Stress Kills: Economic Insecurity and Black Women’s Maternal Health Outcomes

Economic inequality takes a toll on health, and the chronic stress of living in poverty is killing Black women who choose to become pregnant and give birth.

[A Black woman puts her hand to her head and closes her eyes while grimacing]
When we hear “stress kills,” we often imagine a wealthy business executive dying of a heart attack in their early 50s because they put in too many long nights at the office. But stress also kills pregnant Black women and their babies in a more surreptitious way. Young woman with a headache via Shutterstock

This piece is published in collaboration with Echoing Ida, a Strong Families project.

Fifty years ago, President Lyndon B. Johnson announced the War on Poverty, a set of legislation and programs intended to respond to the needs of people living in poverty. Today, many people still need and benefit from War on Poverty programs such as early childhood education, supplemental nutrition assistance (food stamps), work study opportunities, and federal family planning grants.

To commemorate this anniversary, the last few months have seen a kerfuffle of coverage on poverty and economic inequality, opportunity, and growth. Media coverage has also highlighted the connection between economic opportunity and reproductive health in that women need access to reproductive health services to prevent and delay childbearing so they can get further ahead in life, avoid poverty, or lift themselves out of poverty. This is very important. Indeed, data show that women reap substantial social and economic benefits when they are in control of their childbearing; but, that is only one way that economics and reproductive health outcomes intersect. We also understand that economic inequality and injustice can affect the human body and lead to negative health outcomes.

When we hear “stress kills,” we often imagine a wealthy business executive dying of a heart attack in their early 50s because they put in too many long nights at the office. But stress also kills pregnant Black women and their babies in a more surreptitious way. Economic inequality—simply described as the gap in wealth or income between people—takes a toll on health, even when people have health insurance coverage and access to important health-care services. The chronic stress of living in poverty—of knowing a missed paycheck could leave you in dire straits, of not having enough to make ends meet—is killing Black women who choose to become pregnant and give birth.

The negative maternal health outcomes many low-income women and women of color experience—including maternal mortality—often result from conditions exacerbated by economic instability. Research shows that chronic stress causes cardiovascular changes that increase blood pressure, which must remain stable during pregnancy and labor. Hypertension, or high blood pressure, is a risk factor for pregnancy complications such as preeclampsia, low birth weight, pre-term birth, and damage to the mother’s internal organs and other adverse conditions. Chronic stress could also lead to unhealthy coping behaviors such as overeating (leading to obesity), smoking, and alcoholism—all of which increase the risk of adverse pregnancy outcomes. Being financially insecure and experiencing financial hardship is stressful, and Black women are more likely to be poor during pregnancy than women of other races.

The reality of the economic hardships of Black women in the United States is a hard pill to swallow. A 2013 report by the Center for American Progress summarizes the concerning statistics:

  • Black women earn, on average, 55 cents to the dollar that white men earn. The statistic of 77 cents to the dollar for American women just doesn’t hold true for communities of color.

  • Black women are more likely to hold low-wage jobs with few benefits and less job security.

  • The poverty rate for Black women is 28.6 percent compared to 10.8 percent for white women.

  • The most telling of this data is that single Black women have a median wealth of $100, compared to a median wealth of $41,500 for single white women. That’s a huge disparity. Low wealth is indicative of financial insecurity. For example, a single woman earning $40,000 a year with no savings, investments, or assets is essentially living paycheck to paycheck and is at risk of going into debt and falling into poverty even though her income is far above the federal poverty level. Based on our median wealth, Black women are extremely financially insecure, and thus subject to the chronic stress that accompanies that insecurity.

It’s clear that if we want to see better maternal health outcomes for Black women, reproductive health and justice advocates must also work to achieve economic justice. Health happens at the intersection of various parts of our lives and is influenced by where we live, work, and play. We must support policies and action that are outside of the traditional scope of reproductive and sexual health in order to achieve the improvements we seek in a range of health outcomes.

In particular, we must take action and support policies that improve economic security, increase pay, and promote the accumulation of wealth in the Black community. The rhetoric of the War on Poverty may be antiquated but the underlying theme of greater economic security and opportunity is still relevant. In fact, the War on Poverty set a precedent of economic policies that improve pregnancy outcomes. A 2011 analysis concludes that the food stamp program helped to increase infant birth weight, particularly among Black mothers living in high-poverty areas, by increasing the financial resources available to families. If supplemental nutrition programs can help increase birth weight, imagine what strategic and concerted efforts to reduce financial hardship can accomplish.

Researchers and advocates have pointed to a few key opportunities to improve the economic experience, and health outcomes, of people living in the United States over the next 50 years:

Education that leads to economic opportunity

Black people must be better prepared to compete for well-paying jobs that ultimately increase economic and social equity. Specifically, reforming public school funding to more equitably distribute financial resources could go a long way. Currently, public K-12 schools may be funded by the state or local government and property taxes from the school’s surrounding area. What we have seen as a result is under-funded schools in lower-income areas and disparities in quality of education from neighborhood to neighborhood and state to state. As you might have guessed, underfunding is more likely to impact students of color. And school funding has been directly linked to the quality of education and student outcomes.

It is imperative that all children receive a high-quality education that prepares them to enter institutes of higher education or enter the workforce with the skills necessary to compete for higher-paying jobs. Reproductive justice advocates must actively support meaningful attempts to address the way our schools are funded. We know that other issues also plague our schools—the school to prison pipeline, cultural incompetence, and inconsistent instruction and curriculum—but achieving equality in funding is a good place to start.

At least a living wage

Earning a low income and living in impoverished areas not only directly impedes access to health-care services, but indirectly affects health outcomes through the stress of financial insecurity. The Center for American Progress asserts that “the best ticket out of poverty is a job that pays a living wage.” According to the White House, raising the minimum wage to $10.10 would affect 28 million Americans and boost the economy. While a minimum wage of $10.10 an hour would be a good start, it falls far short of a living wage—especially for families with at least one dependent.

Raising the minimum wage is an absolute necessity, but advocates must not be content with that. A living wage must be the new minimum and the work shouldn’t stop there. We should support people in prospering from their work and growing wealth. Wealth can serve as a personal safety net, reducing financial insecurity and increasing health.

Adequate leave to enhance job security

Finally, people must have sufficient and generous personal leave so that they can take off from work when they are sick, take care of their families and personal responsibilities, and rest and relax without having to worry about losing their jobs. Sufficient leave provides job and financial security. Moreover, adequate maternal, paternal, and family leave policies not only have an immediate benefit, but help create a culture that respects the reproductive decision-making of individuals rather than punishing them for creating the families they want. Reproductive health and justice advocates’ participation in pushing for better leave policies is essential.

So, where do we begin? Forming partnerships between reproductive justice and economic justice advocates is a good place to start. Coalitions that cross traditional lines to begin thinking and working across issues will be important for any forward momentum. Strong Families is an example of a network of activists and advocates across movements who collaborate and amplify each other’s work to create meaningful policy and culture change. But, this intersectional collaboration requires the participation of actors at all levels and in various fields, importantly policymakers. For example, the American Public Health Association published guidance to encourage state and local governments to incorporate health into all policies. Incorporating health into all policies is an approach to provide real opportunities for people to achieve and maintain their best health and improve the health of our nation.

Economic inequality produces the stress that manifests as illness in our communities. Advocates, policymakers, scholars, and community representatives must combine forces to address the inequality that hurts Black women and their families, and ultimately our society. Economic injustice makes it nearly impossible to survive and there’s nothing more stressful than that.