Black Mamas Matter. They are the backbone of our families and our communities. And in a political moment where many are giving Black women flowers for their social and political contributions, it’s long past time to speak plainly about the threats we face. This Black Maternal Health Week, we are reminded that Black women continue to experience disparate maternal health outcomes as a result of structural racism and inequitable access to high-quality, comprehensive care.
From higher rates of chronic conditions—like heart disease and diabetes—and oral health issues, to lack of access to care and explicit bias within health settings, Black women, in particular, too often find themselves in challenging circumstances when it comes to maintaining their health and the health of their children. Oral health, too, is often overlooked, but has an incredible impact on maternal and early childhood health.
Health systems rooted in decades of racist, discriminatory policies and narrow, culturally incompetent views of health and wellness are not equipped to address these disparities or adequately support Black mothers. In fact, existing systems simultaneously devalue and exacerbate the pain experienced by Black women. As a result, maternal mortality among Black women in the United States is exponentially higher than the national average, which is already the highest rate among the world’s developed nations. In addition, these systemic conditions lead to more frequent instances of preterm birth, infant death, postpartum mental health challenges, and more among Black mothers.
Make no mistake, maternal health care is a racial justice issue, and it demands bold, systemic solutions to get at the root causes of the preventable negative maternal health outcomes suffered by Black women.
One important step to help solve the problem? Expanding Medicaid.
Today, one in five Americans is enrolled in Medicaid. The program covers over 74 million people nationwide, including more than one out of every four in Massachusetts, and pays for nearly half of all births across the country.
The barrier? Medicaid’s required coverage for pregnant people is deeply insufficient—failing to provide the kind of access, support, and culturally competent care that could meaningfully change maternal health outcomes and save lives.
Today, Medicaid benefits for pregnant people can vary widely, and may use a limited definition of “pregnancy-related” care—failing to account for the impact of other conditions, including oral health, on the overall health of the mother and child. Medicaid coverage may extend only 60 days postpartum, even though 50 percent of maternal deaths occur up to a year after giving birth. Medicaid also often fails to cover culturally competent maternal care, like doulas.
Expanding the breadth and duration of maternal health care covered by Medicaid—especially preventive care including oral health care—is a critical part of the fight to improve health outcomes for mothers and children.
In Congress, Rep. Pressley and her colleagues introduced the Healthy MOMMIES Act, which would expand required Medicaid coverage to include the full range of pre- and postpartum care for up to a year after birth, including oral health services. Four out of every ten pregnant women—and the percentage is even higher for expecting Black mothers—experience oral health issues that raise the likelihood of poor birth outcomes, and which exacerbate underlying conditions that can lead to major complications and even death. The Healthy MOMMIES Act would also increase Medicaid reimbursement rates for mothers in vulnerable communities and improve access to and data on doula care.
By requiring the coverage of a wider range of pre- and postpartum care through Medicaid, we can raise the level of care for millions of new and expecting mothers across the country.
Building a system that is more accessible and equitable also means supporting efforts to integrate oral health into overall health. Improving Medicaid is a critically important step, and just one piece of a much larger effort as we move towards a system of universal health with accessible and responsive care that meets the needs of every person who calls this country home.
We must also take a holistic view of how racism impacts community health. Congress must pass the Anti-Racism in Public Health Act to declare structural racism a public health crisis and develop a base of practical knowledge to root out racism from our healthcare system. All too often, inadequate access to quality maternity care is compounded for Black women when their experiences are diminished and they are dismissed, disrespected, and even abused when reporting signs of pregnancy-related complications. Improving coverage for pregnant people is a necessary step to increase access to services but these efforts must be coupled with intentional efforts to integrate care and create spaces where new and expecting mothers feel comfortable seeking and receiving services. This means making meaningful investments to support doulas and culturally competent health care providers who are caring for birthing people in community, both pre- and postpartum.
A safe and healthy pregnancy should be a fundamental human right, not a privilege, but far too many people—particularly Black women—still find themselves without the care they need for themselves and their babies. As we work toward a more equitable recovery from the COVID-19 pandemic, we must transform our health care systems to center their experiences and ensure that comprehensive pre- and postpartum care is universally available.
When we do, we’ll have paid much more than lip service to the value of Black women and Black mothers. We will have actually saved lives.
Ayanna Pressley is the U.S. representative for Massachusetts’ 7th Congressional District and a founding member of the Black Maternal Health Caucus in Congress. Myechia Minter-Jordan, MD, MBA, is the president and CEO of the CareQuest Institute for Oral Health and former CEO of the Dimock Center in Roxbury, Mass.