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Black Maternal Health: The Landscape and The Legislation We Need

Written by N. Sydney Jemmott, MD, MPH

Director of Policy, Reproductive Rights at SIX


When mamas are healthy, their babies are healthy, their partners are healthy, their families are healthy, their communities are healthy.

The week of April 11 through April 17, 2024, marks the seventh annual Black Maternal Health Week. This is an opportunity to elevate the importance of reducing maternal mortality among Black women and birthing people. The Black Maternal Health Week campaign is a week of education, advocacy, and community building to amplify the voices of Black Mamas and center the values and traditions of the reproductive and birth justice movements. The campaign was founded by the Black Mamas Matter Alliance, Inc. (BMMA), which is a national network of Black women-led organizations and multi-disciplinary professionals who work to ensure that all Black Mamas have the rights, respect, and resources to thrive before, during, and after pregnancy. The 2024 theme is “Our Bodies STILL Belong to us: Reproductive Justice NOW.” This year, BMMA is choosing to highlight the widespread restrictions on access to abortion care, coupled with the rising cases of criminalization due to pregnancy loss, that continue to widen the gaps of adverse maternal and birth outcomes in the United States.



Before delving deeper, the reader should understand BMMA uses the phrase “BLACK MAMAS” to represent the full diversity of lived experiences, including birthing persons (cisgender women, transgender people, and gender-expansive individuals) of African descent from across the diaspora (Afro-Latinx, African American, Afro-Caribbean, Black, and African Immigrant). In addition, In Our Own Voice: National Black Women’s Reproductive Justice Agenda (IOOV) explains Reproductive Justice as a framework, based in human rights, that affirms the right to have a child; the right to not have a child; the right to the social and economic supports to parent children, free from varying forms of interpersonal, community, and/or state-based violence; and the right to sexual expression. “These four values lay out the obligations of the U.S. government and society to ensure conditions exist for each individual to realize these values and combat interlocking systems of oppression–race, class, gender–that undermine the lives of Black people.” Lastly, Birth Justice is a component of reproductive justice. It is a Black-led movement that seeks to recognize inequality and to empower people in the pregnancy and birthing process. As defined by Ancient Song Doula Services, birth justice is achieved when individuals can make informed decisions during pregnancy, childbirth, and postpartum, that is free from racism, discrimination of gender identity, and implicit bias. Birth justice requires that individuals fully enjoy their human rights regarding reproductive and childbirth-related health decisions, without fear of coercion, including coercion to submit to medical interventions, reprisal for refusal of care, and/or face the threat of inadequate medical care. Birth justice centers the intersectional and structural needs of individuals and communities.

Statistics: The Intersection of Gender, Class, and the Racial Caste System

First, maternal mortality rates in the United States are increasing rapidly, from 17.4 deaths per 100,000 live births in 2018, to 32.9 deaths per 100,000 live births in 2021. The U.S. has the highest maternal mortality rate among high-income countries, in part because of the disproportionate burden Black women bear of maternal mortality. In addition to pregnancy-related deaths, women and birthing people are impacted by the emergence of new complications associated with pregnancy and the worsening of existing conditions.

Moreover, over 80% of pregnancy-related deaths in the U.S. were preventable, according to 2017 to 2019 data from Maternal Mortality Review Committees reported by the Centers for Disease Control and Prevention (CDC). To be clear, preventable maternal mortality is a form and symptom of discrimination of women and birthing people’s right to live a healthy life on a basis of equality with men.

Delving deeper into intersectionality, research also reveals the harm Black women and birthing people bear due to their co-existing identities in a racial caste system. According to the CDC in the U.S. in 2021, Black women were 2.6 times more likely than white women to die from pregnancy-related causes. It is important to note that these are national statistics and the rates can be even more catastrophic in certain states, counties, and cities. The high rates of maternal mortality among Black women span across income levels, education levels, and socioeconomic status.

Here are additional examples of the racial caste system and discrimination playing a consequential role in maternal health care experiences and outcomes. First, according to CDC survey data from 2023, 40% of Black mothers, 39% of multiracial mothers, and 26% of white mothers reported discrimination during maternity care. Also, 30% of Black mothers, 27% of multiracial mothers, and 18% of white mothers reported mistreatment during maternity care. Second, the rate of preterm birth among Black women is nearly 50% higher than the preterm birth rate among white or Hispanic women. According to CDC data from 2022, preterm birth is the leading cause of infant morbidity and mortality in the U.S.

In addition, while the COVID-19 pandemic no longer dominates headlines, it remains important to uplift that Black people in the U.S are disproportionately harmed by COVID-19. In fact, COVID-19 is associated with an increased risk of adverse pregnancy outcomes and maternal and neonatal complications. According to CDC data analyzed by the U.S. Government Accountability Office, COVID-19 contributed to 25% of maternal deaths in 2020 and 2021. And Black women had the highest rates of maternal deaths related to COVID-19 in 2020 and 2021, at 13.2 per 100,000 live births, while the rate among white women was 4.5 per 100,000 live births.

Lastly, Black pregnant people are disproportionately burdened with surveillance and punishment, including shackling incarcerated people in labor, drug testing mothers and infants without informed consent, separating mothers from their newborns, and criminalizing pregnancy outcomes.

To summarize, U.S. Black women bear the burden of structural racism, gender oppression, and the social determinants of health inequities, which significantly contributes to disproportionately high rates of maternal mortality and morbidity.



Our Bodies STILL Belong To Us: Reproductive Justice NOW: 

The Impact of Abortion Bans and Criminalization on Maternal Health

As presented above, since the health risks associated with pregnancy and childbirth can be significant, particularly for Black women and birthing people, it is imperative to highlight that abortion care is safe. The Turnaway Study conducted at the University of California, San Francisco, shows that women experience harm from being denied a wanted abortion. The higher risks of childbirth were tragically demonstrated by two women who were denied an abortion and died following delivery. No women died from an abortion. Also, women who were denied an abortion and gave birth reported more life-threatening complications like eclampsia and postpartum hemorrhage compared to those who received wanted abortions.

Moreover, in 2021, Emory University’s Center for Reproductive Health Research in the Southeast (RISE) analyzed data from 2005 to 2015. It revealed Black individuals, at all educational levels, experienced an increased probability of preterm birth with additional exposure to restrictive abortion policies, compared to non-Black individuals. This statistical trend is alarming in light of the U.S. Supreme Court overturning Roe v. Wade with their devastating decision in Dobbs v. Jackson Women’s Health Organization in June 2022.

The U.S. Supreme Court’s elimination of the federal constitutional standard that protected the right to abortion now permits states to set their own policies. With disregard to evidence-based medicine and standards of care, by December of 2023 numerous states had banned abortion care either entirely or in early pregnancy. Guttmacher Institute reported that this affected 21 million women of reproductive age living in those states. As of April 1, 2024, 14 states have banned abortion care and 11 states have gestational limits, reports KFF. Alarmingly, abortion bans and restrictions do nothing to protect a patient’s health or safety. In fact, they have been devastating for patients and providers across the country because abortion care is part of the full spectrum of reproductive health care.

Furthermore, it is crucial to understand that bans on abortion care endanger the health of generations of people by creating and exacerbating medical deserts. The same obstetric and gynecologic providers who manage abortion care, often deliver babies, manage miscarriages, provide prenatal care, screen for cervical cancer, and more, as well as conduct research. Practicing medicine in a state with a ban means training programs are unable to continue to attract top talent, medical professionals are unable to receive life-long training in the standard of care in their states, and providers are unable to transfer knowledge to their trainees. Ultimately, providers flee to states where they will not be subject to laws that can impact their licensure and hold them civilly and criminally liable. This places every person trying to access reproductive health care in that state, presently and in the future, at risk. Current patients do not receive care, the next generation of providers are not receiving comprehensive training, and future reproductive health patients will not be able to access the care they will need. This will continue to accelerate the public health crisis of maternal mortality in specific states, as well as across the U.S., as states with less restrictive laws struggle to absorb the patients migrating to get the health care they need.

On top of that, BMMA notes that as states implement new bans on abortion care and expanding definitions of personhood, they are adding onto the existing architecture of criminalization that has harmed Black women, birthing people, and families for generations. Wielding fetal harm and self-managed abortion laws to criminalize pregnancy outcomes, increases the potential for Black women and birthing people to be surveilled and ultimately involved in the criminal legal system. In addition, efforts to define personhood from the moment of conception have widespread, harmful consequences because any act that involves reproduction has the potential to violate the rights and interests of a fetus, embryo, or even a fertilized egg. Therefore, fetal personhood laws lay the groundwork to arrest, prosecute, and convict the patient accessing abortion care. Additional consequences of fetal personhood laws include: banning contraception, denying access to cancer treatments for pregnant patients, and impacting stem cell research, which discovers cures for disabilities and chronic diseases.

In summary, the current and anticipated exacerbation of the public health crisis of maternal mortality, shortage of healthcare providers, and expansion of criminal penalties on birthing people, dictates the policy solutions highlighted in the following section.




In Our Own Voice: National Black Women’s Reproductive Justice Agenda (IOOV) encourages policymakers to reimagine policy with the communities most impacted at the center, since Black women, girls, and gender-expansive people are often the backbone of families, movements, the economy, and democracy, while simultaneously facing perpetual attacks on civil and human rights. For effective policy in the U.S., IOOV recommends strategic policy solutions to address issues at the intersections of race, gender, class, sexual orientation and gender identity—within the situational impacts of economics, politics, and culture—that make up the lived experiences of U.S. Black women, girls, and gender-expansive individuals.

In alignment with that strategy, the comprehensive policy agenda of Black Mamas Matter Alliance, Inc. (BMMA) is embedded in the reproductive justice framework and organized into six overarching policy issues. Black women and birthing people and Black-led organizations are centered to develop, to implement, and to receive services. Incorporating the Center for Reproductive Rights’ State Legislative Wrap-up from 2022, provides examples of where state legislators have successfully invested in the past. From the perspective of a healthcare provider, the actions outlined below indicate where state legislators should invest in the future.

1. Structural And Social Determinants Of Black Maternal Health

  • Identify, eradicate, and provide restitution for systemic and structural harms against Black women and birthing people in the following social determinants of health: housing; safety-net and wraparound services; environmental justice; pregnancy accommodations and labor rights; human milk feeding, infant formula, and food sovereignty; health education and empowerment; community and social wellness; and human right

2. Full Spectrum Maternal, Sexual, And Reproductive Healthcare

  • Extend Medicaid coverage for up to 12 months postpartum (Ex. Georgia)
  • Require private insurance coverage of postpartum mental health care (Ex. Maine)
  • Make abortion care a fundamental right through statute and prohibit public interference with the right
    • Explicitly state that fetuses do not have independent or derivative rights under state law (Ex. Colorado)
  • Amend the state constitution to expand access to abortion
    • Enshrine reproductive rights (Ex. Vermont)
    • Refer initiatives to the ballot (Ex. California)
    • Approve an Equal Rights Amendment (Ex. Nevada)
  • Expand private insurance coverage for abortion
    • Repeal provisions prohibiting abortion from being covered by private insurance
    • Create coverage requirements for the provision of abortion care by private insurance providers (Ex. Maryland)
  • Fund abortion services
    • Require Medicaid or medical assistance programs to cover abortion, without cost-sharing requirements (Ex. Massachusetts)
    • Provide funding to public institutions for trainings on abortion services or to expand access to abortion services
    • Provide funding to abortion funds (Ex. Oregon)
  • Create employee leave programs
    • Create universal paid parental leave programs; employers and employees can make mandatory payroll contributions (Ex. Delaware)
    • Create state employee paid parental leave programs (Ex. Louisiana)
    • Require employers to extend paid bereavement leave to employees who experience pregnancy loss, including misscarriage or stillbirth (Ex. Illinois)
  • Require all hospitals and freestanding birth centers to implement evidence-based explicit and implicit bias training programs for all staff who interact with patients, including health professionals, administrative staff, and clerical staff (Ex. Delaware)
  • Adopt the Affordable Care Act’s Medicaid expansion
  • Expand telehealth access to eliminate maternity care deserts
  • Divest funding from crisis pregnancy centers/anti-abortion clinics
  • Reject embryonic and fetal personhood laws because they disrupt access to fertility care, including in vitro fertilization

3. Black Maternal, Reproductive, And Perinatal Workforce Development

  • Expand access to midwifery care
    • To permit different training paths, expand the categories of licensed midwives beyond certified nurse midwives (CNMs) to include community midwives [certified professional midwives (CPMs), certified midwives (CM), traditional midwives, etc.] (Ex. Iowa)
  • Expand the scope of midwifery practice
    • Enact laws that allow midwives to prescribe medication, including contraception, antibiotics, antivirals, and certain medical devices (Ex. North Carolina)
  • Amend the state Medicaid plan to allow for Medicaid reimbursement of doula services
    • Require state Medicaid to cover Doula services that are medically indicated (Ex. Maryland)
  • Expand the types of clinicians allowed to provide abortion care
    • Repeal physician-only laws
    • Authorize physician assistants, certified nurse midwives, nurse practitioners, and other qualified medical professionals to provide abortion care (Ex. Maryland)

4. Criminalization Of Black Women, Birthing People, And Families

  • Dismantle the architecture of criminalization in the United States through decarceration, decriminalization, and defunding surveillance and punishment institutions and systems, including juvenile and adult prisons and jails, the family regulation system, and immigration and detention systems
  • Require correctional facilities to provide prenatal and postnatal care, consistent with standards of care
  • Require correctional facilities to arrange for births to occur outside of the correctional facility, when possible
  • Prohibit the use of restraints on people who are in labor, giving birth, or during the immediate post delivery period (Ex. Indiana)
  • Prohibit solitary confinement
  • Reject embryonic and fetal personhood laws because they lay the groundwork to arrest, prosecute, and convict patients accessing abortion care

5. Research And Data Transformation

  • Mandate proportional Black, Indigenous, and People of Color (BIPOC) membership in Maternal Mortality Review Committees (MMRCs)
  • Improve data quality by investing in data collection that is disaggregated by identities, including sex designated at birth, sexual orientation, gender identity, race, ethnicity, nationality, immigration status, language, age, ability, and others
  • Appropriate funds to cover the expenses of a statewide MMRC (Ex. New York)

6. Black Women And Birthing People’s Leadership

  • Sustainably invest in and remove barriers to fund Black-led and centered, community-based organizations whose work is rooted in reproductive justice, birth justice, and the human rights frameworks
  • Prioritize Black women and birthing people for leadership, decision-making, and advising roles; honoring Black women and birthing people’s cultural practices, histories, and traditions

In conclusion, Black Maternal Health Week is an opportunity to focus attention on the staggering health statistics that define the lived experience of Black women and birthing people in the U.S. As new laws bud, and bans bloom, the disproportionate harm the U.S. criminal legal system causes Black women and birthing people will continue to flourish. Fortunately, state legislators have the power to impact this public health crisis by utilizing the policy recommendations championed by multiple Black-led organizations.


“Nobody is free until everyone is free.”

-Fannie Lou Hamer, Gender Justice Icon


If you are interested in introducing Black maternal health policies in your state, please join us in a Rapid Response Room and contact [email protected].




SiX Repro Resources

SiX’s Model BMMA BMHW Resolution 

The Landscape

The Policy Recommendations





  • Birthing Justice by Professor Julia Chinyere Oparah and Dr. Alicia D. Bonaparte
  • Killing the Black Body by Professor Dorothy Roberts
  • Medical Bondage by Dr. Deirdre Cooper Owens
  • Policing the Womb by Professor Michele Goodwin
  • Reproducing Race by Professor Khiara Bridges