Structural Racism and Maternal and Child Health
This blog is part of a series that will highlight how structural racism in the health care system negatively affects the health of individuals of color. Community Catalyst is committed to exposing and dismantling policies, practices and attitudes that routinely produce cumulative and chronic adverse outcomes for people of color in the health system.
When Ronald Reagan framed unwed, poor mothers of color fraudulently relying on government assistance programs as “welfare queens” during his presidential campaign speeches in 1976, the image of the underserving poor took on a form of Black mothers whose lack was justified – lack of resources, lack of access and lack of equity. Now, as Black women are three to four times more likely to die from pregnancy-related causes than White women, it’s time to drop the deserving versus undeserving poor narrative and work to repair the damage of structural racism meant to deny communities of women equitable rights to have healthy pregnancies and families when they choose to.
Storytelling in health advocacy is often a useful approach to give stakeholders, policy makers and other advocates an image of a policy initiative’s impact. These narratives apply a much-needed human aspect to what otherwise could be lost in data and numbers by sharing a human experience and generating social sympathy. But what happens when narratives turn negative, relying on racism, sexism and classism to paint a picture of the deserving and underserving of health resources and social services – especially of black women who are now at most risk for poor maternal health outcomes?
Currently, Black maternal mortality is not just a problem among those with a low socioeconomic status. In fact, the birth outcomes disparities between Black women and White women show similar poor outcomes across all income and education levels, suggesting a direct link to racism further supported by racist narratives. Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age.” They include factors like socioeconomic status, education, the physical environment, employment and social support networks, as well as access to health care. Through policies and programs within the social determinants of health, racist narratives create barriers and can impact how women access health coverage, quality care, employment and other resources to achieve optimal health. Using theories like Critical Race Theory to analyze how racist narratives permeate into policy and programs can help shift view and ultimately outcomes. By rejecting a tradition of meritocracy, the false picture that everyone who works hard can attain wealth, power and privilege is denied and instead we can recognize the impact that systemic inequities have on the marginalization of people of color.
Last month, the Black Mamas Matter Alliance (BMMA) held their first briefing on Capitol Hill to highlight their work and build a supporter base around the alarming rates of black maternal mortality in the United States. Led by Black women, including Community Catalyst board member Dr. Joia Crear-Perry, BMMA is a cross-sectoral alliance that centers Black mamas to advocate, drive research, build power and shift culture for Black maternal health, rights and justice. Through their work, BMMA purports that all women have the right to safe and respectful health care that supports healthy pregnancies and births. These rights mean that before, during and after pregnancy, every woman needs access to quality health services and information, to the social and economic resources that will help her be as healthy as she can.
Critical to black maternal health is our current advocacy campaign to save Medicaid and the Affordable Care Act for children and families. Now is the time when we have to eliminate the racist narrative of the “welfare queen.” Our stories must center around addressing racial discrimination and structural racism by recognizing it. By shedding light on the harmful outcomes of health inequities, we can share multiple narratives. We must also continue to frame our message using a two generational approach meaning that a family’s access to health care cannot be siloed. Healthy parents – mothers and fathers – are able to care for their children, helping ensure that they thrive and become healthy adults. Specifically, when mothers die, it breaks apart families and can lead to negative health consequences for their children. We must trust Black women with the decisions and resources that empower them and their families. We must trust black women to tell their own dynamic stories and shape the narratives that reflect their realities. In her TED Talk, novelist Chimamanda Ngozi Adichie shared, “The problem with stereotypes is …that they are incomplete. They make one story become the only story.”