HealthRaceSex & Gender

op-ed: black people who become pregnant deserve better

June 17, 2019
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In countries around the world, the number of people who die during childbirth continues to decline. But, here, in the United States, pregnancy-related deaths have doubled over the last three decades. In fact, between 1990 and 2013, pregnancy-related deaths for the U.S. increased from an estimated 12 to 28 deaths per 100,000 births. Each year in this country, 700 to 900 new and expectant parents die from pregnancy and life-threatening complications, impacting the lives of an estimated additional 50,000 people. More than half of these deaths are preventable. And while these numbers are shameful, the figures concerning Black pregnant people are tantamount to a national health crisis. However, before we go any further, let’s all get clear on one fact: not all pregnant people identify as women.

As is the case in nearly every other sector of reproductive health, from abortions to access to birth control, the coverage and conversations surrounding pregnancy and postpartum health in our communities and beyond, are often occurring through a cis-gender lens. Cis-gender people are people who identify with the gender they were assigned at birth, while transgender people are people whose gender identity is different from the gender they were thought to be at birth. Rarely is the distinction between cisgender women and transgender men or people with nonbinary identities made when discussing pregnancy and postpartum health. This is in large part due to the lack of available research that focuses on the pregnancy and parenting experiences of these populations. Transgender and nonbinary people face unique barriers to accessing quality health care and deserve more expansive research in the future. For now, however, and at the very least, trans and nonbinary people must be considered when discussing pregnancy-related deaths and complications.

While low wages and a lack of affordable health care are factors that disproportionately affect Black people and may contribute to reproductive health disparities, for Black women and Black people capable of getting pregnant — who, by the way, are three to four times more likely to die during or after childbirth than our white counterparts — it is racism, not race, that plays a critical factor. Contrary to common conceptions that income and education lead to better health outcomes, dying as a result of pregnancy complications is not something Black people can earn or educate our way out of. Serena Williams’ postpartum experience teaches us this. After requesting treatment for what she suspected was a blood clot, Serena was dismissed by her nurses, who believed pain medication was causing the tennis star to be confused. It was only because of her continued insistence that her suspicions were ultimately confirmed, and Serena was eventually diagnosed and treated for a life-threatening pulmonary embolism. Like Serena, Shalon Irving, a 36-year-old Black woman and epidemiologist at the U.S. Centers for Disease Control and Prevention (CDC), had her complaints ignored by those she trusted to care for her. In the 3 weeks after giving birth to her daughter, Shalon, who was considered a high-risk patient, made multiple complaints of pain, elevated blood pressure, blurred vision, headaches and swelling during her postpartum doctor visits. At each of her appointments, Shalon was assured that her symptoms were normal. Not long after her last medical appointment, Shalon took a newly prescribed blood pressure medication, collapsed, and died. For Black transgender and nonbinary people, these reproductive health disparities are further compounded by the bias and discrimination they face due to their gender. Last month, the New England Journal of Medicine detailed the story of a 32-year-old trans man, who after going to the ER with severe abdominal pain, was dismissed by a nurse, concluding only that the man was obese and had stopped taking his blood pressure medication. However, the man was actually pregnant and in labor, and would up delivering a stillborn baby.

Hospitals and healthcare providers regularly undervalue, ignore, and fail Black women and pregnant people. Racial and gender bias, a lack of cultural competence, and medical research that fails to consider race and gender are all contributing factors to the disparities in pregnancy and postpartum health care and treatment that Black people receive. Additionally, the effect of systemic racism in the daily lives of Black people takes a tremendous toll on our physical health. Witnessing racialized police brutality, struggling to make ends meet on a minimum wage income, or working non-stop to be 10 times better than your white counterparts because your Blackness invites lowered expectations and unfair critique, are all chronic stressors that when compounded over time significantly affect our health.

So, what can be done to combat this crisis? First, we need to prioritize understanding the complexity of who Black people are. In the struggle for birth justice, if we ignore that not everyone who gets pregnant is a cis woman, we risk saving the lives of only some Black people, when we should be fighting to save us all. Next, #TrustBlackPeople. While solutions to eliminate racial and gender bias and racism within healthcare likely require involved and complex strategy, we can start by holding those providing care accountable. Medical providers have an obligation to listen and assess the concerns of their patients and must be held accountable in instances where their failure to do so results in misdiagnosis, injury, and/or death. Additionally, we must work to ensure that all Black people have access to a full spectrum of birth and postpartum support, including services and care provided by midwives and doulas. Studies show that access to midwifery care and doulas result in improvements in pregnancy outcomes.

Organizations like Jamaa Birth Village in St. Louis and Roots of Labor Birth Collective in the Bay Area train dozens of Black doulas each year. Currently, 3 states, Minnesota, New York and Oregon, permit Medicaid coverage of doula care, and maternal health advocates continue to work towards expanding the program into more states. Lastly, as 2020 approaches we need candidates who cannot only articulate a plan to save Black parents and babies but are committed to examining and remedying the underlying factors that have and continue to keep us from being able to survive childbirth. We must demand more from those that we entrust to represent us…our lives matter too much not to.

Black Futures Lab works with Black people to transform our communities, building Black political power and changing the way that power operates – locally, statewide, and nationally. To learn more about our work, including the historic Black Census Project – the largest survey of Black people conducted in the United States since Reconstruction – visit us at