Ending the COVID emergency will further harm Black maternal mortality

April 11-17 marks Black Maternal Health Week, a week-long campaign officially recognized by the Biden administration as a time to address racial inequities in Black maternal health and to “amplify ​the voices, perspectives and lived experiences” of Black during pregnancy. 

It is difficult, however, to celebrate this year’s theme, “Our Bodies Belong to Us: Restoring Black Autonomy and Joy!” when our governments and healthcare systems are rolling back COVID protections while largely ignoring the devastating effects these actions will have on reproductive health inequities. How can we achieve autonomy and joy in birth if we fail to keep Black parents and babies safe from a virus that continues to kill an average of nearly 200 Americans daily and leaves countless others with long-term disabilities?

To be sure, a national focus on the longstanding Black reproductive health crisis is long overdue, even in the absence of COVID. We have known for over a century that Blacks are far more likely to die from pregnancy-related causes than their White counterparts and that Black babies are the least likely of any racial/ethnic group to celebrate their first birthdays. 

The reasons for these injustices are complex. Black people report numerous experiences with medical mistreatment, disrespect and neglect during childbirth. For Shalon Irving, that neglect turned deadly as medical providers dismissed symptoms of postpartum hypertension that eventually led to cardiac arrest and brain death. 

The larger drivers of these inequities lie beyond healthcare systems — structural racism denies Black people the resources needed to survive and thrive before, during and after pregnancy. Since the beginning, the Biden administration has made sizable commitments to diversifying and expanding the perinatal health workforce and has provided an option for states to extend postpartum Medicaid coverage for up to one year. The Black Mamas Matter Alliance has also championed the Black Maternal Momnibus Act of 2021, a suite of 12 bills led by Rep. Lauren Underwood (D-Ill.) that addresses both healthcare provision and the social safety net (i.e. housing instability) for Black mothers.

Yet, this year’s calls to celebrate Black Maternal Health Week ring hollow because the Biden administration recently ended the COVID-19 national emergency ahead of schedule and will allow the public health emergency to expire on May 11. This means that most Americans, and certainly those from historically excluded groups, will no longer have access to free at-home COVID tests or vaccines and testing services without cost sharing. Hospitals and clinics across the U.S. have ended or are ending mask mandates, which places patients and newborns at higher risk of COVID exposure. These actions have been met with shockingly little public pushback from advocates for Black reproductive health, despite the fact that COVID has disproportionately orphaned Black children.

It is now clear that COVID likely drove much of the sizable increases in deaths resulting from pregnancy, including an 18 percent increase from 2019 to 2020 and a nearly 40 percent increase from 2020 to 2021. For Blacks, the data are bleakest: the overall mortality rate is the highest seen in recent history — 69.9 per 100,000 live births. Contracting COVID during pregnancy increases the risk of health complications, including maternal morbidity and within-hospital mortality. COVID is why Atlanta resident Marrisha Kindred Jenkins died before getting to hold her infant son for the first time. This much we know.

But there is much that is unknown. We do not yet have a complete picture of the long-term effects of COVID on reproductive health. Yet, if the past remains prologue, Black people will likely shoulder a disproportionate share of long COVID’s effects on reproduction. While prenatal vaccination can reduce COVID-related risks during pregnancy and pass on protection to babies, vaccination rates for the pregnant remain low, particularly among Blacks.

How can we begin to address the continued threat to the well-being of Black families and babies in the context of an ongoing pandemic?

First, healthcare providers and public health practitioners must clearly communicate the heightened risks of COVID during pregnancy to patients and their families. We must collectively oppose attempts to make masking optional in clinical settings, push for additional funding for COVID surveillance and advocate for universal masking at the onset of COVID-19 surges. 

Further, we must emphasize the use of high-quality masks and educate the public about how to properly wear a mask to maximize efficacy. Given that structural racism has disproportionately funneled Black Americans into “essential” jobs that increase their risk of COVID exposure and lack benefits such as paid leave and health insurance, such policies and interventions remain vital to promoting equity. Mask requirements are literally the least that the healthcare system can do to protect the vulnerable.

It is also vital that healthcare practitioners, public health advocates and birth workers collaborate to improve vaccine access and uptake, particularly among Blacks. We must recruit those who are pregnant into clinical trials earlier in the development process, integrate COVID vaccination into routine prenatal care and advocate for expanded access to primary care. We must also fight targeted vaccine disinformation and fund infrastructure that enables trusted community partners to deliver ongoing evidence-based interventions in marginalized communities.

Finally, Black-white inequities in reproductive health are a structural issue that cannot be resolved by focusing on medical care alone. Congress must act swiftly to pass the Black Maternal Momnibus Act in full. The act will provide resources to address the effects of pandemics during pregnancy and funds to community-based organizations that serve Black families.

As two Black women who are reproductive health scholars and mothers, we call upon our elected officials and reproductive health advocates to follow the evidence and address the continued effects of the pandemic on reproductive equity. Doing so will make room for Black families to embrace the joy and autonomy that we deserve and have long been denied.

Tiffany L. Green, Ph.D. is an associate professor in the Department of Population Health Sciences and the Department of Obstetrics and Gynecology at the University of Wisconsin-Madison. Views expressed in this piece are those of the authors and do not reflect the views of any institutions or organizations.

Editor’s note: This piece was updated on April 15 to correct the byline.