Monday, April 11th, partners from all over the world issued a call to action for the UN to officially recognize the International Day for Maternal Health and Rights. And for good reason: globally, maternal deaths are largely preventable if women can secure their right to respectful, high quality health care services. In the United States, risk factors for pregnancy complications that lead to maternal death, such as hypertension, advanced maternal age, obesity, and maternal smoking, can be monitored and, in some cases, managed through adequate primary care before and during pregnancy.
Access to primary care services is often out of reach for those women in the U.S. who cannot afford health insurance, or who live in an area where physical distance to a health care provider is a considerable barrier. While most uninsured women are eligible for Medicaid, government-sponsored coverage for prenatal care and childbirth for low-income women, the gap in primary coverage misses women whose pregnancies are unintended and the all-important preconception period, when potential threats to the health and safety of women and her baby are identified before pregnancy.
Financial inequality to health care access is just one barrier women face to exercising their right to a healthy pregnancy. As highlighted by reproductive justice advocates and the recent MTHF blog series, women of color in the United States are disproportionately at risk for pregnancy complications, poor birth outcomes and maternal death. Despite the overall reduction of maternal mortality in the U.S. during the 20th century, one constant that remains is that black women in the United States have been three times more likely to die due to pregnancy-related causes than white women, regardless of income, since 1935. Causes for these disparities are rooted in the intersectionality of many factors, including race, gender and geography.
Consider Louisiana, where lack of health care access and racial inequity converge to produce devastating maternal health statistics. Named one of the worst states in the country for social justice, black women are three times more at risk of dying due to pregnancy-related causes than white women. Nearly 1 in 5 women in Louisiana are uninsured, higher than the national average of thirteen percent, and sixty-five percent of pregnancies are unplanned. The majority of pregnant women in Louisiana are on Medicaid (68%), the second highest enrollment in the U.S., nearly all of whom do not have any preconception or interconception care. In addition to being profoundly unjust, the disparities are financially burdensome; estimates show that eliminating racial disparities in adverse pregnancy outcomes in the South alone could save $100 to $214 million per year in Medicaid spending.
The fundamental right for respectful, high quality health care should extend beyond the perinatal period to accommodate women throughout their lifespan. The intersectionality of race, gender, class and access to health care must be considered to ensure that every woman in the United States has the healthy pregnancy and birth to which she is entitled. As we celebrate and push for an International Day for Maternal Health and Rights, let’s remember that the fight for the right to health and equality begins outside the labor and delivery room. In the land of plenty, we can do better.