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Maternal and Infant Mortality: How we are Failing Black Women and Children

The United States continues to have the highest rates of maternal and infant mortality among developed countries.[1] However, maternal and infant mortality rates do not impact all racial and ethnic groups equally.[2] In fact, maternal and infant mortality rates for Black women and children are significantly higher compared to other racial or ethnic groups.[3]

While global rates of maternal mortality have steadily decreased since the 1990s, maternal mortality in the United States has increased, impacting all mothers but especially Black mothers.[4] For example, in New York “between 2006 and 2010 black women were 12 times more likely than white women to die from pregnancy-related causes,” an increase “from seven times more likely between 2001 and 2005.”[5]

In 2020, 861 women in the United States died due to maternal causes, an increase from 754 women in 2019 and 658 women in 2018.[6] This means that 23.8 women died per 100,000 live births in 2020.[7] When broken down by race, 55.3 Black women died per 100,000 live births compared to 18.2 Hispanic women and 19.1 White women per 100,000 live births during the same year.[8]

Although infant mortality rates have decreased since the 1800s, “the disparity between Black and White infant deaths today is actually greater than it was under antebellum slavery.”[9] In 1850, enslaved Black infants were estimated to die “at a rate 1.6 times higher than that of White infants.”[10] Yet, Black infant mortality rates in 2017 were more than 2.3 times higher than White infant mortality rates.[11]

In 2017, the overall infant mortality rate in the United States was 5.79 deaths per 1,000 live births.[12] However, infant mortality rates for Black children was 10.97 deaths per 1,000 live births, more than double the infant mortality rates for Hispanic (5.1 deaths per 1,000 live births) and White (4.67 deaths per 1,000 live births) infants.[13] Of the Black infants who died in 2017, approximately two-thirds died within the first 28 days of their life (neonatal deaths) and one-third died between 28 and 364 days after birth (post neonatal).[14]

Public health officials, medical experts, and social scientists have long pointed to social determinants of health as the cause for racial disparity in maternal and infant mortality rates. However, social determinants by themselves do not fully explain why Black women and children die at such higher rates than their White counterparts in the United States.[15] Instead, unconscious biases embedded in medical institutions amplify the problems involving social determinants of health, impacting the quality of medical care Black women and children receive.[16]

Research has shown that racism is one of the root causes of unequal health outcomes for people of color, “not simply the conditions in which people are born, grow, live, work, play, and age.”[17] In fact, researchers who study the infant mortality difference between Black and White babies have discovered “that controlling for maternal background factors” does not completely explain the racial disparity in infant mortality.[18] Additionally, racial disparities in maternal deaths for Black women persist “regardless of seemingly protective factors,” such as education.[19] Black, college educated women “are more likely to die from pregnancy-related causes than pregnant white, Hispanic, and Asian/Pacific islander women without high school diplomas.”[20] Unfortunately, “Black women, regardless of social or economic status,” have higher rates of maternal mortality.[21]

Every day in the United States Black women and children die because medical providers and institutions fail to listen to Black mothers and do not intervene to save Black women and children’s lives.[22] Cori Bush, a United States Congresswoman, explained how she and her two children almost became maternal and infant mortality statistics.[23] Bush alerted doctors to medical issues she was experiencing during her first pregnancy, but doctors ignored her, instead telling her to go home.[24] A week later, Bush went into preterm labor and delivered her son at 23 weeks gestation.[25] When Bush began going into preterm labor during her second pregnancy, a doctor told her “the baby was going to abort.”[26] Bush pleaded with the doctor to save her baby.[27] The doctor told her “‘Just go home. Let it abort. You can get pregnant again because that’s what you people do,’” clearly referring to Bush’s identity as a Black woman.[28] Fortunately, Bush and her children survived, but their stories stand as a testament to how racism continues to kill Black people.[29] Bush explained in her own words: “Every day, Black women are subjected to harsh and racist treatment during pregnancy and childbirth. Every day, Black women die because the system denies our humanity.”[30] Black women and children deserve better; Black women and children deserve to live.

[1] Jamila Taylor, Katie Hamm, Cristina Novoa & Shilpa Phadke, Eliminating Racial Disparities in Maternal and Infant Mortality: A Comprehensive Policy Blueprint1 (Ctr. for Am. Progress ed., 2019).; Jamila K. Taylor, Structural Racism and Maternal Health Among Black Women, 48 J. of L., Med. & Ethics 506 (2020).

[2] Evelyn J. Patterson, Andréa Becker & Darwin A. Baluran, Gendered Racism on the Body: An Intersectional Approach to Maternal Mortality in the United States, Population Rsch. & Pol’y Rev. 1, 2 (2022).; Reproductive Health: Infant Mortality, Ctr. for Disease Control & Prevention (Sept. 8, 2021), https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm#:~:text=Infant%20mortality%20is%20the%20death,for%20every%201%2C000%20live%20births.

[3] Taylor, supra note 11.;Rabah Kamal, Julie Hudman, & Daniel McDermott, What do we know about infant mortality in the U.S. and comparable countries? Peterson-KFF (Oct. 18, 2019), https://www.healthsystemtracker.org/chart-collection/infant-mortality-u-s-compare-countries/.

[4] Patterson, Becker & Baluran, supra note 12.

[5] Robin Fields, New York City Launches Committee to Review Maternal Deaths, ProPublica (Nov. 15, 2017), https://www.propublica.org/article/new-york-city-launches-committee-to-review-maternal-deaths.

[6] Donna L. Hoyert, Maternal Mortality Rates in the United States, 2020, Nat’l Ctr. for Health Stat. (Feb. 2022), https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/E-stat-Maternal-Mortality-Rates-2022.pdf.

[7] Id.

[8] Id.

[9] Deirdre Cooper Owens & Sharla M. Fett, Black Maternal and Infant Health: Historical Legacies of Slavery, 109 Am. J. of Pub. Health 1342, 1343 (2019).

[10] Id.

[11] Kamal, Hudman, & McDermott, supra note 13.  

[12] Kamal, Hudman, & McDermott, supra note 13.  

[13] Id.

[14] Id.

[15] Kamal, Hudman, & McDermott, supra note 13.; Taylor, supra note 11 at 506, 511.

[16] Martin & Montagne, supra note 40.

[17] U.S. Dep’t of Health and Hum. Serv., supra note 26.  

[18] Kamal, Hudman, & McDermott, supra note 13.

[19] Keri Carvalho, Anna Kheyfets, Pegah Maleki, Brenna Miller, Siwaar Abouhala, Eimaan Anwar, & Ndidiamaka Amutah-Onukagha, A Systematic Policy Review of Black Maternal Health-Related Policies Proposed Federally and in Massachusetts: 2010—2020 9 Frontiers in Pub. Health 1, 2 (Oct. 2021).

[20] Id.

[21] Taylor, supra note 11 at 506, 511.

[22] Colleen Murphy, Congresswoman Cori Bush Shared Her Pregnancy Story — And It Highlights the Inequities of Birthing While Black, Health (May 7, 2021), https://www.health.com/condition/pregnancy/congresswoman-cori-bush-pregnancy.; Congresswoman Cori Bush (@RepCori), Twitter (May 6, 2021, 12:05 PM), https://twitter.com/RepCori/status/1390352127579594753?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1390352127579594753%7Ctwgr%5E%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fwww.health.com%2Fcondition%2Fpregnancy%2Fcongresswoman-cori-bush-pregnancy.

[23] Congresswoman Cori Bush, supra note 2. 

[24] Id.

[25] Id.

[26] Id.

[27] Id.

[28] Id.

[29] Id.

[30] Id.

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Anti-Prostitution Laws are Hurting Juveniles

The movement to decriminalize sex work has been pushed by sex workers for decades and has gained national popularity in criminal justice discussions. Decriminalizing sex work would halt arrests and charges for prostitution. While this may not seem like a juvenile justice issue, there is a small but significant group who have been impacted by anti sex work laws: juveniles arrested for prostitution.

The Trafficking Victims Protection Act defines sex trafficking as recruiting, patronizing, or otherwise causing a person under 18 years old to participate in a commercial sex act.[1] Most states have statutory rape laws which state a person under a certain age cannot consent to sex with an adult. In Texas, for example, an adult cannot engage in sexual contact with a person under 17 years old.[2] These laws indicate a general consensus that minors cannot consent to sex work or sex with adults. If that is the case, the 290 children aged 0-17 who were arrested in 2019 for prostitution should have been treated as victims instead of criminals.[3]

The interception of child trafficking victims and criminal prostitution laws can be seen in the 2010 Texas case In re B.W. This case involved a 13 year old girl who was arrested for prostitution in Texas.[4] The offense was filed in adult criminal court, where it was discovered the arrestee was a child. [5] The prostitution charge was then dismissed, but B.W.’s involvement with the justice system was not over. The charges were transferred to juvenile court, where B.W. pleaded true to the allegation, which is the equivalent of pleading guilty in adult court, and was sentenced to 18 months probation.[6]

On appeal, the Supreme Court of Texas ruled that because the legislature has determined children under 14 do not have the mental capacity to consent to sex with anyone, they are exempt from prostitution charges. [7] This was a win for B.W. and child sex trafficking victims all over Texas, but the impact of criminalization was already felt. B.W. had already been subjected to arrest and booking in adult court. In re B.W. protects juveniles who are 14 or younger, but leaves other teenagers in Texas age 15-16 vulnerable to prostitution charges and arrests. There is not clear data on how many 15 and 16 year olds have been arrested for prostitution in Texas since In re B.W., but Texas makes up part of the 290 total arrests, indicating there have been some. Not all arrests lead to charges, but all arrests traumatize the children who are subject to them.

The effects of arrest on juveniles cannot be taken lightly. Youth who have been arrested are much less likely than their peers to graduate high school or enroll in college.[8] A child who is arrested and is then confined at a juvenile detention facility is virtually guaranteed to not finish their high school education.[9] Young people without a high school degree will face more difficulties finding stability and employment.[10] High school dropouts may face an increased risk of grooming by sex traffickers because they are not around teachers who recognize the signs and can refer the student to school counseling or other services.

Criminalization of sex work is causing lifelong effects in vulnerable juveniles. While full decriminalization of sex work may not be popular in every state, laws preventing minors from being charged with prostitution would go a long way in protecting the country’s youth.

[1] 18 U.S.C. § 1591
[2] Tex. Penal Code §21.11
[3] Office of Juvenile Justice and Delinquency Prevention, https://www.ojjdp.gov/ojstatbb/crime/ucr.asp?table_in=1
[4] In re B.W., 313 S.W.3d 818
[5]Id.
[6] ​​Id.
[7] Id.
[8] David S. Kirk & Robert J. Sampson, Juvenile Arrest and Collateral Education Damage in the Transition to Adulthood, 36, 47 (American Psychological Association 2013).
[9] Id at 55
[10] Id.

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COVID-19 and Child Poverty: How a Pandemic Showed Us We Have a Choice

Over the course of the global COVID-19 pandemic, the rate of child poverty in the United States has fallen dramatically “from 14.2% in 2018 to less than 5.6% in 2021” with severe poverty cutting almost in half.[1] In fact, the 2020 child poverty rates in the United States were the lowest they have been since the 1960s when the US Census Bureau began measuring child poverty rates.[2]

The decrease in child poverty is due to the government’s expansion “of the social safety net,” including the “child tax credit and funding for food.”[3] The child tax credit alone decreased child poverty by approximately 40 percent after providing families with monthly checks to cover basic necessities.[4] In addition to the child tax credit, “other safety-net expansions” provided during the pandemic included “three stimulus checks, a moratorium on evictions, increased unemployment benefits and more funding for food, through the Supplemental Nutrition Assistance Program (SNAP), and housing.”[5] According to research, if these safety-net options were not provided, approximately one out of three children in the United States “would be living in poverty.”[6]

However, experts warn that permitting these “measures to expire may” result in child poverty rates increasing once again.[7] The child tax credit already expired in January 2022, resulting in 3.7 million more children in poverty, “a 41% increase from December.”[8] Families who previously used the child tax credit to cover basic necessities are struggling to provide their families with “food, pay rent and keep the lights on,” especially because prices continue to rise.[9]

Not only is alleviating poverty the right thing to do, but there are also economic benefits for reducing the rate of child poverty.[10] In fact, the National Academy of Sciences found that “child poverty costs the US between $800bn and $1.1tn each year” due to “lost adult productivity and the increased cost of health and criminal justice spending.”[11]

The safety-net expansions implemented during the pandemic demonstrate how allowing children to remain in poverty is a choice and how we know some ways to end child poverty.[12] Now, it is time to implement policies to end child poverty once and for all.

[1] Melody Schreiber, Child poverty will rise if US withdraws COVID-era benefits, experts warn, Guardian (Mar. 17, 2022) https://www.theguardian.com/us-news/2022/mar/17/us-child-poverty-rate-welfare-measures-expire-experts.

[2] Id.

[3] Id.

[4] Id.

[5] Id.

[6] Id.

[7] Id.

[8] Id.

[9] Id.

[10] Id.

[11] Id.

[12] Id.

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