The U.S. has the highest maternal death rate in the developed world—and Black and Indigenous moms are hit the hardest, with Black women dying at 3 to 4 times the rate of their white counterparts, and Indigenous women dying at 2 times the rate of white women.

But how did things get this bad—and how can we dig ourselves out? The second workshop in our reproductive rights and justice series—Maternal Health: Justice for Mothers in 2021—focused on these questions. Moderated by Jamia Wilson of Random House, a founding member of The Meteor Fund advisory board, it featured Breana Lipscomb of the Center for Reproductive Rights, a global legal advocacy organization, and Marinah V. Farrell of Changing Woman Initiative, a New Mexico-based organization focused on promoting reproductive wellness and Indigenously-centered childbirth options for Native women.

Their conversation was illuminating—and, in places, optimistic—since there are steps we can all take to help. Read the highlights here—and sign up to hear about future workshops.

How things got this bad

First of all, it is this bad. “We’re at a time when most other countries are making dramatic progress on maternal health, but pregnant and birthing people in the U.S. are suffering death and injury at ever-increasing rates,” says Breana Lipscomb. “We have the worst maternal mortality ratio in the developed world and are one of only 13 countries where maternal mortality is on the rise….And we’re in the midst of a COVID-19 pandemic that is only exacerbating that problem.”

But the rise isn’t happening uniformly everywhere, she points out—the majority of the deaths are preventable, and happen in Black, Indigenous and low-income communities. That’s for one reason only: systemic racism. “The issue is that these rates are driven by the racial disparities that are rooted in systemic inequalities. So that’s how we got here. Systemic inequalities that are rooted in racism.”

And it's not about economic brackets

The conventional wisdom used to be that higher death rates for Black mothers were about economics more than race. “So for years, we’ve heard, ‘if you’re healthy before you get pregnant, then you’ll have a healthy pregnancy outcome.’ And that’s just simply not always true, especially for Black women,” says Lipscomb. “This trend of increased maternal death risk for Black women is pervasive across all income and educational levels. And the increased rate of maternal death also persists despite individual health status.”

“For years, researchers and policymakers have really perpetuated narratives that blame individuals for their poor outcomes, but we’ve seen healthy, well-educated, affluent Black women dying due to pregnancy-related complications,” she continues. “We’ve heard the stories of Serena Williams and Beyoncé about their own pregnancy complications and their difficulties advocating for their own health. So when we’re seeing those cases, I think we have to acknowledge that there’s something in our health care system that is broken.”

There's a similar dynamic in rural Native communities

That same blame-the-mother mentality exists with regard to Native health hazards, explains Marinah V. Farrell. Many Native communities have been hard hit by the lack of access to care—a problem that’s only worsened during the pandemic.

“We often hear and read that maternal mortality is caused by the preexisting health issues, lifestyle or lack of education in Indigenous communities,” she says. But actually, part of the problem is that traditional Indigenous community-based providers have been removed from Western health care settings in Native communities, leaving many without any options for affordable health care.

“The systems of health care in this nation removed the Indigenous traditional healers and almost eliminated midwives,” who traditionally perform births and abortions, she explains. “The system did this by removing the legitimacy of the community-based health worker and healer and medicine people. Add to this [the fact that] almost 40 percent of Native communities live in rural America where our health care system is critically lacking in reproductive health care providers, hospitals, birth centers and home birth midwives….Even now during COVID, obstetric units, such as the Indian Health Services unit here in Phoenix, Arizona closed their doors, leaving many birthing families without any affordable options of where to birth.”

More than half of maternal deaths occur in the weeks and months AFTER delivery 

“There is a misconception that pregnancy complications only happen during pregnancy or at the time of delivery, but those complications can persist several months after pregnancy,” says Lipscomb. “The CDC has found that 60 percent of maternal deaths occur in the year after delivery. And the majority of these deaths are preventable.”

The culprit here is postpartum care—or the absence of it. In over half of U.S. births, women lose access to health care coverage 60 days after delivery—meaning that potentially routine postpartum complications can lead to death. And while there’s growing support among states to extend their coverage, there are still wide variations in health care coverage, says Lipscomb.

“The bottom line here is that the state you reside [in] should not determine the length of your pregnancy Medicaid coverage,” she says. “And that’s why we’re working on state and federal legislative strategies to extend Medicaid pregnancy coverage to at least one year postpartum for all eligible birthing people.”

Access to postpartum care is an issue for Indigenous communities as well, says Farrell. “Many people think that Indian Health Services (IHS) covers every type of primary and reproductive health care and that is actually not true. It really is very limited in terms of what it provides….Many times Indigenous families are not receiving prenatal or postpartum care because either the challenges of the distance or because there just is no IHS services available where they live.”

But there are solutions, at both state and federal levels

Here’s a quick overview of what CRR is getting behind, from Lipscomb:

At the state level: “A lot of what we’re doing… is this need to really invest more and support community-based providers. And so that means expanding access to midwifery care. So looking at state regulations that are restricting access to community-based midwives and also looking at how we can better support access to doula care….We’re also, as I mentioned, working on efforts to extend Medicaid in the postpartum period.”

“At the federal level, we’ve been really closely engaged with the Black Maternal Health Caucus on their Momnibus, which is a package of nine bills, specifically looking at how we can improve federal-level policies that would impact Black maternal health….And so this package of bills ranges from addressing the social determinants of health, such as food security, transportation, housing, all of those things, to addressing the type of data that’s collected around maternal mortality to diversifying the perinatal workforce….So it’s a robust package of bills to really look at it holistically.”

We also need to measure the problem better

States differ in how they report maternal mortality, making it hard to compare numbers and, in certain areas and communities, ensuring that the problem is underreported says Farrell. “We know that Native maternal mortality is often not well-documented—that the statistics do not show the actual numbers. And so these numbers could be far worse.

“The lack of data—this is very real,” Farrell continues. “And I think as people are starting to think about it more, some things are changing…It’s definitely not a good system yet, but it’s in process.”

“We’re better than we were even just three years ago,” adds Lipscomb, “but we still have a lot of improvement to make sure that we have sound quality maternal health data that we can really compare across states.”

Ironically, anti-abortion states lack maternal health care

File this under not-surprising-but-maddening-nonetheless: “States that have the highest abortion restrictions also have some of the fewest supportive maternal health policies,” says Lipscomb. “It’s what we see as a bit of hypocrisy. So you limit access to abortion, but then you’re not necessarily providing the supportive structures and those safety net programs that would support a family to survive and thrive.”

“Then of course there’s, as we’re reminded right now in this moment of kind of racial reckoning in the U.S., we have this pro-life narrative of being anti-abortion, but evidently that only applies to a fetus and not to an actual person that is encountering law enforcement.”

“And somehow just that disconnect is ever present. And so I think the best that we can do is to continue fighting it, to continue displaying the hypocrisy of it all. And to continue to talk about and to break down the silos of abortion care and maternal health care—because it’s all part of the reproductive health continuum.”

Want to get involved? 

Amplifying the issues and helping to tell the stories are key to changing the narrative about maternal health, says Lipscomb. “We really have to figure out how to shift the narrative—where we genuinely value life, and value Black lives and Indigenous lives—because I think the lack of that is why we have not seen more policy reform as it relates to maternal health.”

To get involved in the fight for maternal health, Lipscomb and Farrell encourage connecting with, following and supporting your local community-based organizations that are focused on reproductive justice work. The Center for Reproductive Rights and Changing Woman Initiative have resources to guide you as well.

Read the takeaways from the first workshop in this series—Reproductive Rights and Justice: What’s Ahead in 2021.


Jamia Wilson

Jamia Wilson (she/her/hers) is a feminist activist, writer and speaker. The Executive Editor of Random House and author of several books, her work has appeared in The New York Times, Elle and The Washington Post. She is a founding advisory board member of The Meteor Fund.

Breana Lipscomb

Breana Lipscomb (she/her/hers) is the Senior Manager of the U.S. Maternal Health & Rights Initiative for the Center for Reproductive Rights, where she develops advocacy strategies to promote Black maternal health and works to advance state level policies that further reproductive rights as human rights.

Marinah V. Farrell

Marinah V. Farrell (she/hers/ella) is the Executive Director of Changing Woman Initiative, a Native American centered health and justice organization serving New Mexico and Arizona. A trained midwife, Marinah is a longtime advocate for traditional and community health workers.