The impacts of the Black maternal health crisis in the United States are hitting home, both in the lives of Black women and their families and in the states in which they reside. Black women are about three times more likely to die from a pregnancy-related cause than White women. This disparity is driven by structural racism, which is deep-seated in reproductive health care and economic policies at all levels of government. Restrictive state laws governing bodily autonomy and reproductive health care access have disproportionately harmful impacts on Black women.  

Forty-five percent of the population of Black women and girls under the age of 55 live in states that have heavy abortion restrictions or total bans. So, it isn’t surprising that maternal death rates in abortion- and reproductive health-restricted states are 62 percent higher than in states with abortion access. Why, then, are Black mothers in states that otherwise lead in health care, education, and income still suffering more?   

Because even state legislatures that haven’t actively pursued harmful reproductive health legislation have too often been negligent (at best!) on this issue. In truth, legislative inaction is also a failure to protect women from pregnancy-related fatality. State governments ought to take more seriously their power to improve Black maternal health outcomes.  

The humanity and dignity of Black women should be enough to prompt urgent state policy action. But money talks, too. As states fight to remain competitive in the national economy, the choices that legislators make on maternal health and reproductive freedom have economic consequences as well. As a result of the Dobbs decision, “about 40 percent of Black women of reproductive age say they feel less safe, think about the risk of death if they become pregnant, have considered moving to states with access to full reproductive care, and are unsure whether or not they will even have children,” according to a recent poll by In Our Own Voice. Polling conducted by IWPR shows that 76 percent of students prefer to attend school in a state where abortion is legal and accessible, and 100 percent of parents who contribute financially to their children’s education say the same. Obstetricians and medical professionals trained to manage high-risk pregnancies are leaving states with restrictions on reproductive health care, and maternal care deserts are forming in their wake. Protecting and expanding abortion access is just one way states could attract and retain residents within their own borders while extending life-saving reproductive health care to mothers in need. 

Expanded access to abortion and miscarriage care is critical for so many mothers with pregnancy complications, but states can and should go further to address the quality and accessibility of a broad range of maternal health services for Black women. Since 40 percent of births in the US are covered by Medicaid, and 53 percent of pregnancy-related deaths occur up to one year after giving birth, the Biden Administration and Congress made it possible for states to extend Medicaid coverage from two months to one year postpartum. Extended coverage keeps women with low incomes connected to care when they are most vulnerable to pregnancy-related complications and death.  

So far, 45 states and the District of Columbia have opted to extend Medicaid coverage to one year postpartum. Of the five remaining states, Nevada and Idaho are planning to implement the 12-month extension, and Iowa and Wisconsin have legislation pending approval. Notably, Governor Sarah Huckabee Sanders of Arkansas insists the extension isn’t needed in her state, which had the highest maternal mortality rate in the country from 2018 to 2020. 

Alarming maternal mortality rates in New Jersey, where abortion is protected and Medicaid is extended, confirm these policy solutions alone are not enough. Despite ranking high nationally on health care, education, and income, New Jersey ranks 47th for its maternal infant mortality rate—among the worst nationwide. Black women in New Jersey die from pregnancy-related causes at 7.6 times the rate of White women. The Garden State boasts world-class hospitals, yet not all mothers have equal access to them.  

In response to the worsening state of the Black maternal health crisis in New Jersey, First Lady Tammy Murphy launched “Nurture NJ,” a strategic plan to reduce maternal mortality by 50 percent over five years and to eliminate racial disparities in birth outcomes statewide. The plan makes a series of recommendations, including examining standards of care for maternal and infant care, promoting workforce recruitment and retention in communities of color across executive health, higher education, and labor agencies, funding comprehensive family planning services, and affirming the right to reproductive autonomy.  

Even when Black mothers receive care at the best institutions, medicine is not immune to the impacts of structural racism. Racism is a public health crisis and a key contributor to poor and disparate maternal health outcomes for Black women. To improve the quality of care for Black mothers and promote patient-provider trust, states should implement requirements for anti-racism bias training for medical professionals, as well as diversify the perinatal workforce. The better trained medical professionals are to listen and respond to the needs and experiences of their patients, the better equipped they are to provide those patients with equitable care.  

States urgently need to step up to curb Black maternal mortality rates and improve maternal health outcomes overall, and IWPR has outlined the path forward. The lives of Black mothers and their infants depend on it. So does the competitive edge for states positioning themselves as destinations of choice for Black women starting families, students attending college, and future medical practitioners.