Our nation is in the midst of one of the worst maternal health crises in recent history. Not only is it a dangerous time to desire the termination of a pregnancy with the overturn of Roe v. Wade, but it is also a particularly dangerous time for those who look to start or grow families. As we honor Pregnancy and Infant Loss Awareness Month, which aims to illuminate the harrowing realities underlying these losses, we should hone in on the latter group and take a closer look at the issue of stillbirth in the United States.
Stillbirth describes the loss of a pregnancy after 20 weeks. Most stillbirths occur before the birthing person goes into labor, with very few happening during labor or birth. Each year, about 1 in 175 families face the tragedy of stillbirth. Federal lawmakers are taking concrete steps to acknowledge and address the crisis that very few are naming. In July of this year, a bipartisan group of lawmakers reintroduced the Maternal and Child Stillbirth Prevention Act, which would explicitly allow the allocation of federal funding towards stillbirth prevention.
According to the Centers for Disease Control and Prevention, medical conditions such as diabetes, high blood pressure, and substance abuse are among the risk factors for stillbirth. Additionally, pregnancy conditions and pregnancy history such as expecting multiples; previous diagnoses of preterm birth, pre-eclampsia, or fetal growth restriction; and previous miscarriages or stillbirth come with increased risk. Advanced maternal age and lack of social support also heighten risk.
There exist other ‘risk factors’ that warrant further investigation. The Centers for Disease Control and Prevention names stillbirth as disproportionately impacting low-income birthing people and Black birthing people. In addition, a ProPublica investigation found that a lack of comprehensive action, research and awareness, and stark racial disparities all contribute to our nation’s stillbirth crisis. What’s worse, a growing body of research underscores the need for intentional effort and action—the same investigation found that as many as 1 in 4 stillbirths are preventable, and that families in the United States are 6.5 times more likely to lose a baby to stillbirth than they are to SIDS, which is widely acknowledged as a problem.
The extent of named disparities is equally as astounding. While 1 in 175 pregnancies in the United States end in stillbirth overall, 1 in 97 Black pregnancies end in stillbirth, and 1 in 128 Indigenous or Alaska Native pregnancies end in stillbirth. The lack of research speaking to the mechanisms underlying stillbirth and the racial disparities they reflect is a part of the problem, but the findings of research from the American College of Obstetrics and Gynecology provide a solid framework for making sense of these problems.
Unfortunately, these disparities may reflect an extension of existing ones. Conditions like preeclampsia and gestational diabetes are risk factors for stillbirth, and birthing people of color experience them at the highest rates, with the worst complications. Receiving adequate support and medical care requires the attentiveness of the provider, and notions of Black women and birthing people’s strength and imperviousness to pain still shape medical interactions. Providers cannot treat the worst manifestations of these conditions if they do not acknowledge the conditions themselves, and our current statistics regarding stillbirth reflect this reality.
Furthermore, research suggests that the embodied effects of structural racism manifest during major transformations such as pregnancy and childbirth. In other words, with increased stressful interactions, which are a concomitant of structural racism, comes neurobiological changes that present on the bodies and psyches of birthing people. What this means is that improving the conditions surrounding stillbirth, and pregnancy and birthing in general, requires the uprooting of larger structures and systems. Legislative and advocacy efforts are incredibly important for making the case for these changes in the interim.