This story is part of SELF's ongoing series exploring black maternal mortality. You can find the rest of the series here.
Pregnancy and childbirth are becoming increasingly dangerous and deadly in the United States, the only industrialized country in the world with a rising maternal mortality rate, according to the American College of Obstetricians and Gynecologists. And according to the Centers for Disease Control and Prevention (CDC), black mothers face over three times the risk of dying from pregnancy or childbirth-related causes as white women. This is an urgent public health crisis that demands a response. So we asked all the major 2020 presidential candidates what they plan to do about it.
The numbers are sobering. Using international data from 2015, the most recent year available, the World Health Organization estimates that women in the United States have a maternal mortality rate of 14 deaths per 100,000 live births. In comparison, the rates in Finland, Iceland, and Greece are around three deaths per 100,000 live births. Italy, Kuwait, and Austria have around four deaths per 100,000 live births, and Japan, Norway, and Switzerland come in at around five deaths per 100,000 live births. The maternal mortality rate in the United States soars past these numbers, placing us in the company of Saudi Arabia (12 deaths per 100,000 live births), Qatar (13 deaths per 100,000 live births), Bahrain (15 deaths per 100,000 live births), and Uruguay (15 deaths per 100,000 live births). Clearly the number of people dying due to pregnancy or childbirth in the United States is already staggeringly high. But for certain racial groups, the crisis is even more urgent.
Black women are three to four times more likely to die from a pregnancy-related cause than white or Hispanic women, according to the most recent CDC data available. The maternal mortality rate for black non-Hispanic women is 42.8 deaths per 100,000 live births. That's compared to 13 deaths per 100,000 live births for white non-Hispanic women; 11.4 deaths per 100,000 live births for Hispanic women; and 14.2 deaths per 100,000 live births for Asian and Pacific Islander women. At 32.5 deaths per 100,000 live births, American Indian women have the second highest chances of dying because of pregnancy or childbirth after black women.
Even more devastating: A January 2017 CDC report determined that almost 60 percent of the maternal deaths in these reports could have been prevented, according to recent Maternal Mortality Review Committee (MMRC) data from Colorado, Delaware, Georgia, and Ohio, which makes sense given the most common causes of maternal deaths are heart conditions, infection, hemorrhage, hypertension, and embolisms, per the CDC. Many of these issues are things we know how to detect, monitor, and treat. It is inexcusable that so many people are dying from them.
So why is this happening—and why are black women at such higher risk? It's complicated and there’s no single answer: Contributing factors range from systemic barriers to health-care access to a lack of standardization in maternity care in general to growing rates of preeclampsia (and particularly severe preeclampsia) among many others. And public health researchers and activists say systemic racism and structural inequality also play indisputable roles in why black people who are pregnant and/or give birth are so much more likely to experience these issues and die from them than white people.
“Our nation is just not doing a good job when it comes to women’s health overall,” says Angela Aina, codirector of the Black Mamas Matter Alliance, a black women–led organization with the goals of driving policy changes, directing research, and shifting the cultural understanding of black maternal mortality.
“Factors such as poverty, lack of access to health care, social inequality, and exposure to racism all undermine health and may contribute to the elevated number of Black maternal deaths,” the Alliance explains. A tool kit produced by the alliance illustrates the effects of these factors: Black people are more likely to live in poverty and live in areas where there is a shortage of health-care providers. Black people are less likely to have health insurance and more likely to have unintended pregnancies. Black people are also more likely to experience discrimination from a health-care provider. All of these things contribute to the type of care a pregnant person or new parent receives.
Because there’s no single cause of high black maternal mortality, approaches to resolving the problem must be multifaceted and nuanced. The alliance says that the social determinants of health are affected by policies, economics, and social hierarchies. Public-health researchers and policy experts are proposing solutions. Activists from the most affected communities are also weighing in about what they believe will make a meaningful difference. And some of our elected officials and those seeking office are giving this issue the attention it deserves. The structural and institutional changes necessary to decrease black maternal mortality won’t happen overnight, but a robust plan to address them is a meaningful start.
To that end, we reached out to all the major 2020 presidential candidates from both sides of the aisle to ask how each candidate plans to tackle black maternal mortality if elected. Here’s what they said—or didn’t say—presented in alphabetical order by last name.
Michael Bennet (D), Senator from Colorado
“Michael believes the high maternal mortality rate, especially for black women, is exacerbated by systemic inequities in our health care system,” a spokesperson for the Bennet campaign tells SELF in an email statement. According to the spokesperson, Bennet plans to expand health care access by introducing Medicare-X, his plan to create a public Medicare option “that starts in rural areas and covers essential health benefits, including maternity care.”
The spokesperson added: “Additionally, Michael believes we need to improve support services that have a direct effect on women's health, including access to housing, nutrition, and transportation. As president, he will bolster home visitation programs to support new moms. He will invest in telemedicine to deliver health care services to remote and rural areas and reduce the risks to expectant mothers and newborns. He will also prioritize increasing the number of ob/gyns, especially in rural areas.” Bennet’s campaign did not offer information on how he plans to address the racial gap in maternal mortality specifically.
Joseph Biden Jr. (D), 47th Vice President of the United States
"Health care is a right—not a privilege,” Biden said in an email statement provided to SELF. “Unfortunately, racism, sexism, homophobia, transphobia, and other forms of discrimination continue to permeate our health-care system, especially with the Trump administration turning their backs on our most vulnerable and underrepresented communities. Despite our role as a leading developed country, the United States has the highest maternal mortality rate amongst other developed nations. The maternal mortality rates are even higher among black women, who die from complications related to pregnancy at a rate that is three times higher than the rate for non-Hispanic white women. This is a disgrace.”
In his statement, Biden called for investing “significant resources” to gather data, fund services, and expand access to health services. “We have a responsibility to improve the overall health and health care of women before, during, and after pregnancy, and my health care plan will address this crisis head-on,” he said. “We must do better, which is why my health-care plan tackles this issue head-on by implementing California’s 2006 maternal health strategy across the entire country.”
In 2006, California introduced the California Maternal Quality Care Collaborative (CQMCC) to gather data about mortality rates, provide recommendations and tool kits to hospitals, and publish research about this issue. Though California did dramatically reduce the state’s maternal death rate overall, a racial gap persists—black women in California are still dying at a significantly higher rate than white moms, per the CMQCC.
Cory Booker (D), Senator from New Jersey
“The disparity in maternal mortality along lines of race and class is a travesty, and it’s due in large part [to] centuries of bad policies that harm mothers of color and low-income mothers,” Booker tells SELF in an email statement.
On September 25, 2018, Booker introduced the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES) Act along with cosponsors Kirsten Gillibrand (D-NY), Kamala Harris (D-CA), Tammy Baldwin (D-WI), Ben Cardin (D-MD), and Richard Blumenthal (D-CT). Medicaid currently covers women for 60 days after giving birth; this bill would extend that period to one year. The bill would also:
- Grant pregnant and postpartum women full Medicaid coverage, rather than access to pregnancy-related services only
- Increase access to doula services
- Research if telemedicine could effectively improve access to maternity care
- Help establish demonstration maternity care homes to see if these homes improve health outcomes
“This bill is a step toward ensuring that we close the disparities that continue to put women and children of color at risk,” Booker’s statement to SELF continues. “It’s the sort of bold, forward-thinking policy we have a responsibility to support—and I’m proud to have introduced it in the Senate.”
According to a press release from Booker’s team, supporters of the MOMMIES Act include advocacy organizations such as the Black Mamas Matter Alliance, the National Partnership for Women and Families, and Every Mother Counts, among others.
Booker also cosponsored several additional pieces of legislation addressing this issue, including the Modernizing Obstetric Medicine Standards (MOMS) Act, introduced by Senator Kirsten Gillibrand (D-NY) on August 28, 2018 (endorsed by the American College of Obstetricians and Gynecologists (ACOG), the National Birth Equity Collaborative, MomsRising, and the Association of Maternal and Child Health Programs (AMCHP), among others); and the Healthy Maternity and Obstetric Medicine Act, introduced by Senator Sherrod Brown (D-OH) on May 15, 2019 (supported by the Black Mamas Matter Alliance, March of Dimes, ACOG, and others).
In a July 19, 2019, op-ed in Essence, Booker wrote about the next administration’s responsibilities towards people of color.
"The next president of the United States has an obligation…to commit to repairing centuries of harm with a bold, forward-looking vision—for taking on the maternal mortality epidemic that is disproportionately killing women of color, for closing the persistent racial wealth gap, for ending the separation of families of color in America, in our broken immigration system and in our broken system of mass incarceration,” he wrote.
Steve Bullock (D), Governor of Montana
“The most important thing we can do is expand Medicaid,” Bullock tells SELF in an email statement. “States that have expanded Medicaid under the Affordable Care Act saw a 50 percent greater reduction in infant mortality than nonexpansion states.”
Bullock also said he would “increase federal funding to community health centers, health-care providers, and state and local health departments.” He said that he would “focus additional support in communities with the highest rates of maternal mortality.”
Pete Buttigieg (D), Mayor of South Bend, Indiana
“As president, Pete will address the maternal mortality crisis head-on by taking a comprehensive approach to improving the health and well-being of women before, during, and after pregnancy through improved access to reproductive health care, with special attention to eliminating the disparities in health outcomes for women of color,” national press secretary Chris Meagher tells SELF in an email. “He recognizes that our health care system is burdened by structural racism, resulting in black women having overall worse health and dying from maternal complications at three to four times the rate of white women. He strongly believes that [a] woman's race should have absolutely no bearing on her health or life expectancy in this country.”
Buttigieg proposes a policy called the Douglass Plan for Black America, a plan that “dismantles old systems and structures that inhibit prosperity and builds new ones that will unlock the collective potential of Black America.” With regards to health care, the plan suggests creating coalitions called Health Equity Zones to help resolve health disparities in marginalized communities. Buttigieg’s campaign site also mentions plans to address the underrepresentation of black Americans working in health care, along with training current health care workers to combat racial bias in treatment scenarios.
According to Meagher, the plan also includes policies like offering implicit bias and discrimination training to health-care providers, establishing maternal mortality review committees, and expanding Medicaid coverage for pregnant mothers to one year after birth.
On August 9, Buttigieg announced a new healthcare plan that specifically supports rural Americans, noting that among rural regions "one in five people are people of color, including Black, Latinx, and Native Americans." The plan specifically mentions the maternal mortality rate disparity among black and Native American women and seeks to address it in the following ways:
- Guarantee that people in rural areas have affordable health insurance options.
- Ensure that people in rural areas have access to critical health services by increasing the availability of health providers.
- Expand access to preventive efforts and effective treatment for mental illness and addiction.
- End the rural maternal health care crisis by making it easier for women to access critical services before, during, and after pregnancy.
- Make it easier for patients to receive treatment at or near their home by expanding telehealth services.
- Strengthen rural health facilities to better address new models of health and community wellness.
- Support rural communities in meaningfully reducing local health inequities.
- Reduce obesity and combat food insecurity.
- Improve access to transportation services.
Julián Castro (D), former Secretary of Housing and Urban Development
The Castro campaign did not respond to multiple requests for comment, and its website does not include any mention of maternal mortality at press time.
Bill de Blasio (D), Mayor of New York City
The de Blasio campaign responded to our initial request for comment but did not supply details or respond to subsequent follow-up requests. Its website does not include any mention of maternal mortality at press time.
John Delaney (D), former U.S. Representative for Maryland’s 6th congressional district
The Delaney campaign did not respond to multiple requests for comment. The Delaney campaign website does list racial health disparities as an issue Delaney plans to tackle and proposes two policies:
- A universal health care plan that “will eliminate a clear barrier to accessing care and medical services”
- A plan to implement “Pay for Success programs like the Nurse-Family Partnership in South Carolina to improve health outcomes during [the] first two years of a child’s life.” The Nurse-Family Partnership (NFP) sends trained nurses to visit young first-time mothers-to-be from the beginning of their pregnancy until their child is two years old. Its Pay for Success program in South Carolina receives government funds for support if the NFP meets key goals.
Tulsi Gabbard (D), U.S. Representative for Hawaii’s 2nd congressional district
The Gabbard campaign responded to our initial request but did not provide details or respond to subsequent follow-up requests. Its website does not include any mention of maternal mortality at press time.
Kirsten Gillibrand (D), Senator from New York
"The very first plank of Senator Gillibrand's Family Bill of Rights, her agenda for the first 100 days of her administration, is the right to a safe and healthy pregnancy,” national press secretary Evan Lukaske tells SELF in an email statement. “The cornerstone of this right is her MOMS Act, which aims to reduce maternal mortality rates in the black community through new funding and better practices.”
Gillibrand introduced the Modernizing Obstetric Medicine Standards (MOMS) Act on August 28, 2018, with cosponsors Senators Cory Booker (D-NJ) and Kamala Harris (D-CA).
Among other things, this bill would:
- Create and update standardized maternal safety best practices
- Offer funding to states and hospitals interested in implementing those best practices
- Ensure that the CDC receives maternal mortality data from state Maternal Mortality Review Committees (MMRCs)
According to a press release from Gillibrand’s team, this legislation was endorsed by the American College of Obstetricians and Gynecologists (ACOG), the National Birth Equity Collaborative, MomsRising, and the Association of Maternal and Child Health Programs (AMCHP), among others.
Gillibrand also directly addressed the high rate of black maternal mortality in her Family Bill of Rights, the economic policy platform she would put into motion in her first 100 days as president. “These are largely preventable deaths—they’re generally caused by a lack of supplies, insufficient training, and the institutional racism and bias that put women of color at risk,” she wrote on Medium when introducing the Family Bill of Rights on May 22, 2019. “I’ll make sure states and hospitals are equipped to prevent and respond to pregnancy complications.”
Gillibrand also cosponsored several additional pieces of legislation on this topic, including the Maternal Care Access and Reducing Emergencies (CARE) Act introduced by Senator Kamala Harris (D-CA) on August 22, 2018 (endorsed by the Black Mamas Matter Alliance, ACOG, the Center for Reproductive Rights, and others); the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES) Act, introduced by Senator Cory Booker (D-NJ) on September 25, 2018 (supported by the Black Mamas Matter Alliance, the National Partnership for Women and Families, and Every Mother Counts, among others); and the Healthy Maternity and Obstetric Medicine Act introduced by Senator Sherrod Brown (D-OH) on May 15, 2019 (supported by the Black Mamas Matter Alliance, March of Dimes, ACOG, and others).
Mike Gravel (D), former Senator from Alaska
The Gravel campaign did not respond to multiple requests for comment. The Gravel campaign website does list the maternal mortality rate as something that needs to be addressed, although does not mention the racial disparities in maternal mortality. The website doesn't expand on how to address the maternal mortality rate specifically, but focuses on plans to implement universal health care.
Kamala Harris (D), Senator from California
"My mother, a breast cancer researcher, imparted on me the importance of addressing women's health issues,” Harris tells SELF in an email statement. “Every day we don’t address maternal mortality is a day a mother could die or not receive the necessary health care that can prove disastrous for her or the heath of her baby. You don’t have to scratch the surface of this issue very deep to know it is about racial bias. The health status and the well-being of a Black mother is an issue that should concern everyone—just like the maternal health of any woman should concern everyone.”
On August 22, 2018, Harris introduced the Maternal Care Access and Reducing Emergencies (CARE) Act, cosponsored by U.S. Senators Kirsten Gillibrand (D-NY), among others.
The bill proposes:
- Grants for up to 10 states to create pregnancy medical home (PMH) programs, with the purpose being to “deliver integrated health care services to pregnant women and new mothers”
- Grants for health-care training programs to implement implicit bias training
- Requiring the National Academy of Medicine to study implicit bias and make recommendations for how to assess it within clinical testing in medical schools and other health-care training programs
“Passing my Maternal CARE Act is one step to ensuring our medical system finally treats women—especially Black women—with the dignity they deserve,” Harris wrote in a Medium post about the bill on May 26, 2019. “What’s good for our Black mothers is good for our babies, families, and communities—and it’s good for the entire country.”
According to a press release from Harris’s team, the bill was endorsed by the Black Mamas Matter Alliance, ACOG, the Center for Reproductive Rights, and many more organizations.
Harris also cosponsored several additional pieces of legislation addressing this issue, including the Modernizing Obstetric Medicine Standards (MOMS) Act, introduced by Kirsten Gillibrand on August 28, 2018 (endorsed by the American College of Obstetricians and Gynecologists (ACOG), the National Birth Equity Collaborative, MomsRising, and the Association of Maternal and Child Health Programs (AMCHP), among others); the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES) Act, introduced by Cory Booker on September 25, 2018 (supported by the Black Mamas Matter Alliance, the National Partnership for Women and Families, and Every Mother Counts, among others); and the Healthy Maternity and Obstetric Medicine Act introduced by Sherrod Brown on May 15, 2019 (supported by the Black Mamas Matter Alliance, March of Dimes, ACOG, and others).
“Kamala has been a leader in the fight for racial justice throughout her career,” her campaign site says. “Working to repair the systemic inequalities people of color face in this country will remain a top priority for her as president.”
John Hickenlooper (D), former Governor of Colorado
"Governor Hickenlooper believes that every woman has a right to safe and affordable maternal care,” campaign spokesperson Mark Ranneberger tells SELF in an email statement. “A Hickenlooper administration would work with Congress to pass the Mothers and Offspring Mortality and Morbidity Awareness Act to expand Medicaid coverage for new mothers from 60 days post birth to one year and standardize data collection and analysis so we can better understand and address the root causes of elevated levels of maternal morbidity rates, particularly for the Black and Native American communities."
The Mothers and Offspring Mortality and Morbidity Awareness Act, also called the MOMMA’s Act, was introduced by Representative Robin Kelly (D-IL), and Senators Dick Durban (D-IL) and Tammy Duckworth (D-IL), on March 27, 2019. The bill proposes:
- Using a federal committee of experts to establish national obstetric emergency protocols
- Expanding access to culturally competent care
- Ensuring that maternal mortality review committees across the country share information and best practices.
Supporters of the MOMMA’s Act include the Black Mamas Matter Alliance, ACOG, and the Center for Reproductive Rights, among others.
Jay Inslee (D), Governor of Washington
The maternal mortality rate in the United States is “a tragedy and national embarrassment,” Katie Rodihan, the press secretary for Inslee for America, tells SELF in an email statement.
“As president, Inslee would require that federally-funded health research include focused studies on women’s health and on women of color,” Rodihan continues. “This includes expanding medical research to evaluate the effects of medications on women and women of color specifically. Men and women react differently to certain treatment, but not enough research has been devoted specifically to study women’s reactions. Governor Inslee also believes we should create local maternal mortality review committees comprised of local health experts to evaluate local issues around maternal health.”
Inslee would also call for further support for Planned Parenthood. “In rural areas, Planned Parenthood is often the only health-care provider, and many areas served by Planned Parenthood do not have a local Federally Qualified Health Center,” Rodihan says.
Amy Klobuchar (D), Senator from Minnesota
An Amy for America staffer pointed SELF to a June 18, 2019, Medium post in which the Klobuchar campaign outlined over 100 actions the senator would take during her first 100 days as president. One of those steps: “Develop best models of care to address disparities in maternal and infant mortality and address the shortage of maternity care health professional in underserved rural and urban areas.”
The post says that Klobuchar would “immediately implement a new law that tackles the shortage of maternity care health professionals—including nurses, midwives, and obstetricians—in underserved areas, and she will develop best models of care to address racial disparities in maternal and infant mortality.”
Klobuchar also cosponsored the Maternal Care Access and Reducing Emergencies (CARE) Act introduced by Senator Kamala Harris (D-CA) on August 22, 2018 (endorsed by the Black Mamas Matter Alliance, ACOG, the Center for Reproductive Rights, and more); and the Healthy Maternity and Obstetric Medicine Act introduced by Senator Sherrod Brown (D-OH) on May 15, 2019 (supported by the Black Mamas Matter Alliance, March of Dimes, ACOG, and others).
Wayne Messam (D), Mayor of Miramar, Florida
The Messam campaign did not respond to multiple requests for comment, and its website does not include any mention of maternal mortality at press time.
Seth Moulton (D), U.S. Representative for Massachusetts's 6th congressional district
In an email statement provided to SELF, Moulton pointed out that low maternal mortality rates in certain U.S. states is proof that we can and should improve maternal mortality across the board. He used California as an example, citing the California Maternal Quality Care Collaborative (CQMCC).
“[California] substantially lowered its maternal mortality rate by taking up the recommendations of a commission, the CMQCC, that it formed to study the problem,” he said. “They found among other initiatives that lowering the rate of C-section births and requiring easy access to hemorrhage carts during labor can lower mortality rates substantially. Ensuring that these straightforward and successful initiatives are taken up nationwide will be a top priority for my administration.” For reference: In 2006, California introduced the CMQCC to gather data about mortality rates, provide recommendations and tool kits to hospitals, and publish research about this issue. Though California did dramatically reduce the state’s maternal death rate overall, a racial gap persists—black women are still dying at a significantly higher rate than white moms, per the CMQCC.
Moulton also pledged to tackle institutional racism and inequality. “We will never be able to achieve the minimal maternal mortality rate until we address the roots of poverty and racism in this nation,” he said. “Maternal mortality is highest among populations that suffer most from these national problems. Closing regional and racial gaps in education funding and achievement, criminal justice, and other socioeconomic disparities will be a focus of my administration. Doing so would get at the root of much of the maternal mortality crisis and improve so many other difficulties as well.”
Beto O’Rourke (D), former U.S. Representative for Texas's 16th congressional district
“The key to tackling the maternal mortality crisis head-on will be listening to women of color and learning from their experiences,” a spokesperson for O’Rourke’s campaign tells SELF in an email statement. “At a time when women’s reproductive rights are under unprecedented attacks, and when our country still faces inequality in access to health care, we must ensure that the voices and experiences of women — particularly women of color — living the consequences of this crisis every day are part of the solutions we implement.”
According to the spokesperson, O’Rourke would first work with Congress to pass universal access to affordable, high-quality health care. He would also seek more funding for Title X Family Planning Programs, providing low-income women with health services, and support the Black Maternal Health Caucus in Congress. “He will support legislation to provide grants to states designed to collect accurate data on the causes of maternal deaths, make recommendations to help reduce maternal deaths, and ensure health providers are educated on how they can improve care,” the spokesperson said.
In an October 30, 2018, op-ed for Essence magazine, O’Rourke called for expanding Medicaid to cover more women’s prenatal and postnatal care and increasing support for state-level maternal mortality review committees.
Tim Ryan (D), U.S. Representative for Ohio’s 13th congressional district
The Ryan campaign did not respond to multiple requests for comment, and its website does not include any mention of maternal mortality at press time.
Bernie Sanders (I), Senator from Vermont
Sanders’s plan to address black maternal mortality starts with tackling low insurance rates, Bernie 2020 spokesperson Sarah Ford tells SELF in an email statement. According to nationally representative U.S. Census Bureau data released in 2018, around 10 percent of black non-Hispanic women in the United States had no insurance coverage at any point in 2017, while only 6 percent of white non-Hispanic women could say the same. Sanders’s Medicare for All plan, which aims to guarantee free health care for everyone, would address this disparity, Ford says.
“His plan requires the Department of Health to conduct an evaluation of health disparities, including racial and geographic disparities, and to submit a plan to Congress for addressing the disparities found in the evaluation,” Ford says. “It also creates an Office of Primary Health to increase access to care, including training the workforce we need to address these disparities.”
Ford says Medicare for All would ban providers from discriminating against patients and remove the profit motive from the healthcare system. Sanders would also seek to place providers and resources in traditionally underserved communities.
“Bernie understands that we must not only guarantee health care to all as a right, but end the long-standing disparities which exist within the health care system,” Ford says. “This means addressing the need for more black doctors, more black dentists, more black nurses, and more black psychologists who can provide culturally competent care in their communities.”
Joe Sestak (D), former U.S. Representative for Pennsylvania's 7th congressional district
Sestak will take a “holistic and ambitious approach” to tackle black maternal mortality if he becomes president, he tells SELF in an email statement. In the over 1,100-word statement, he proposed the following, among other steps:
- Adjusting the Affordable Care Act by introducing a “public” option that can eventually make it easier to transition to universal health care. “It's my strong belief that the success of the public option will create more public support for a national system, which I believe we should model after the broadly successful Veterans Health Administration, already a nationwide primary health system providing quality care for over 9 million people,” Sestak says.
- Supporting organizations like Planned Parenthood
- Increasing support for sex education programs
- Increasing access to contraception
- Addressing economic inequality. “When black women are no longer disproportionately poorer and less advantaged than other women, black maternal mortality will stop being disproportionately higher,” Sestak says. “To this end, I support expanding early childhood education to all four-year-olds, and subsidizing day care for all parents living in poverty; I support increasing access to higher education and job training; I support a national infrastructure plan and more support for small businesses, which will help create more good jobs; and I support increasing the minimum wage, and increasing federal support for public housing.”
- Addressing pollution issues which can contribute to adverse health outcomes
“Some of this may seem quite far afield from the issue of maternal mortality, but it is all connected,” Sestak says. “All social justice issues—from environmental injustice and health-care disparities to housing discrimination and mass incarceration—play a role in increased black maternal mortality (and indigenous and Hispanic maternal mortality as well). It is a problem we cannot solve unless [we] take a wide view of everything that feeds into it.”
Tom Steyer (D), hedge-fund manager and activist
“It is unacceptable that black women are three times more likely than white women to die from pregnancy or childbirth,” Steyer tells SELF in an email statement. “It is unacceptable that these mothers do not have access to comprehensive reproductive health care before, during, and after delivery.”
A campaign spokesperson says that in the coming weeks, Steyer plans to release “comprehensive steps” to reduce racial disparities in health care. According to the staffer, Steyer supports both the Maternal Care Access and Reducing Emergencies (CARE) Act introduced by Senator Kamala Harris (D-CA) on August 22, 2018 (endorsed by the Black Mamas Matter Alliance, ACOG, the Center for Reproductive Rights, and more); and the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES) Act, introduced by Senator Cory Booker (D-NJ) on September 25, 2018 (supported by the Black Mamas Matter Alliance, the National Partnership for Women and Families, and Every Mother Counts, among others).
Donald J. Trump (R), 45th U.S. President
The Trump campaign did not respond to multiple requests for comment, and its website does not include any mention of maternal mortality at press time.
Elizabeth Warren (D), Senator from Massachusetts
"America is facing a maternal mortality crisis and race is right at the center of it,” Warren tells SELF in a statement provided via email. “Black women are three to four times more likely than white women to die in and around childbirth. We need to hold health systems accountable for protecting Black and Brown moms. Under my plan, health systems that are able to reduce complications, raise survival rates, and narrow the mortality and morbidity gaps between white mothers and women of color can earn a bonus. The ones that don't will be identified and invested in so we can improve their outcomes and end this epidemic."
Warren’s April 30, 2019 op-ed for Essence outlines her plan to reduce maternal mortality in more detail. She proposes a health-care pricing model based on “episodes” rather than each separate visit or procedure. “In maternity care, health systems would have the flexibility to cover key services—like prenatal and postpartum visits, hypertension and depression screenings, and doula and lactation support—based on their effectiveness, not on their reimbursement rate,” she wrote. Warren had previously said in an April 24, 2019, She the People forum that hospitals that don’t improve their outcomes will “have money taken away from them” under her plan, but her subsequent op-ed makes no mention of penalizing hospitals.
In her op-ed, Warren acknowledged that her plan would not resolve underlying equality issues and stressed that rigorous research, testing, and evaluation would be necessary to make this type of reform safe and effective. During that process, she wrote, it will be essential to prioritize the voices of the people and families most affected.
William Weld (R), former Governor of Massachusetts
The Weld campaign did not respond to multiple requests for comment, and its website does not include any mention of maternal mortality at press time.
Marianne Williamson (D), self-help author
“Many black maternal deaths can be prevented,” Williamson tells SELF in an email statement. “We need to take action on several fronts to improve the situation and save lives. Black women are showing the way through groups like Black Mamas Matter Alliance, along with the Alliance for Innovation [on] Maternal Health whose goal is to eliminate preventable maternal mortality through proven approaches to safety and quality.”
Williamson declared her support for the Maternal Care Access and Reducing Emergencies (CARE) Act introduced by Senator Kamala Harris (D-CA) on August 22, 2018 (endorsed by the Black Mamas Matter Alliance, ACOG, the Center for Reproductive Rights, and more); the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES) Act, introduced by Senator Cory Booker (D-NJ) on September 25, 2018 (supported by the Black Mamas Matter Alliance, the National Partnership for Women and Families, and Every Mother Counts, among others); Elizabeth Warren’s policy proposal; and the Black Maternal Health Caucus.
“The key to success will be to identify the most effective solutions and share them in communities, health-care systems, and hospitals across the country,” Williamson says. She proposed the following areas for action:
- Increased access to contraception, counseling, and abortion services
- Addressing racial bias among medical personnel
- Improving performance at “hospitals that care for black women”
- Protecting the Affordable Care Act, Medicare, and Medicaid
- Defending reproductive health access
- Stopping proposed cuts to “nutrition programs such as Women Infants and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) which support low-income women in feeding their families”
- Increasing economic security by increasing the minimum wage to $15 an hour
- Enacting the FAMILY Act, which would ensure that “workers can take up to 12 weeks of paid leave for a pregnancy, the birth or adoption of a child, recovery from a serious illness, or to care for a seriously ill family member.”
- Expanding legal protections for pregnant workers
“Black women deserve safe pregnancies and good health,” Williamson says. “I will work to make that a reality.”
Andrew Yang (D), entrepreneur
The Yang campaign did not respond to multiple requests for comment. Its website does mention the high rate of U.S. maternal mortality but does not include any policy proposal for maternal mortality at press time. The website doesn't expand on how to address the maternal mortality rate specifically, but focuses on plans to implement universal health care with Medicare for All.
So how can you evaluate these plans?
As you can see, a number of candidates have introduced legislation on this matter already, offered up multistep plans, or promised to release more detailed policy proposals in the near future. With so much information available, how can you evaluate what each candidate is proposing? How can you tell which plans, if implemented, will actually make a difference?
The first step is ensuring that every candidate even has a plan to tackle black maternal mortality, Monica Simpson, executive director at SisterSong Women of Color Reproductive Justice Collective and an advisory committee member for the Black Mamas Matter Alliance, tells SELF.
“This is definitely an epidemic,” Simpson says. “It’s something that should be sounding an alarm in everyone’s office if they care about the health and well-being of people in this country.” So if your preferred candidate has not outlined a plan to tackle black maternal mortality or you aren’t satisfied with their policy proposals, you can reach out to their campaign to ask them about it.
Next Simpson recommends checking each plan for the voices and input of the communities most impacted: “Who is behind these pieces of legislation? Are there black women involved?”
To that end, Aina, codirector of the Black Mamas Matter Alliance, recommends looking for any mentions of partnerships between politicians and organizations doing this work, which you can do by following these groups on social media and getting their newsletters. “A green light is clear language that explicitly [talks] about partnering with community-based organizations doing the work in black maternal mortality,” she says. “It’s important…to seek out those like ourselves and others who are doing the work and that whatever they are coming up with is fully informed, not developed in isolation or coming from a top-down approach.”
Here are a few other points you may consider:
- If there is legislation involved, has it been endorsed by nonpartisan grassroots activist voices or political entities on this issue, like the Black Mamas Matter Alliance, SisterSong, or the Black Maternal Health Caucus?
- Do the proposals specifically mention black maternal mortality, not only maternal mortality in general?
- Do the proposals center and support black women’s leadership in this arena?
- Do the proposals have a plan to tackle structural inequality and institutionalized racism?
An important part of caring about this issue goes beyond informing yourself and others. It necessitates holding our elected officials and presidential hopefuls accountable by showing them that voters demand change. You can ask questions during campaign events or town halls. You can ask activists and researchers how everyday people and voters can help advance research and raise awareness. You can support community organizations and grassroots activist groups financially or through volunteer work. Because pregnant people should not be dying from preventable causes—and black pregnant and postpartum people should not be dying at three to four times the rate of white ones.
*Note: In order to make it clear that you don’t have to identify as a woman to be pregnant and therefore at risk for the outcomes we’re talking about when we discuss “black maternal mortality,” we use non-gendered language whenever we can. When you see gendered words like women, mother, maternal, etc., it’s because we’re quoting a person or source who used those words, or because we’re referring to studies that looked specifically at populations of women.
