I’ve seen the joy of a healthy birth and the relief when a complicated labor ends safely. But I’ve also seen the fear—a pregnant person’s blood pressure spiking and a hemorrhage that won’t stop. I’ve seen patients sent home too soon because they didn’t have maternity care coverage for an extra night in the hospital.
Activists talk about reproductive rights as part of the abortion debate, but we need to talk more about what happens after birth. We need a broader discussion about who gets access to healthcare and who gets left to fend for themselves.
The United States has the highest maternal mortality rate of any wealthy nation, and instead of fixing the crisis, politicians cut off postpartum care, ignored social disparities, and forced people into dangerous situations.
The U.S. treats pregnancy as a political talking point—not a healthcare issue.
The Gaps in Maternal Health Coverage
In the U.S., Medicaid covers 42% of all births, making it one of the biggest safety nets for maternal care. But in many states, Medicaid drops patients just 60 days after they give birth. Patients in states that refuse to expand Medicaid face higher rates of maternal death, especially Black and Indigenous women, who already suffer the worst health outcomes.
Let’s be clear about what that means: A Black birther in Mississippi can get through childbirth, hemorrhage at six weeks postpartum, and show up at the ER with no insurance and no access to follow-up care. It means patients suffering from postpartum depression lose coverage before they can even get a therapist appointment.
What’s more, maternity care deserts force pregnant people into dangerous situations, including traveling long distances for care or forgoing it altogether. Between 2006 and 2020, more than 400 maternity wards closed across the country, exacerbating access issues, especially in rural areas.
Black and Indigenous Mothers at Risk
Recent data from the Centers for Disease Control and Prevention (CDC) reveals that in 2023, the maternal mortality rate for Black women was approximately 50.3 deaths per 100,000 live births, nearly 3.5 times higher than the rate for white women, which stood at 14.5 per 100,000.
Indigenous women in the United States face a maternal health crisis that demands urgent attention. According to the Guttmacher Institute, Indigenous women are two to three times more likely to die from pregnancy-related causes than white women. Additionally, the Centers for Disease Control and Prevention (CDC) reported in 2020 that 50% of pregnancy-related deaths among American Indian or Alaska Native women occurred between 7 and 365 days after birth, underscoring the critical need for extended postpartum care.
These statistics expose bias and unequal access to quality care. Many of these deaths are preventable, yet the healthcare system often fails to provide adequate support and intervention.
What Needs to Change? (And What You Can Do)
We don’t need more “task forces” or performative concerns about maternal health. We must ensure that this important data continues to be collected.
I recently wrote to my Arizona Senators to let them know that this is an important issue for me as their constituent. Maternal Mortality Review Committees (MMRCs) are multidisciplinary groups organized at the state level that review and report on all deaths that occur either during or within one year of a pregnancy. The Omnibus Bill has not moved at the federal level.
Substantive changes that we need include:
1. Extend Postpartum Medicaid Coverage to 12 Months Nationwide
Currently, Medicaid provides coverage for only 60 days postpartum in many states. Extending this to 12 months is crucial, as nearly half of maternal deaths occur within the first year after childbirth. The American Hospital Association supports this extension, emphasizing that maternal healthcare extends beyond six weeks postpartum.
2. Hold Healthcare Institutions Accountable for Racial Disparities
This means publicly reporting racial disparities in maternal outcomes, ensuring hospitals implement bias training that actually changes patient care, and enforcing penalties for facilities that ignore life-threatening symptoms in Black and Indigenous patients. No more silent deaths. No more unchallenged failures.
3. Expand Access to Midwives, Doulas, and Culturally Competent Care
Integrating midwives and doulas into maternal care has been shown to improve outcomes, particularly for women of color. The American Medical Association recommends increasing access to such care providers to address disparities in maternal health outcomes.
4. Implement Universal Paid Family and Medical Leave
The United States is one of the few high-income countries without universal paid family and medical leave. The American Academy of Pediatrics advocates for universally available paid family and medical leave, highlighting its importance for improving health outcomes for children and families.
Maternal Health Is a Reproductive Justice Issue
The U.S. talks about pregnancy as if giving birth is the hardest part, but surviving the healthcare system is even harder.
We must hold the people elected to represent us accountable for the necessary work of improving maternal health in this country. Coverage must be expanded, racial disparities eliminated, and policies and systems dismantled that harm the most vulnerable among us. We cannot remain silent while watching policymakers strip away rights in the name of family values.
No one should have to fight to survive childbirth. No one should have to beg for postpartum care. If we care about maternal health, we need to fight for healthcare, coverage, and dignity—for everyone, not just those who can afford it.
