Excerpted From: Logan K. Jackson, Willful Disregard: How Ignoring Structural Racism in Maternal Mortality Has Led Black Women to Become Invisible in Their Own Crisis, 38 Berkeley Journal of Gender, Law & Justice 131 (2023) (190 Footnotes) (Full Document)


LoganKJacksonThe tragedy of maternal mortality in the United States is not a novel issue. Efforts to collect data on pregnancy-related deaths started in the early twentieth century. What was true then still holds today--maternal mortality rates in the United States are significantly worse than in similar countries in the developed world. Today, approximately 700 women in the United States die annually from pregnancy-related causes. Moreover, there are racial disparities in maternal mortality. The maternal mortality rate for Black women in the United States is significantly higher than rates for white and Hispanic women. Strikingly, Black women are nearly three times more likely to suffer a pregnancy-related death compared to white women. It is no secret that the issue of maternal mortality in the United States is a profoundly racial one. So, why have some of the solutions to an issue of racial inequity ignored the impact of race?

As Professor Khiara M. Bridges has emphasized, the United States' maternal health crisis will never be fully resolved if the discourse surrounding the issue is not one of race. Although the United States government knows that Black women have disproportionately suffered poor maternal health outcomes for over a century, these disparities persist because of the willful disregard of structural racism in health care and its impact on Black women's reproductive health outcomes. This willful disregard has been on display throughout history: from the time of slavery, where enslavers exploited and diminished Black women's reproductive autonomy, up to the present day, when the United States government has the power to protect Black pregnant people's reproductive health but willfully fails to do so.

This article begins with a brief introduction to the issue of racial disparities in maternal mortality in the United States. The remainder of the analysis proceeds in five parts. Part I discusses the historical legacy of slavery on Black women's reproductive health and autonomy. Part II then transitions into a critique of the mainstream Reproductive Rights framework in the United States, discussing how Black women and feminists of color birthed a framework that brought their reproductive health needs and freedoms to the forefront. Part III reviews maternal mortality rates in the United States, specifically for Black women, and surveys multiple factors contributing to racial disparities in maternal health outcomes in the United States. Of these factors, access to affordable, reliable, and quality health care is a significant determinant of Black maternal health outcomes. Thus, we would expect that our legal institutions' responses and solutions to maternal mortality would include closing the gaps in access to such health care. However, this expectation is largely unmet. Part IV assesses how federal and state institutions' (in)action has impacted the United States' maternal health crisis, or, rather, its Black maternal health crisis. Part V concludes the article with recommended solutions to the Black maternal health crisis-- solutions that are not only attainable on an individual and institutional level, but also crucial to the survival of Black pregnant people in the United States.

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Although it may seem as if the Biden-Harris Administration has made significant progress towards rectifying the United States' maternal health crisis, there is still much progress to be made. Given the composition of the Supreme Court, it is more than likely that further challenges to the ACA will arise. The Court may decide to diminish or completely remove necessary healthcare coverage for many at-risk individuals, including Black birthing people. However, there are many other avenues to protect Black people with the capacity for pregnancy, their reproductive justice, and bodily autonomy. These efforts include educating those who directly provide reproductive care to Black people, ensuring that Black people are well-represented in the health care profession, and listening to Black pregnant people and their needs. However, every solution must begin with addressing the reality of structural racism and its impact on Black women's maternal health outcomes. Only then will the United States begin to see transformative results in protecting its most endangered pregnant people.

J.D., Stetson University College of Law (2023).