For more anti-racism resources, check out our guide, Racial Justice Is Reproductive Justice.

Erica Garner died on December 30 at the age of 27, after being placed in a medically induced coma following a heart attack precipitated by an asthma episode, according to news reports. Her death inspired profound rage, as she took on the burden of fighting for racial justice and police reform following the death of her father, Eric Garner. For many people, her death was a cruel reminder that systemic racism in the United States is an inescapable toxin that slowly degrades Black women’s health. The many deaths of Black women, Black mothers, from similar causes, continues to raise the question: What can we fight for in order to protect Black women’s health?

Years of academic literature implicates racism-induced chronic stress as the primary factor in accelerated biological aging of Black Americans and racial disparities in maternal death, poor sleep quality, and heart disease.

The Sojourner Syndrome, introduced by anthropologist Leith Mullings, is a useful way of looking at the ways racism, sexism, and classism intersect to deteriorate the health of Black women and their maternal health outcomes. In her book, Stress and Resilience: The Social Context of Reproduction in Central Harlem, she writes:

Like John Henry, Sojourner Truth is a larger-than-life legend and assumes extraordinary roles and responsibilities. Her account embodies the issues we have raised in this volume: the assumption of economic, household, and community responsibilities, which express themselves in family headship, working outside the home (like a man), and the constant need to address community empowerment—often carried out in conditions made difficult by discrimination and scarce resources.

The idea of the Sojourner Syndrome represents a common narrative: Black women caretakers are providing support to family, friends, and significant others, in the home, workplace, church, and more—often at a cost to their well-being and health.

Cultural stressors contribute to Black women’s “deep inequalities,” as professor and political commentator Melissa Harris-Perry pointed to in a recent Elle article. “We are angry because Erica was unique, special, and wholly original, and because the burdens and vulnerabilities which likely contributed to her shockingly brief life expose deep and deadly inequalities facing black women as a group,” Harris-Perry wrote. These inequalities extend beyond state violence at the hands of police and include the numerous “isms” highlighted by the Sojourner Syndrome that Black women encounter daily—persistent and pervasive poverty, polluted neighborhoods, and the misogynoir that justifies interpersonal and systemic discrimination, abuse, and exploitation.

To fully relieve Black women of these burdens would require the dismantling of the racist, sexist, and capitalistic structures that plague the United States—a formidable challenge, to say the least. These structures are so pervasive that they are implicated in the health of other women of color. One study found that infants born to Latina mothers in Iowa had a 24 percent higher risk of low birthweight (LBW) in the period following a major immigration raid in Iowa, while an earlier study found an increase in LBW among Arabic-named women, or those perceived to be Arab, following the September 11, 2001, terrorist attacks. Both studies suggest that even acute exposure to racialized discrimination and stressors have a pervasive effect on the health of a community. Imagine the effects of chronic exposure to multiple facets of discrimination, including the burden of the criminal justice system, that unfairly burdens Black people.

Yet, we can chip away at those structures through fighting for solutions that can alleviate some of the burdens that undermine the health of Black women and members of other marginalized communities. Initiatives that strengthen the nation’s social safety net while acknowledging and uplifting the collective strength and resilience of Black women and their communities is one way to start.

Despite its wealth and power, the United States has a weak and fragmented social safety net, including a health-care system that continues to fail those most at risk. Whereas most developed countries provide some sort of health care for their citizens, access to health care is largely determined by employment status in the United States. High-quality social safety net programs that protect poor and vulnerable people from economic shocks and crises are few and far between. Yet, as Black women contend with social, economic, and psychological factors that increase chronic stress and strain outside of the health-care system, health insurance reform, exemplified by the Affordable Care Act, is not enough. Black women need a holistic system that recognizes existing social, environmental, and economic inequities, one that is easily navigable and integrated with high-quality social safety net programs, services, and resources to help shield them from the many situations that contribute to chronic stress.

Where national policy falls short, organizations like the Black Mamas Matter Alliance are advocating on behalf of Black women for real change. The alliance is a committee led by Black women with a mission to “advocate, drive research, build power, and shift culture for Black maternal health, rights, and justice.” Kwajelyn Jackson, who serves on the steering committee of the Black Mamas Matter Alliance, told Rewire.News that “beyond eradicating systemic racism and oppression, I believe accessible, affordable, comprehensive health-care coverage would have the most significant, immediate impact on the most people. I want Black women to have access to consistent, quality, preventative, and holistic health care, in our own communities, that is delivered by providers that understand and acknowledge how our lived experiences affect our health,” said Jackson, who is also community education and advocacy director of the Feminist Women’s Health Center in Atlanta, Georgia.

Poor social, economic, and environmental conditions often lead to poor health. Black women need services that would mitigate the effects of these conditions in order to alleviate chronic stress: mental health services, nutrition counseling, food vouchers, housing and shelters, unemployment benefits, and other resources. But far too often, they are unable to access these services due to state or federal budget shortfalls or insurance coverage idiosyncrasies. Political efforts like welfare reform and budget cuts caused by economic instability, like the Great Recession, have led to a fragmented and unstable social services safety net.

Strengthening the systems that support better general health can also mitigate the stressors of pregnancy and childbirth, which are often vulnerable times for families, especially for those with little support and resources. Pregnant women, new mothers, and their families need additional support, and home visiting programs that seek to improve care management for at-risk women can help. Last year Congress let expire two programs that provided beneficial services for low-income and otherwise vulnerable families, including the Children’s Health Insurance Program (CHIP), which provides health insurance for 9 million children and has since been renewed for six years. The other program, the lesser-known Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV), matched in-need families with trained professionals and provided regular, planned home visits to help improve childhood health and development. In 2016, the MIECHV program served 160,000 families in all 50 states and five U.S. territories—a third were Black and another third Latino. Without crucial federal funds, states face having to freeze enrollment of new families and even having to disband programs and services.

The Mamatoto Village is a D.C.-based nonprofit organization that provides expectant and new mothers with support services during the perinatal period (around the time of birth). Centered on reproductive justice, the team provides a slew of comprehensive services that expand beyond doctor’s visits: health and wellness coaching, classes on perinatal fitness and parenting, and mental health services. Furthermore, expectant and new mothers receive referrals to community-based organizations that provide health insurance; Special Supplemental Nutrition Program for Women, Infants, and Children, also known as WIC; and other services.

As Mullings explained in her research, Black women often juggle multiple caretaking roles, paid and unpaid, providing instrumental and emotional support for members of their family, community, church, workplace, and other domains. More than 80 percent of Black mothers are considered breadwinners in their households, meaning Black mothers are usually working mothers.

“Black women are not only the caregivers in their homes,” Jackson said. “They are the caregivers in their workplaces, in their communities, in their churches—always caring for someone other than themselves literally since America’s inception. We are the most consistent voting base. Black women were just credited with saving Alabama. It’s like Black women are the cogs that keep the American machine functioning. Yet we are not well-maintained, well-oiled. We are regularly neglected.”

Caregivers experience chronic physical and psychological strain and have elevated rates of anxiety, depression, and physical disorders. In the United States, high-quality child care is incredibly expensive and low-cost; high-quality child care would relieve Black mothers of the stress of paying for expensive child care. Comprehensive unemployment benefits, a livable wage, institutionalized time off for caretaking responsibilities and childbirth, and the provision of afterschool programs and free or very low-cost high-quality child care are also policies to fight for when thinking about ways to relieve Black women’s stress.

A comprehensive safety net is not the end-all-be-all to easing the burden of racism-induced stress on Black women. Black women need neighborhoods with clean air, water, and soil, adequate public transportation, safe and community-oriented alternatives to police. Battling decades of formal and informal neglect and disenfranchisement in our communities through activism is a chronic strain that never lets up. Dismantling the racist and sexist images and stereotypes that perpetuate discrimination and abuse is necessary in order for the aforementioned solutions to work. The People’s Institute for Survival and Beyond, a New Orleans-based organization, initiates and supports anti-racist efforts in communities, institutions, and organizations through several programs, including their Undoing Racism workshops.

Reflecting the reproductive justice framework, interrogating and dismantling unjust structures that stem from racism, sexism, and capitalism also benefits our sisters from other marginalized communities, including Native women, queer women, and women with disabilities, to various extents. Solutions must build on these efforts and strategies that women have developed throughout the years, efforts based on collective action and organizing.

Lastly, Erica Garner’s death urges those who count on Black women’s work to interrogate the way we use Black women’s labor and contribution to the greater good. “Erica Garner’s death was heartbreaking,” Jackson said. “But one of the disappointing sentiments I heard after she passed was how it was a loss for the movement. While I understand the thought behind this, what it ultimately feels like is that her value was in her usefulness, her labor, how her life benefited us. This is often the case when people think of the lives of Black women, and value us for what we contribute rather than who we are.”

In the same breath we use to thank Black women for doing progressive work this country sorely needs, we should also speak of how to support them in return—through resources and power that would improve not only their health but also the health of their communities and other marginalized women as well.