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Louisiana: A Dangerous Place for Black Women to Become Pregnant or Give Birth

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Vanessa Lopez-Littleton & Carla Jackie Sampson
September 2, 2022

The overturning of Roe v. Wade brings with it the harsh reality that more Black women and infants may lose their lives in the state of Louisiana. The combination of the post-Roe era and structural racism contribute to a deepening of the maternal health crisis experienced by Black women in the state.

Throughout the United States, but particularly in Louisiana, pregnancy and childbirth are life-threatening events for Black women. In the healthcare setting, barriers to a successful pregnancy include provider bias, no or poor insurance coverage, and the lack of access to culturally responsive and skilled care. Providers tend to dismiss the concerns raised by Black women or label them as non-compliant or combative when they advocate for themselves. In community settings, economic instability, access to quality education and poor neighborhood conditions contribute to the disadvantage. In sum, Black women are at an increased risk of poor pregnancy outcomes.

In the United States, Black women are four times more likely to die from pregnancy-related complications than white women. From 2011-2016, the Black maternal mortality rate was 22.8 deaths per 100,000 live births, while the rate for White women was 5.6.

The same is true for Black infants. In 2019, almost twice the number of Black babies in Louisiana did not see their first birthday. That year, according to the most recent data available, the mortality rate for Black infants was 11.3 deaths per 1,000 live births compared to 5.8 White infants. According to the CDC, most maternal and infant deaths are preventable.

Compared to other nations, the United States is a dangerous place for Black women to give birth. Black women experience birth outcomes similar to those in lower-income countries (e.g., Libya, Tunisia and Armenia). The danger looms large in Louisiana, where reproductive health outcomes for Black women and infants are the second-worst in the nation. Individual risk factors and behaviors account for some of the poor outcomes, but any known combination of factors does not fully explain the difference in birth outcomes.

To be clear, it is not that an individual does not have any responsibility for their health outcomes. Health disparities are linked to social, economic and environmental disadvantages beyond the individual’s control. In other words, genetics and health behaviors do not explain the difference either.

Black women in Louisiana deserve access to quality healthcare services and the full suite of healthcare options to provide them with the best chances for life, liberty and the pursuit of happiness. Without systemic change, Black women will continue to be denied fundamental rights that could improve their life chances and contribute to the state’s overall climate, economy and culture. The experience of Black women is one clear example of how Black women have been devalued, overlooked and disregarded in United States society.

Some public officials summarily dismiss calls for health equity by suggesting that equity is a form of reverse discrimination. How else do you correct historic wrongs and neutralize the impact of generations of bias and prejudice? In this regard, Louisiana officials are missing a prime opportunity to make an important difference in the lives of its residents.

Health equity requires an unbiased consideration of the history of subjugation coupled with the reallocation of power, opportunities and resources. Herein lies the problem—ceding power. Working towards health equity is not a zero-sum game; in fact it is the contrary. Creating conditions where Black women can do more than merely survive will undoubtedly improve conditions for everyone. Yet, through the perpetuation of race-neutral policies and entrenchment of structural racism, Black women are being erased.

Elected officials should not be allowed to explain the poor outcomes by suggesting there are a large number of Black people in the state, or negate the pertinence of racism. By downplaying these realities, Louisiana officials are derelict in their duties, exacerbating the damage and ignoring a prime opportunity for meaningful change. Thus, a pro-life stance in favor of Black women would make a powerful statement about the value of the sanctity of human life.

Instead of dismissing the disparate impact of health inequities experienced by Black women, the state of Louisiana must purposefully work to create and sustain a systemic approach to addressing the complex issue of Black women’s health by considering the effects of racism and bias. This policy issue should not be left to elected officials. Instead, public health officials and public service professionals need to develop and implement place-based strategies in communities across the state to improve outcomes and the well-being of Black women and infants.

From our perspective, it is critical that Louisianans grapple with the harsh reality that the playing field is not level and that historic and current laws and practices have created insurmountable barriers to accessing quality health care services. Without that acknowledgment followed by equity-driven strategies, the outcomes for Black women will continue to illustrate that it is dangerous for them to become pregnant or give birth in Louisiana.

Learn more about potential interventions to improve Louisiana’s maternal and infant mortality rates here.


Author: Vanessa Lopez-Littleton, Ph.D., RN, is an Associate Professor at California State University, Monterey Bay, Chair of the Health, Human Services, and Public Policy Department, and Chief Assistant to the Dean for the College of Health Sciences and Human Services. She is the Chair of the ASPA Section on Democracy and Social Justice. Her research interests include social determinants of health and racial equity. Dr. Lopez-Littleton may be reached at [email protected], DrVLoLil.Com or @DrVLoLil

Author: Carla Jackie Sampson, Ph.D., MBA, FACHE, is a Clinical Associate Professor and Director of the Health Policy and Management Program and online Master of Health Administration Program at NYU’s Robert F. Wagner Graduate School of Public Service. She is the editor of Frontiers of Health Services Management, and co-editor of Human Resources for Healthcare Management: Managing for Success.  Her research interests include healthcare workforce policy and management, social determinants of health, and anchor mission strategy development. She may be reached at [email protected] or @ProfessorSamps1

 

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