This piece is published in collaboration with Echoing Ida, a Forward Together project.
On Wednesday, August 13, the United Nations Committee on the Elimination of Racial Discrimination begins a two-day review of the United States government’s efforts, or lack thereof, to address pervasive racial discrimination in law and practice. When the United States ratified the International Convention on the Elimination of All Forms of Racial Discrimination in 1994, it consented to a periodic review by human rights experts of its progress toward meeting the goals in the treaty. The last time such a review was conducted was 2008, when the committee expressed specific concern about persistent and worsening disparities in sexual, reproductive, and maternal health in the United States—particularly for Black women—and offered recommendations about how the country could reduce those disparities.
It’s no secret that Black women are more likely than others to experience negative maternal health outcomes, such as preterm birth or stillbirth, to suffer from conditions like preeclampsia, and to die at higher rates from pregnancy-related causes. A new shadow report, Reproductive Injustice: Racial and Gender Discrimination in U.S. Health Care, by the Center for Reproductive Rights, the National Latina Institute for Reproductive Health, and SisterSong Women of Color Reproductive Justice Collective shares some alarming data on maternal health outcomes as well as disturbing firsthand accounts of the racial discrimination experienced by Black women.
The stories of women who participated in focus groups led by SisterSong included in the report convey the gross under-education and discriminatory treatment of Black women living in the South, in particular, where sexual and reproductive health education is nonexistent and stigma is rampant. Women in the focus groups shared how they turned to friends or “the street” for information, but found it was often incorrect. When asking health-care providers for information, many were met with stigma about their sexuality and sexual decision making, and were lectured rather than offered helpful information. The women also encountered providers who made assumptions about their ability to utilize health information, undermining the quality of reproductive health care they received and jeopardizing their health.
In one such interview, for example:
Aaliyah from Jackson [Mississippi] said her doctor had assumed she would not or could not effectively use contraception: “After I had the baby, and I went back for my checkup … [the doctor] told me, ‘I’ll see you in six weeks.’ I said, ‘Why?’ He said I’d be pregnant again.”
She sought the care she wanted to plan her family, but her provider refused to counsel her about contraceptive options and help her make an informed decision.
Tiffany, also from Jackson, Mississippi, tells the story of how she was forced to wait in a public hospital’s hallway during labor because there were no available beds, and how she was ignored until the baby crowned. Even then, she was told not to push until they could get her a room, endangering her health and the health of her baby.
Aaliyah, a Medicaid patient, explained how she received what can only be described as substandard prenatal care. A week before she was due, her doctor realized she had not received an ultrasound since she first found out she was pregnant. When an ultrasound was finally performed, they found low amniotic fluid and her labor was induced. Her baby suffered complications and remained on breathing tubes for three weeks.
These women are far from alone. Millions of women in the United States share these experiences and a million more suffer the consequences. While maternal deaths are rising all across the country, Black women are disproportionately affected. In rural Chicksaw County, Mississippi, the maternal mortality ratio is 595 women per 100,000 live births—worse than that of war-torn and developing nations like Kenya and Rwanda (400 and 320 per 100,000 live births, respectively). In Detroit, the ratio is 58 per 100,000 live births, although data shows the ratio in Michigan state could be as high as 391 per 100,000 live births among Black women who often experience a delay in receiving prenatal care.
This has not happened by chance. Rather, this is a direct result of political disinterest in helping the most vulnerable in our society, an unwillingness to acknowledge and address racial discrimination as a major factor in health outcomes, and a refusal to invest in health and well-being beyond insurance access to health care. Increased health care spending and newer technology hasn’t improved maternal health for all women in the United States, and definitely not for Black women.
Black women are victims of something much worse than stigma, judgment, and discrimination: We are victims of a system and society that abrogates our basic human rights, including the rights to health, life, and non-discrimination. It is apparent in stories of the women in the SisterSong focus groups who were fortunate enough to survive their pregnancies, and also reflected in data (some of which can be found here, here, here, and here) from the U.S. Department of Health and Human Services. The United States is the only industrialized nation to have an increase in maternal mortality over the past decade—now triple the rate of that in the United Kingdom. We’re sliding backward when we should be making progress, not just in science and medicine or the slow crawl toward health equity, but in achieving better health for all. Why is this?
We could blame the problems for being too complex, for the multiple factors that feed into these outcomes, and for solutions that require levels of coordination and partnership that seem daunting. But, are these problems insurmountable? I believe, as many of you might, that although the problems that lead to negative health outcomes for Black women are certainly complex and undoubtedly challenging, they can be overcome by investing appropriate attention and resources. The U.S. government’s own report to the committee acknowledges that more can be done, but it doesn’t outline a plan for changing the situation.
Fortunately, the Reproductive Injustice report offers some key recommendations, which include providing comprehensive sexual education, addressing racial and gender stereotypes that promote stigma, improving the quality of maternal health services for women relying on the public health system, providing paid parental leave, and ensuring access to remedies for those who experience discrimination. These recommendations mirror those included in Amnesty International’s report, Deadly Delivery: The Maternal Health Care Crisis in the USA, and there is little doubt that women and families will benefit when these recommendations are fully implemented. For example, researchers have proven the benefits of high-quality prenatal and maternal health care for both mother and baby.
Finally, international organizations have identified political commitment as a precondition for reducing maternal mortality and improving health outcomes. Clearly, change will not happen without political will and thoughtful decision making at the federal, state, and local levels, and in all levels of government. The United States made a commitment to address racial disparities, but it hasn’t followed through. Now we need answers, not excuses. It’s time for lawmakers to act. The lives of women across the nation depend on it.