When you think of maternal mortality and morbidity it is unlikely that the United States is first to come to mind. In fact, the U.S. spends over twice as much per capita on healthcare than any other industrialized country in the world. Yet, the number of women dying from complications in pregnancy and childbirth in America has nearly doubled in the last 25 years and is continuing to rise.
The burden falls on women of colour
This phenomenon is not, however, present across society—an intersectional approach is necessary to understand the maternal health disparities in America. Racial inequalities are the most pronounced in terms of maternal health, with women of colour faring worse in every category. Black women are three to four times more likely to die during pregnancy or childbirth, and half of these deaths may be preventable.
Health professionals have pointed to a number of factors influencing this dramatic disparity. One explanation is that 32 per cent of black women and 41 per cent of Indigenous women in America do not receive prenatal care. This makes them three to four times more likely to die after giving birth than women who attend even one prenatal appointment.
The overall health of women of colour is also often considered a cause of their maternal health outcomes. Rates of obesity and high blood pressure tend to be higher among women of colour and help explain other racial health disparities, including rates of heart disease. Others point to a lack of access to affordable, culturally appropriate, and timely maternal care. These factors are all perpetuated by higher rates of poverty experienced by women of colour, and historically low levels of insurance persisting under the Affordable Care Act. Institutionalized racism entrenched in health systems should also be considered a deterrent to accessing proper and safe healthcare for women of colour.
Rural America’s struggle to give birth
At the same time, maternal healthcare is disappearing in rural America, and as a result many women have to travel an hour or longer for prenatal appointments and to deliver their babies. In 1980, of the 54 rural counties in Alabama, 45 provided obstetrical services; today that number has dwindled down to 16. Only six per cent of the nation’s ob-gyns work in rural America, despite being home to 22.8 per cent of women over 18 years of age.
This is a result of hospitals across the country shutting down obstetrical wards, due to hospitals’ tight budgets and the costly nature of this care. Women are choosing to schedule caesarean section births out of fear that they will not be able to make it to a hospital on time. This phenomenon explains why Alabama has one of the highest caesarean rates in the country at 35.4 per cent. Unsurprisingly, rural America also experiences a dramatically higher maternal mortality rate than metropolitan areas, recording 29.4 versus 18.2 deaths per 100,000 live births, respectively.
Mothers’ health impacts on babies
A mother’s health has significant implications on the health of their babies. The experience of racism that women of colour face has been linked to increased stress levels, which leads to a higher risk of going into labour early. Premature birth is one of the reasons black babies in America are twice as likely to die in the first year of their lives as white babies. This is not a genetic difference between black and white women; if it were, similar rates would be occurring in other parts of the world.
Another explanation for this disparity in infant health is an epigenetic explanation, whereby the lived experiences of a mother impact the genetic expression of their children. The effects of racial discrimination on black mothers impact the perinatal health of their children, including increased risk of lower birth weight, high blood pressure, diabetes, and cardiovascular disease.
What can be done?
A radical restructuring of healthcare in America must occur, which prioritizes maternal health access. This must occur while recognizing the intersectional disparities that put some women at significantly higher risk of maternal morbidity and mortality. Non-discrimination and culturally appropriate methods of maternal care are crucial to this movement.
Affordability of childbirth, including pre- and post-natal care, must be addressed through expanded health insurance coverage for all low-income women. This can be achieved through the reduction of Medicaid eligibility barriers. As well, access to family planning methods, contraceptives, and sexual education must be improved throughout the country.
The problem of accessibility must also be addressed for the most vulnerable populations, including those in rural America. One approach to solve this is through telemedicine, whereby patients can have online video call appointments for prenatal care. Another option is to allow certified nurses, midwives, and nurse practitioners in geographically remote areas take on more significant roles in childbirth.
Finally, attention must be drawn to America’s failure to afford women of colour, low-income, and rural women the maternal healthcare they deserve in such a wealthy and medically advanced country.
The MGA Intersectional Feminist Collective is committed to inclusivity regardless of age, gender identity, class, sexual identity, ethnolinguistic group, or religious affiliation. The purpose of the Collective is to provide a safe space for discussion, support, and learning around issues and topics within intersectional feminisms.