Each year in the United States, more black women get sick or die during and after pregnancy than the year before. That’s because America is the only developed country in the world where maternal mortality has actually increased in recent decades. The U.S. maternal mortality rate—defined as the death of a woman while pregnant or within a year of the end of her pregnancy—was 26.4 per 100,000 births in 2015, compared to less than 10 for Germany, the United Kingdom, France, Japan and Canada. Almost two American women die each day from pregnancy-related complications, according to the Center for Disease Control, and more than 50,000 every year suffer life-threatening complications like heavy bleeding or heart attacks.
The picture is even grimmer for African-American women, who are three to four times more likely to die during or after pregnancy than white women. Although rates of maternal death are lower in Nevada than the national average, black women in the Silver State still encounter serious delivery complications twice as often as white women.
There are many reasons for such different outcomes. For one thing, African Americans face both more limited access to health services and lower-quality care when they do have coverage. Women who are on Medicaid, for instance, have gaps in coverage both before pregnancy and after delivery. In Nevada, only 66.9 percent of black women get prenatal care starting in the first trimester—significantly lower than the 78.6 percent of white women who do. Access to birth control is also crucial—women who have planned pregnancies are better able to manage their medical and financial wellbeing to support their own and their babies’ health.
But it’s not just access to healthcare—if it were, health outcomes of black mothers would track with the outcomes of their peers. That’s not the case. Instead, college-educated black mothers are dying at rates higher than white women who didn’t finish high school. Beyond differences in care, African-American women can also encounter overt bias and unconscious ignorance from some health providers. Studies have shown that black patients get treated differently when they see doctors for cardiovascular problems, cancer and pain management, among other conditions. In a 2017 survey, one-third of African Americans said they’d been discriminated against by a health provider. On the other side, African-American patients have an understandable mistrust of the healthcare system. But bias goes beyond the medical system. Recent research suggests that the stress of living in a society with pervasive racism has a “weathering” effect, aging victims of discrimination on a cellular level. Black women also face higher rates of depression, which worsens pregnancy outcomes for both mothers and infants.
Despite America’s terrible track record on maternal health, the CDC estimates that we could prevent up to 60 percent of pregnancy-related deaths. That’s why we need to double down on efforts to track maternal mortality specifically so that we can learn how to improve maternal health in general. Experts agree that one of the best ways to decrease maternal mortality rates is to fund state maternal mortality review committees or MMRCs. These state boards—made up of doctors, nurses, public health officials, advocates, and others—take a hard look at each and every mom’s death. MMRCs are there to understand why that death happened and what could have been done to prevent it, and then to put those insights into action to save lives in the future.
We know that MMRCs work. When they were introduced in California in 2006, the state’s maternal mortality rates dropped by 55 percent. This May, Nevada Gov. Sisolak signed into law AB 169, a bill sponsored by Assemblywoman Daniele Monroe-Moreno, to create an MMRC in Nevada. To support these efforts nationwide, in 2018 I helped pass the Preventing Maternal Deaths Act to fund and set guidelines for state MMRCs. The Act provides $12 million over 5 years to help establish these crucial panels.
We also need to continue pushing for comprehensive and affordable healthcare for everyone, which is why I’m fighting to protect and expand the Affordable Care Act. The ACA guarantees maternity care, and it also prevents insurers from charging women more just because they’re women. It offers women other key benefits, including free birth control, cervical cancer screenings and yearly wellness exams. And it prevents insurance companies from denying or limiting coverage for pre-existing conditions. I’ve repeatedly pushed back against efforts by President Trump and the Republican Party to weaken the ACA.
I’ve also cosponsored the No Junk Plans Act to get rid of shoddy healthcare plans that don’t offer the robust protections for women that the ACA requires. And I’ve cosponsored the Healthy MOM Act to expand healthcare coverage for pregnant and postpartum women. This bill allows women to upgrade their insurance plans when they learn they are pregnant and improves postpartum care for women on Medicaid. I’m also using my seat on the Finance Committee to rein in out-of-control prescription drug prices on behalf of Nevadans so that pregnant and postpartum women don’t face high costs for medicines on top of the challenges of parenthood.
These changes are vital to protecting African American families. I won’t stop fighting for them—not when we can save hundreds of lives each year by working to keep black women healthy and well-cared-for at a pivotal time in their lives.
Catherine Cortez Masto is a United States senator from Nevada, the first Latina and the first woman from Nevada ever elected to the U.S. Senate.