provide a living wage, health insurance and paid family and medical leave; access to quality and affordable child care, safe housing and nutritious food and communities safe from state violence and environmental pollution. A nation that allows an expanded Child Tax Credit responsible for a 30 percent reduction in child poverty to expire or takes free school meals away from children is not doing enough to protect maternal and child health. 

With an Apgar Score far less than 7, maternal health in the United States needs emergency care. Too many babies will not grow up healthy and thrive because our nation hasn’t done enough to protect those who conceive and care for them. Congress can provide the care that is needed to address this emergency. We urge them to act now.

Avenel Joseph, Ph.D. is vice president for policy at the Robert Wood Johnson Foundation. Twitter: @DrAvenelJoseph. Leah Jones is deputy director at SisterSong. Twitter: @SisterSong_WOC.