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| Kiersten Hash |
In May, Black congressional members reintroduced the Black Maternal Health Momnibus Act to address concerning racial maternal health disparities. Representative Alma Adams, who’s daughter went through a near-fatal pregnancy crisis, explained:
“Racial disparities in maternal health have not improved in three decades. Regardless of educational attainment and income, Black women and their children are at risk.”
Her concern is more than valid. In 2021, the maternal mortality rate for Black women was 2.6 times that of white women, and 2.4 times for infant mortality. But as we near the end of 2023, the Momnibus has languished in Congress and its success seems elusive. The crisis and lack of government response beg the question: How did this crisis come to be, and what does it tell us about America’s treatment of Black mothers?
To answer this question, we must understand Black mothers’ historical interactions with American healthcare and welfare, characterized by exclusion, coercion, and stigma.
In Sojourner Truth’s “Ain’t I A Woman?” speech, she paints a picture of early Black motherhood:
“I have borne thirteen children, and seen most all sold off to slavery, and when I cried out with my mother’s grief, none but Jesus heard me! And ain’t I a woman?”
Truth’s grief gives us a glimpse into the experience of enslaved Black mothers who often endured animal-like breeding practices, sexual abuse, and poor living conditions which led to high infant mortality rates. Based on plantation records, the infant mortality rate was about 50% more for Black infants than rural whites.
The Black maternal mortality rate may have actually been “surprisingly low”, which could be from slave owners wanting to “preserve their property.” But after emancipation Black women experienced disproportionate maternal mortality rates, worsened by exclusionary social policies, forced sterilization, and stigma that painted Black mothers as undeserving.
Exclusion
Disparities were worsened by discriminatory policies like mothers’ pensions, which were passed in 46 states between 1910 and 1930. Less than 3% of pensions were given to Black families.
Eligibility often required losing a male provider, being unemployed, and having good “moral standing.” For many Black mothers who worked and were subject to discriminatory criteria, they were ineligible. This exclusion continued with the Sheppard-Towner Act, which covered maternity costs, and even the 1935 Aid to Dependent Children program.
This exclusion contributed to increasing disparities. By the mid-20th century, the Black maternal mortality rate was 3.63 times more than white mothers. Community leaders recognized the
inequalities behind this disparity. A 1947 article from the Black-owned Atlanta Daily World noted, “It is not possible to have two systems of maternal welfare,” commenting on the inaccessibility of new maternal care technology and services.
Coercion
The 1960s saw the passage of Medicare and Medicaid, which was crucial in making healthcare more accessible to Black mothers. But this came with a horrible cost. Forced sterilization, already an issue, became more targeted towards Black women to control their sexual choices.
Doctors often coerced Black girls and women to get sterilized to receive treatment, or performed the procedure without their consent, especially if the patients were Medicaid recipients.
In 1973, two Black girls, Minnie Lee and Mary Alice, were forcibly sterilized and their lawsuit helped uncover over 100,000 instances of mostly Black and Brown women, forcibly sterilized annually under U.S. government programs. This horrifying trend only deepened Black distrust in American medical systems and contraceptives, and failed to address the root of a still increasing disparity.
Stigma
In addition to exclusion and coercion, cultural stigma against Black mothers and dangerous stereotypes have justified unequal social support and medical discrimination. In the 1980s, the caricature of the “welfare queen” emerged along with the revival of conservative, free-market policies.
Since the 80s, politicians like President Reagan have cut social programs for mothers under the guise that low-income, Black women were “cheating the system,” which has continued and worsened the state of the Black maternal health crisis to this day.
Simultaneously, Black women have been depicted as biologically different and more resistant to pain, which manifests in disparate treatment. University of Virginia researchers in 2016 found medical professionals held and may use beliefs about biological differences to inform medical judgments. These phenomena are linked to the stereotypes and demonstrate the importance of cultural narratives in shaping health outcomes.
Ultimately, we must reckon with this depressing history of exclusion, coercion, and stigma to remedy this crisis and heal the generational wounds caused by it. Given this history, we must support initiatives like the Momnibus that are working to remedy this crisis.
Because in the words of U.S. Rep. Alma Adams, “As a Black mother and grandmother, take it from me: Black mamas can’t wait!”
Kiersten Hash of Charlotte is a junior at Harvard College and 2021 Charlotte Post Top Senior.
