The Maternal Care Crisis in the United States: A Call for Radical Change

The maternal care crisis in the United States transcends the country’s high rate of maternal mortality and infant mortality. Adverse pregnancy outcomes like miscarriage, premature birth, and conditions such as gestational diabetes, preeclampsia, eclampsia, embolism, and postpartum depression all feature prominently in this crisis. All these adverse outcomes, including the rate of maternal and infant mortality, disproportionately affect Black birthing individuals and their babies more than any other demographic in the country​1​.

The Centers for Disease Control and Prevention reported that maternal mortality rose by 40% from 2020 to 2021, with the maternal mortality rate for Black women being 2.6 times higher than that for white women. This statistic is not only alarming but points to a deeply entrenched problem of racial inequity in the healthcare system​1​.

The causes of this disparity are multifaceted, ranging from healthcare access issues and underlying chronic conditions to structural racism and implicit bias​1​​2​. Chronic conditions such as hypertension and diabetes often go uncontrolled during pregnancy, increasing the risk of complications​1​. Lack of adequate insurance coverage before, during, and after pregnancy, the absence of interprofessional teams trained in best practices, and the closure of maternity units in many communities all exacerbate the crisis​1​.

Structural racism has played a significant role in these dismal health outcomes. It has led to the devaluing of Black people and has significant impacts on people’s health. It is a powerful social condition rooted in centuries of oppression and continues to persist today in our healthcare policies and practices​2​. Over time, harmful institutional practices and negative cultural representations have contributed to traumatic pregnancy and birthing experiences for Black women​2​.

In response to this crisis, health care providers need training to recognize and address racism and bias in their interactions with Black patients, ensuring that care respects and values Black life​2​. Public policy changes are also necessary, especially those related to healthcare access. The American Rescue Plan Act of 2021 extended Medicaid coverage for pregnant people from 60 days to one-year postpartum, but more permanent solutions are needed, such as mandatory extension of postpartum coverage to at least one year, and the passage of the Black Maternal Health Momnibus​2​.

Sympathy and awareness are necessary but insufficient; there must be a radical shift in how Black women and birthing people are treated and cared for on a systemic level. This shift begins by acknowledging their humanity, hearing their voices, and listening to their stories. The role of each individual in dismantling structural racism, a key contributor to racial disparities in maternal health, cannot be overstated. It is well past time to implement policies and healthcare practices to ensure quality healthcare that is equitable and respectful of Black women and birthing individuals​2​.

In the words of Dr. Plenty, “Advocate, advocate, advocate for yourself. And if you need a second opinion, that’s not insulting” to the first physician​1​.

With Love, Lakischa Smith

Meet Lakischa Smith, a proud mother and a dedicated public health advocate. With a Bachelor’s from Dillard University and a Master’s in Public Health from Florida International University, she’s committed to sharing honest narratives about black motherhood. Lakischa believes in fostering sisterhood to combat the pervasive forces of white supremacy, and empowering African American women to be agents of change for future generations. She asserts that recognizing and addressing our community’s struggles is crucial, for healing is the key to moving forward. Armed with the power of education and a deep belief in collective action, Lakischa is determined to ensure that the issues impacting African American maternal health aren’t just seen—they’re addressed and resolved.

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