Credit: National Partnership for Women & Families

America’s maternal health system is failing everyone, but it’s failing Black and Indigenous mothers hardest.

A national maternal health survey found persistent themes of lack of respectful care, unaddressed mental health conditions, low-value care, and racial disparities, with Black and Indigenous moms and pregnant women enduring the brunt of inequities. The results are from the National Partnership for Women & Families Listening to Mothers survey of moms and pregnant women about their prenatal, perinatal, and postpartum experiences, in partnership with Black Mamas Matter Alliance (BMMA) and Moms Rising.

And the data spotlight a maternal health system that is failing to meet all women’s childbearing needs and choices and one ripe with racially-driven outcomes.

Pregnant women and mothers discussed their childbearing experiences across measures such as perinatal care, agency, respectful care, and mental health.

Racial disparities were stark among respondents who experienced mental health symptoms such as depression: 38 percent of American Indian and Alaska Native (AIAN-NHPI) respondents and 35 percent of Black respondents were more likely to indicate depression symptoms in pregnancy than 18 percent of Latina respondents and 18 percent white respondents.

“The survey results tell us we have a system that is failing everyone and not failing everyone equally: people of color, people with disabilities, and people paying with Medicaid,” Nan Strauss, lead report author and Senior Director of Maternal Health at National Partnership.

This is National Partnership’s fourth Listening to Mothers survey of women’s childbearing experiences, which the 55-year-old organization describes as the “largest research instrument to provide quantifiable information about pregnancy, childbirth, the postpartum period, and infancy as described by new mothers themselves.”

A health coverage gap

Report authors noted several persistent failures in providing high-quality care, such as critical prenatal visits, shown to improve mother and child outcomes and result in lower hospital admissions; or providing doula support, which helps ensure birthing mothers have agency and, according to Black Mamas Matter Alliance, is a key factor in birth justice.

One respondent said she did not have a prenatal visit until one week before her delivery “because of health insurance issues.”

Such missed opportunities were due to health insurance type in some cases. And the survey data revealed a private insurance and Medicaid disparity, showing respondents who are covered by Medicaid frequently had worse results than respondents with private insurance, perpetuating barriers to accessing high-quality care.

For instance, bodies of research show that women Medicaid beneficiaries are less likely to have prenatal visits in the first trimester or receive adequate care. And regarding mental health symptoms, Listening to Mothers survey data show that 29 percent of respondents with Medicaid were more likely to indicate symptoms of depression compared to 13 percent of those with private insurance.

However, Medicaid narrows a health coverage gap for Black women, who are three times more likely than white women to experience a pregnancy-related death, and American Indian and Alaska Native women are two to three times more likely than their white counterparts to experience maternal morbidity or mortality.

States have acted to lower maternal morbidity and mortality rates and improve perinatal health care reduce by using person-centered care models such as group prenatal care, pregnancy medical homes, and enhanced coordination of data collection and oversight.

Effective policy solutions are at risk

Medicaid expansion has proven to help improve maternal health care by increasing access to prenatal and postpartum care and lowering maternal mortality rates. The District of Columbia along with forty-nine states extended Medicaid coverage from 60 days to 12 months postpartum.

And federal level action includes expanding maternal mortality review and investing $18 million in Health Resources and Services Administration’s Maternal Health Innovation Program, a community-based perinatal support program established in part to improve state-level data collection and “increase access to care that is comprehensive, high-quality, appropriate, and on-going before, during, and after pregnancy.”

However, report authors fear maternal healthcare advances are now in peril following recent scale-back efforts. Even though America leads wealthy nations in maternal mortality—80 percent of which are preventable according to federal government’s own data (now archived)—the Trump administration has shaved maternal health programs, and reduced investments in federal maternal health data and workforce. Such policy moves signal additional Administration rollbacks; and some states have responded by restricting doulas and midwives from providing care. Birth centers have also been targeted by new regulations, contributing to maternal deserts, which are increasing in number according to a 2024 March of Dimes report.

Despite changes in regulations and looming additional threats to care, states such as Virginia are moving forward, passing bipartisan Momnibus legislation last April to support high-risk mothers, increase access to maternal mental healthcare screenings, and enhance the tracking and reporting of pregnancy complications, according to Gov. Abigail Spanberger’s press release about the bills.

“These new laws make sure mothers can get the care they deserve and children have the best start in life,” said Senator L. Louise Lucas, Co-Chair, Virginia Black Maternal Health Caucus. “Too many mothers, especially Black mothers, are facing life-threatening and high-risk childbirth. Virginia’s maternal mortality rate is one of the highest in the nation. By getting this legislation signed into law, we are fulfilling a moral duty today to protect mothers and their children from harm.”

The Listening to Mothers survey findings emphasize how critical policy interventions are to improve outcomes and increase equity.

The data also underscore the successes in jeopardy as the number of U.S. pregnancy-related deaths increase and racial disparities continue to influence maternal health experiences and outcomes.

“The system is failing everyone who is going through it. Even those who fare the best, the outcomes are absolutely unacceptable. The system needs an overhaul to implement solutions that work and that mothers want,” Strauss said.

Read more about the Listening to Mothers survey

Report

 Share your childbearing experience story

 Read about Tatyana Ali’s birthing experiences and the importance of listening to mothers

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