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Enhancing Maternal Care in the United States Requires a Shift From the Lens of Survival

Bintou Diarra, A.B | Medical Anthropology, Brown University | September 20, 2023

Our nation currently faces its worst maternal health crisis in recent history. With maternal mortality on the rise since 1990, it is more dangerous for a birthing person to give birth in the United States than it was a generation before. What’s worse, the maternal health conditions of other high-income nations far surpass those of the United States—underscoring the reality that societies where birthing people and their infants are safe is not only achievable, but a standard in many parts of the world.

Conversations centering the issue of maternal mortality are absolutely necessary. Not only is the maternal mortality crisis worsening with time, but racial gaps are also persisting with them. Black birthing people are three to four times more likely to die from pregnancy and childbirth-related complications when compared to their white counterparts, with our worst regions seeing wider disparities. While these conversations are significant, recent findings on the state of maternal health in the United States call for a shift in our understanding of what a safe world and better conditions look like for birthing people. A framework that centers a liberatory future for birthing people must go beyond demanding survival.

It is not enough for birthing people to make it home with their babies. According to the National Institutes of Health, nearly half of new mothers experience birth trauma, with the effects persisting long after their deliveries. March of Dimes attributes birth trauma to a number of risk factors, including: birth complications, emergency c-sections or the use of forceps or other medical devices, birth injuries, and the birthing person having an experience that unnecessarily deviates from their wishes for their birthing experience.

These risk factors are not just conducive to birth trauma. They also underlie the United States’ high rates of maternal mortality. Shifting from the lens of survival, ironically, means that more mothers will live to meet their babies, because childbirth is no longer deemed (or made to be) a process that is inherently traumatic. It means that when those mothers meet their babies, they will tell stories of joy, rather than stories of abuse, neglect, mistreatment, and the loss of dignity. 

Unfortunately, a new Centers for Disease Control and Prevention report paints a troubling picture about the prevalence of the latter. According to their survey, a glaring one in five United States mothers report facing mistreatment during pregnancy and childbirth. This number was slightly higher for reports of discrimination—29%. The disparities in maternal mortality mirror those of mistreatment, with Black, Hispanic, and multiracial birthing people reporting mistreatment at the highest rates. There exist disparities in income as well. Birthing people with no insurance or public insurance at the time of their deliveries experienced mistreatment at higher rates than people with private insurance. 

According to the survey, the most common types of mistreatment reported were: receiving no response to requests for help, being shouted at or scolded, not having their physical privacy protected, and being threatened with withholding treatment or made to accept unwanted treatment. At the core of a framework that centers thriving, rather than survival, is the understanding that it is this normalized, routine, mistreatment that snowballs into fatality for our nation’s birthing people. 

It was the lack of response to requests for help that resulted in the tragic passing of Kira Johnson, who hemorrhaged for hours after the birth of her second child. It was the unwanted administration of an epidural, followed by the failure to administer oxygen after hearing complaints, that led to the passing of Sha’Asia Washington. It is not enough for birthing people to survive current conditions. Current conditions must shift so that pregnancy and childbirth are safe, dignified processes—no matter the setting.

The time after childbirth also underscores the significance of centering a lens of thriving in the fight to improve maternal care. A recent New York Times study named the postpartum period maternity’s most dangerous time. Based on data from 36 states, the CDC concluded that a whopping 30% of maternal deaths occurred between six weeks and a year after childbirth. One thing is clear: getting birthing people in and out of the hospital is not enough, even when we hone in on the issue of maternal mortality alone. 

Unfortunately, our systematic disregard for mothers outside of birthing settings ultimately upholds our disregard for birthing people at the time of childbirth. As of 2023, the United States currently has no universal mandate for paid parental leave. This means that for many new mothers, embracing the rest and recovery that the postpartum period calls for, quite literally comes at an expense. Among the potential expenses are health, as financial hardship often renders low-income, uninsured postpartum mothers bereft of adequate care. 

Women and birthing people in the United States deserve outcomes that do not merely paint a picture of making it past the point of childbirth. Enhancing maternal care in our country is about work on the ground, and the societal work of constant analysis and evaluation about the realities we are working to create. In this way, fighting the maternal health crisis calls for an uprooting of all systems that currently fail our mothers and birthing people—including those of thought.

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