Doctors of the World has been involved in the issue of maternal mortality on the international stage for years as part of our sexual and reproductive health and rights pillar of action. While maternal mortality rates around the world have continued to trend downward, the numbers in the United States have been climbing. Moreover, in the United States, huge disparities exist within populations, with Black and Indigenous women at much higher risk of maternal mortality and morbidity than white women. We believe this points to a larger problem of structural racism within our country, both in the healthcare system, as well as in access to care, education, housing and economic opportunities.
While maternal mortality is a complicated issue with no easy fix, it is reported that up to two thirds of maternal deaths are preventable. A huge part of our mission is to bear witness, spotlight injustices, and advocate for healthcare infrastructure solutions. This initiative is our attempt to engage in advocacy that speaks directly to this problem.
Lots of work has been done in maternal mortality and there are many resources already available for us to draw upon. Many Black, female-led organizations are already providing effective and thorough leadership on this issue.
To name a few, Black Mamas Matter Alliance, National Birth Equity Collaborative, SisterSong Women of Color Reproductive Justice Collective, Black Maternal Health Caucus, and many others can be found on our Resources page. We look to these organizations and the work they have already done and continue to do for direction when forming our framework, and for guidance on what would best serve the communities most affected by this crisis.
According to the Center for Reproductive Rights’ Guiding Principles for Maternal Health Policy Change: “Movements for change are most impactful when affected communities lead. Efforts to change policy must center the experiences and leadership of people directly impacted by poor maternal health outcomes and related violations of their human rights. At the same time, the work of eliminating poor outcomes, disparities, and human rights abuses in the field of maternal health belongs to everyone. Decision makers must engage community leaders in authentic collaborations, and policy advocacy must respond to the needs identified and prioritized by the most severely affected individuals and communities.” (emphasis added)
Doctors of the World seeks to use our platform to bear witness, spotlight injustices, and advocate for healthcare infrastructure solutions. Our goal is to highlight the extensive work that has already been done by so many organizations to further bring light to this public health issue and engage healthcare professionals.
These five states have the highest levels of maternal mortality in the U.S. and we would like to bring light to this very important issue during this crucial election cycle. We seek to educate voters about maternal mortality outcomes in these five states specifically and hope that they will use our tool to contact their candidates to let them know how important maternal mortality is to them.
Our long-term goal is to expand this voter education initiative to all fifty states, but for this pilot, we are focusing our efforts on the states most affected by this crisis.
As a not-for-profit 501c3 organization, we cannot promote a specific candidate or party. However, while we believe that maternal mortality is rooted in a number of policy issues, we do not believe it needs to be a partisan issue. We would like all candidates and all elected officials to be working towards the best proactive measures to reduce maternal mortality and improve overall maternal health in our country. In that spirit, we wanted to collect information from each candidate in the target states and present it without bias.
In order to accurately reflect the position of each candidate, we sent out a questionnaire to every candidate in the three key races in our target states. We published the questionnaire responses as we received them. You can see the questionnaire we sent here.
The United States has the highest level of maternal mortality among other developed countries, and for some racial and ethnic groups in the United States, the numbers are on par with the developing world, such as Malaysia, Cabo Verde, and Turkmenistan.
Black women in the U.S. are 3 to 4 times more likely to die before, during, or after childbirth due to pregnancy complications. This disparity applies to Black women across all educational levels and persists even after controlling for differences in socio-economic status. Understanding and addressing the root causes of these disparities is the key to reducing maternal mortality throughout the United States, and saving many lives.
Research tells us that racial and gender inequities are constant barriers to Black women in receiving adequate healthcare throughout their lives, and this is part of the cause of some of the maternal mortality disparities. Black women are also more likely to suffer complications depending on where they live, with the Southern United States being a particularly difficult region with limited health coverage in many states, and a lack of provider coverage in rural and inner city areas. Racial discrimination is believed to play a significant role in the levels of maternal mortality among black mothers. Studies have shown that providers treat Black patients differently than white patients with the same symptoms. Stereotypes, implicit bias, and a lack of trust are thought to cause providers to consider fewer diagnostic and therapeutic interventions, and even less pain medication. Poverty is an issue that directly affects maternal mortality, and Black women are more likely than white women to live in poverty due to a plethora of systemic racial inequalities within our educational, housing, economic and healthcare systems.
There is much more research you can explore on why the U.S. has higher levels of maternal mortality, particularly among Black women, and we encourage you to visit our Resources page to find out more.
According to the CDC, a death was considered pregnancy-related if it occurred during or within one year of pregnancy and was caused by a pregnancy complication, a chain of events initiated by pregnancy, or aggravation of an unrelated condition by the physiologic effects of pregnancy.
Maternal morbidity and infant mortality are also important issues and often the result of racial disparity, but for the purposes of H.E.A.T. on Maternal Mortality, we are focused only on deaths during and after pregnancy and birth.
Some measurements place the United States overall at 16.9 deaths per 100,000 live births (CDC, 2016), while others place it as high as 19 deaths per 100,000 live births (WHO, 2017). For the purposes of this campaign, considering all the most recent and reliable research available, we are placing the ratio at 17 deaths per 100,000 live births. As we state many times throughout this website, these numbers differ greatly depending on the region of the country, and an individual’s racial identity. For example, in Louisiana, Black women comprise about 39% of the women giving birth, but 68% of pregnancy related deaths.
You can find out more about the racial disparities and the breakdown of maternal mortality in individual states on our Resources page.
This education and advocacy pilot initiative is focused on educating candidates about this issue and asking them to commit to advancing policies that reduce maternal mortality. However, many leading organizations have been focused on this issue for many years, including those listed above, and they have created policy recommendations that, if adopted, would help immediately decrease maternal mortality.
While many changes have to be addressed on the state level, there are certain policy positions on the federal level that would also help decrease maternal mortality nationwide. Candidates for federal office can go on the record, pledging to:
These are just a few of the policy recommendations that candidates can support in order to help reduce rates of maternal mortality.
As a health and human rights organization, healthcare professionals are an essential part of our community and audience. While there are many organizations doing the work on the ground in the regions we are focused on, we wanted to leverage our relationships and connections with healthcare professionals in our target states.
Many healthcare providers are already acutely aware of the dangers facing pregnant people in our country, especially Black mothers. However, there is more work that needs to be done. Our goal is to educate and activate healthcare professionals as both members of the healthcare community and as voters. While many of the structural problems must be addressed by policies, there are also actions that healthcare providers can take in order to help decrease maternal mortality. Learn more at What Can I do as a Healthcare Professional page to find out what actions you can take to help decrease maternal mortality in your community.
Voter education: To increase awareness of this issue among our audience of healthcare professionals, and activate them by giving them tools to engage with their candidates around this issue
Candidate education: Educate candidates about maternal mortality in their state and ask them to commit to addressing this issue during their campaign
Recently there has been a long overdue reckoning among actors in the humanitarian and international aid community to address the systemic racism intrinsic to the founding and principles at the heart of the work we do. As part of this community, Doctors of the World is committed to fostering a dialogue among the international network that addresses these issues, and we are determined to make change within our own organization. In our United States chapter, we are taking the following immediate steps to become more anti-racist as an organization:
Our journey to being an anti-racist organization is an ongoing process, and it is one we are committed to for the long-term.
WHO Maternal Mortality Levels and Trends link
Center for Reproductive Rights’ Guiding Principles for Maternal Health Policy Change link
Brian D. Smedley et al., Inst. of Medicine of the Nat’l Academies, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care 162-174 (2003) link
Joshua H. Tamayo-Sarver et al., Racial and Ethnic Disparities in Emergency Department Analgesic Prescription, 93 Am. J. Public Health 2067, 2071 (2003) (showing that physicians have demonstrated a lower likelihood of prescribing opioids to Black patients for migraines and back pain)
Janice A. Sabin and Anthony G. Greenwald, The Influence of Implicit Bias on Treatment Recommendations for 4 Common Pediatric Conditions: Pain, Urinary Tract Infection, Attention Deficit Hyperactivity Disorder, and Asthma, 102 Am. J. Public Health 988, 991 (2012) (showing that pediatricians’ implicit attitudes and stereotypes about race affect their decisions about children’s pain management, with their likelihood of prescribing narcotic pain medication to Black patients decreasing as their pro-White bias increased)
Kevin A. Schulman et al., The Effect of Race and Sex on Physicians’ Recommendations for Cardiac Catheterization, 340 N. Engl. J. Med. 618, 621-625 (1999) (showing that race and sex independently influence physicians’ decisions about how to manage patients complaining of chest pain, with Black women being significantly less likely to be referred for cardiac catheterization than White men).
Black mothers in the U.S. are dying at similar rates as mothers in underdeveloped countries. This is unacceptable and it is time for a change.