The end of Roe v. Wade adds uncertainty to the black maternal health crisis

When Maya Jackson gave birth to her first child, she was in a room full of strangers, surrounded by doctors-in-training and hospital staff.

For Jackson, birth is an intimate moment and space—not a place for medical residents.

“I felt like my birth was made to be a spectacle against the people who were actually paying attention to me while they were caring,” she said.

Jackson, who requested a natural birth process, said hospital staff wanted to watch because they had never seen anyone give birth naturally. She felt that the staff were neglecting to carry out their regular duties to ensure her safety.

After giving birth to her child, Jackson was unknowingly hemorrhaging for over an hour.

“I heard this pop that just came from under me, I called the nurse and it took them about an hour and a half, two hours to come in to check on me,” she said. “And then she realized it was blood.”

After that experience—as well as after a second hospital birth with a midwife—Jackson developed white coat syndrome, which is when blood pressure rises while in a medical clinic or hospital but reads normal otherwise.

For her third and fourth children, Jackson chose to work with a birth center and doula instead of a hospital. She said she finds this environment more loving and affirming.

Because of her experience, Jackson founded Mobilizing African American Mothers Through Empowerment (MAAME).

MAAME is a not-for-profit, community-based, maternal health organization serving Black, Indigenous and people of color who give birth. They also support LGBTQ+ and low-income birthing people and their families in the Triangle.

Along with this care, MAAME trains doulas to serve and educate the community about maternal health care.

Jackson said she personally decided to become a doula to help other families of color navigate the health care system in a way that would be culturally competent, trauma-informed and affirming.

MAAME works to combat the black maternal health crisis that exists because of institutional racism in the maternal care system, she said.

Inequality in maternal health

Black women are three times more likely to die from a pregnancy-related cause than white women, according to the Centers for Disease Control and Prevention.

Racial disparities also persist in infant mortality rates. The death rate for black infants is 2.5 times that of white infants, according to a 2022 report by the North Carolina Child Mortality Task Force.

Also, women of color are more likely to have symptoms that are dismissed by doctors, said Caitlin Williams, a doctoral student in the Department of Maternal and Child Health at UNC’s Gillings School of Global Public Health.

They said this dismissal can occur regardless of socioeconomic class and can cause near-fatal or even fatal birth experiences.

Williams said there are many ways to increase maternal health equity at both the state and federal level — such as expanding Medicaid in North Carolina.

Nationally, the Black Maternal Health Momnibus Act, introduced in 2021, will direct multi-agency efforts to improve maternal health, particularly among vulnerable populations.

Williams noted that they were one of the experts consulted on the bill.

“We need to diversify our health care workforce to make sure we have people delivering care who understand where their patients are coming from, in a real personal way, right?” she said.

Consequences of Roe v. Wade

Williams, who studies how policy changes affect access to health care, said overturning Roe v. Wade would create greater maternal health inequity for low-income people and people of color.

Jackson described Roe v. Wade as “a Band-Aid on a wound that was already festering.”

Rebecca Kreitzer, associate professor of public policy at UNC, said that although abortion is still legal in the state, North Carolina is starting to see ripples from the overturning of Roe v. Wade. That includes an influx of out-of-state patients, she said, which can make it difficult to schedule appointments.

Gillian Riley, NC director of public affairs for Planned Parenthood South Atlantic, said a third of Planned Parenthood’s North Carolina patients come from out of state.

Riley said he expects the number of out-of-state patients to grow as surrounding states continue to change their abortion restrictions.

Both Kreutzer and Williams said that while the end of the constitutionally protected right to abortion currently has no legal impact on NC, it could in the future.

Under North Carolina state law, abortions are prohibited after 20 weeks except to save the life or health of the mother.

However, the 2016 case Bryant v. Woodall ruled that the ban was unconstitutional because the 20-week marker is several weeks before a pregnancy is considered medically viable. In 2019, a district court issued an injunction preventing the state from enforcing its 20-week abortion ban.

On July 21, North Carolina Attorney General Josh Stein announced that the North Carolina Department of Justice would not overturn the injunction in Bryant v. Woodall.

“I don’t know what is a medical emergency or not,” Williams said, noting what health care providers might think when faced with a difficult case. “How nearly dead does someone have to be before we’re allowed to act? It’s probably better for me to just not provide care after 20 weeks so I don’t get sued and maybe have my license revoked.’

Kreitzer said cases after 20 weeks make up less than 1 percent of abortions and are usually done because of extreme factors, such as fetal abnormalities or risks to the mother’s health.

Alice Cartwright, a doctoral student in the Department of Maternal and Child Health at UNC, said the full impact of the U.S. Supreme Court overturning Roe v. Wade on people who have miscarriages remains to be seen.

@msingleton42

@DTHCityState | [email protected]

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