This week, a community of organizations across the country are speaking out about the importance of supporting, trusting, and listening to Black women, as we mark the fourth annual Black Maternal Health Week.
As a Black woman and physician who has provided the full range of pregnancy-related care—including prenatal, delivery, postpartum, and abortion care—for thousands of patients, I have seen firsthand how our maternal health system is failing and how Black women* are bearing the brunt of this failure.
I have also seen how this failure is intimately tied to Black women’s lack of access to comprehensive reproductive health care, including access to abortion care. The same systems and structures that result in Black women experiencing higher rates of mortality, morbidity, and mistreatment when accessing pregnancy care are directly correlated to the experiences Black women face when seeking abortion care.
The commonality here is not race, but racism.
The racial uprisings over the last year have clearly shown us that the legacies of white supremacy, and its resulting violence and harm, are not behind us. And the convergence of these uprisings with a global public health pandemic proves that the medical system is not somehow unaffected. When health-care providers don’t listen to the lived experience and personal expertise of Black women, they are perpetuating harm. When Black women aren’t able to make decisions about building their families due to medically unnecessary restrictions on abortion care, the result is harm. Understanding the connection between these two is critical.
Abortion restrictions are part of a long legacy of attempts to exercise power and control over the bodies of Black women. Restrictions on access to abortion care, such as targeted regulations of abortion providers (TRAP laws), insurance coverage limitations, and gestational age bans, disproportionately impact Black women for many reasons. Black women are more likely to live in states where these restrictive laws have been passed and less likely to have access to insurance that provides coverage for abortion care.
Black women are also less likely to have quality, culturally responsive community-centered care during their pregnancy and the postpartum period and are three to four times more likely to die during pregnancy and the postpartum period than white women—meaning the decision to carry a pregnancy to term is a life-or-death decision for Black women. When abortion care is inaccessible, Black maternal health as a whole suffers because agency, autonomy, and self-determination are compromised.
While we continue to do the work as health-care providers to center and ground our care in trust and respect for individual agency and autonomy, we must also follow the lead of organizers across the country making meaningful impact on all aspects of maternal health, including abortion access. Black-led and Black-centered organizations like Black Mamas Matter Alliance advocate to shift culture in support of Black maternal health, rights, and justice. This includes advocating for policies that center Black pregnant people and supporting the work of the congressional Black Maternal Health Caucus, including the Momnibus bill, a comprehensive set of regulations and investments to address the crisis in maternal mortality and its disproportionate impact on Black women.
Our nation is in a moment of reckoning. We have an opportunity to actively lean into a liberatory framework that centers the health and rights of all people. In order to do that we must trust and follow the expertise of those who have been most impacted by these inequities in access and outcomes. The same is true for maternal health and abortion care. Our dreams for a future where Black pregnant and birthing people are thriving must include a world where all people, including Black people, can access the full range of pregnancy-related care—including abortion when and where they need it.
*More than cisgender women access reproductive health care, including trans people and gender nonbinary people. This piece uses “women,” while acknowledging the fact that people of all genders need and deserve access to comprehensive reproductive health care including prenatal, pregnancy, and abortion care.