Racial inequities are on full display in light of COVID-19, but they have been drastic pre-pandemic for families of color giving birth. Black women are 3 to 4 times more likely to die due to pregnancy-related issues. Native American and Indigenous women are two to three times more likely to die from complications that are often preventable in childbirth. Nearly 33% of people of color who give birth in hospitals report experiencing disrespectful care of mistreatment.
Maternal deaths were rising in the United States in the early 1990s, which set us apart from the rest of developed and industrialized countries. Then, in 2013, our rates of maternal death more than doubled, and while 700 to 900 new mothers and or pregnant individuals die in the United States every year, more than 500,000 experience life-threatening postpartum complications. Not to mention, more than half of these deaths are from preventable causes. According to the World Health Organization, the odds of surviving childbirth as a woman of color in the United States are comparable to countries where significant populations are in poverty — like Uzbekistan and Mexico.
Another type of racial inequity is the experience of traumatic birth, obstetric violence, and coercion during prenatal care or in labor. Black women are much more likely to have a traumatic birth when compared to white women. Traumatic birth experiences can have severe mental health consequences after the baby is born. A traumatic birth can be the result of experiencing obstetric violence, which still isn’t adequately tracked in Colorado. Obstetric violence could result from disrespectful attitudes from doctors, discrimination from providers and lack of consent for treatment, or coercion to receive care that should have been consented to by the client. The American College of Gynecologists published a committee opinion that discouraged “manipulation (and) coercion” to influence a woman’s treatment decision. While this may offer guidance to practitioners, there is nothing that holds providers accountable to that committee opinion suggestion, and many women of color face drastic examples of obstetric violence and obstetric coercion.
Racial inequities in birth and pregnancy-associated death have placed the United States in the group of only a handful of countries where the maternal mortality rate (and other racial inequities) has worsened for the current generation in comparison to women birthing 25 years ago. Women of color face widespread discrimination within the maternity care field. Doulas, who are trained to support birthing people emotionally, physically, and spiritually have helped to reveal how doctors (OB-GYNs) often justify acts of obstetric violence simply by feigning paternalists worry and falsely claiming that either mother or infant was in danger. For many women of color, the news of a pregnancy or a baby can evoke immense fear — because they are aware of how treatment teams may disregard their wishes and concerns.
Colorado deals with other inequities in pregnancy and childbirth. We know our families who are incarcerated deal with a whole other set of challenges when it comes to getting prenatal education, the labor support, and the postpartum care they and their baby need to ensure a healthy beginning to that child’s life. In 2018 Diana Sanchez gave birth in her jail cell, alone. She screamed for help in labor and no one attended to her for hours. Even though that story got national attention, and a federal lawsuit was filed against Denver Health Medical Center, reaching a settlement two years later, there is still not an accountability process to track obstetric violence that Sanchez endured to hold providers accountable. It remains up to the client to file a lawsuit if things go horribly wrong.
These are all reasons why Colorado needs a human rights approach to maternity care. A human rights approach to maternity is a vision and practice among our greatest racial equity leaders in maternal health, including Black Mamas Matter Alliance, Elephant Circle, The World Health Organization, United Nations of Human Rights, and others.
Colorado needs legislation to protect and ensure quality care through a human rights approach for birthing families. A great model is the federal Momnibus bill package, which addresses intersectional issues that impact maternal and infant health, such as housing, substance misuse, veteran moms, mental and behavioral health, and other factors that impede maternal health. This federal bill package takes a human rights approach to maternity care, and its champions, like Congresswoman Lauren Underwood, and former Senator, now-Vice President Kamala Harris, knew that is exactly the approach that families need to address inequities.
We need a maternity care bill package that has a human rights approach to maternity care for Coloradans, particularly now at this point in history with COVID-19 worsening circumstances for birthing families of color.