Last week I spoke at the United Nations Office of the High Commissioner for Human Rights to urge the United States to use a human rights framework to improve maternal mortality in the U.S. That’s right: Black women are dying around the world, and black women in the U.S. need to be placed in the context of an international crisis.
The United States is the only developed country in the world where maternal mortality is on the rise. Black women in the South are acutely at risk. Black women in the U.S. die at three to four times the rate of white women. Despite clear evidence of this inequity, policymakers and, as a consequence, the government have not made this an urgent public health and human rights issue.
As a black mother from Louisiana who is also an obstetrician, I feel a deep desire to end this inequity, a desire that is amplified every time I look into the mirror and into the faces of my daughter and patients. In my own home state, black women die 3.5 times more than white women within one year of birth. Many of these women die from homicide or suicide. This is why my organization, the National Birth Equity Collaborative, joined the group Black Mamas Matter. Black Mamas Matter is adapting the United Nations’ technical-guidance document on maternal mortality.
Black women cannot buy or educate their way out of dying at three to four times the rate of white mothers. Maternal mortality rates persist regardless of our class or education status. Deaths among mothers extend beyond the period of pregnancy or birth. Nine months of prenatal care cannot counter underlying social determinants of health inequities in housing, political participation, education, food, environmental conditions and economic security—all of which have racism as their root cause.
Many state governments, especially in the South, are resistant to sexual and reproductive rights or even state support for basic health care services. This recalcitrance impedes Southern women’s access to the information, facilities, services and resources they need to plan and have healthy pregnancies.
Good maternal health outcomes depend upon implementation of all sexual and reproductive rights, from comprehensive sexual education to access to birth control. The U.S. has a privatized health system. Some families qualify for public health insurance or Medicaid, but income qualifications vary by state. Generally, in the South, you have to be very poor to qualify for Medicaid. So in the South, you can be poor and also lack insurance.
Even if women are insured, coverage of sexual and reproductive health services is not comprehensive. There is a strong political resistance to sexual and reproductive health services in the South. Consequently, there are many legal barriers to services and information. This lack of a safety net for poor women produces gaps in access along the reproductive life course. There are impediments ranging from limited access to contraception in order to plan healthy pregnancies to inadequate postpartum care to help manage infections and identify risk factors for mortality.
The U.S.—a country that spends more per capita on health care than any other developed nation—has one of the most sophisticated, technologically advanced health care systems in the world, but we still have inequities. Black women are still suffering from preventable maternal deaths. A human rights framework provides a road map to solutions.
U.N. Human Rights Council resolutions on maternal mortality and the related technical guidance shift the discourse on maternal mortality from a solely public health or personal-responsibility problem to one of women’s rights. The U.S. is an example of how investment in biotechnology and not people leads to the improvements of things and not human beings, especially women.
The human rights framework gives us a way to address structural racism in the U.S. Human rights law provides a more robust analysis of discrimination than the U.S. legal framework, which was constructed on the premise of inequality of human value based upon race. Consequently, recourse though the legal system only is built around finding discriminatory intent and not institutional racism. A human rights framework will help the U.S. legal system and policymakers understand how many forms of discrimination—in this case, gender, race and socioeconomic class—intersect to affect black women differently.
A human-rights-based approach helps to uncover discrimination by putting women who are most affected at decision-making tables and encourages participation of marginalized groups in reforming laws, policies and practices. Members of Black Mamas Matter are prioritizing engagement and leadership of black women as well as community-driven solutions that recognize the importance of local context.
The Black Mamas Matter toolkit uses the technical guidance as a framework to assess the policy solutions that are being proposed by various sectors and stakeholders. It puts forward ideas that will help ensure human rights compliance in maternal health. We already know some of the reasons that black women are dying. Now we are working on policy responses that can catalyze black women’s reproductive and human rights.
Ultimately, what black women in the U.S. need is accountability. We need to know that our lives are valued. The United States is slowly making progress voluntarily on maternal-death review processes through the Centers for Disease Control and Prevention, which can make systems-level recommendations about clinical factors. However, to ensure true equity and improvement, we need to push the role of racism and nonbiomedical factors. Black women need a lens that sees black women as having solutions—not as being the problem.
The Root aims to foster and advance conversations about issues relevant to the black Diaspora by presenting a variety of opinions from all perspectives, whether or not those opinions are shared by our editorial staff.
Dr. Joia Crear Perry is president of the National Birth Equity Collaborative. She has previously been executive director of the Birthing Project USA and director of Women’s and Children’s Services at Jefferson Community Healthcare Center.