Maternal Mortality is a Racial Justice Issue: The Impact of Policy Packages and City Composition on Aggregate Level Maternal Mortality and Racial Disparities in Maternal Health Outcomes

Abigail L Nawrocki, Purdue University

Abstract

The United States is currently facing a maternal mortality crisis with disproportionate impacts on Black and Brown women. Indeed, approximately 700 women die of complications related to childbirth in the U.S., numbers that have more than doubled over the past 25 years (American College of Obstetricians and Gynecologists 2019; March of Dimes 2019; Petersen et al. 2019). While maternal mortality rates (MMRs) in the U.S. have continued to rise, MMRs in other industrialized countries are in decline (American College of Obstetricians and Gynecologists 2019; March of Dimes 2019; Petersen et al. 2019). Overall, maternal health is an established indicator of the overall health of a nation and the local community (American College of Obstetricians and Gynecologists 2019). Maternal mortality rates (MMR) in the United States are higher than in other industrialized countries despite outspending every other country in the world on medical care, which has been the case since the 1990s (American College of Obstetricians and Gynecologists 2019; Petersen et al. 2019). Finally, the Centers for Disease Control and Prevention (CDC) also reports that nearly three in five (60 percent) of pregnancy-related deaths are preventable (March of Dimes 2019; Petersen et al. 2019). As stated, maternal mortality is a highly racialized issue in the United States. In fact, the CDC reports that women of color are three to four times more likely to experience maternal mortality than white women (American College of Obstetricians and Gynecologists 2019; Petersen et al. 2019). These rates remain consistent even when controlling for socioeconomic status (SES), meaning that wealthy women of color are not free from the risks of maternal mortality (March of Dimes 2018, 2019; Petersen et al. 2019). Historically, racialized and gendered ideologies about reproduction have been paired with reproductive policies and social movements in ways that consistently and systematically exacerbate disparities in maternal health outcomes. Eugenics and forced sterilization laws targeted women of color, using state power to assert control over the reproductive ability of these marginalized women in ways that negatively impacted their health and relationship with the healthcare system (Roberts 1997; Ross 2017c; Stern 2005). The transition to births attended by physicians came at the expense of women of color birth workers and mothers and was enacted by policy change rooted in dominant discourses undermining women of color’s expertise, bodies, and reproductive rights (Bonaparte 2016; Diaz-Tello 2016; Oparah and Black Women Birthing Justice 2016; Owens 2017). Eugenic ideologies that frame the reproduction of women of color as something to be controlled also influenced the adoption of welfare family cap policies and compulsory birth control and sterilization practices for low-income women, who were disproportionately women of color (Roberts 1997; Romero and Agénor 2017). Although social movements did arise to address issues of reproductive rights, secondwave feminism, the natural birth movement, and the pro-choice movement all engaged in white supremacist rhetoric and advocacy. These centered the needs and experiences of wealthy white women to the detriment of women of color, whose bodily autonomy was differently threatened (Oparah and Black Women Birthing Justice 2016; Ross 2017c).

Degree

Ph.D.

Advisors

Stryker, Purdue University.

Subject Area

Economics|Health care management|Public health|Sociology

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