On May 6, 2021, Dr. Jamila Taylor, director of health care reform and senior fellow, The Century Foundation, testified before the House Oversight and Reform Committee for their hearing, “Birthing While Black: Examining America’s Black Maternal Health Crisis.” Dr. Taylor’s testimony— which draws from her article in the Journal of Law, Medicine and Ethics, “Structural Racism and Maternal Health among Black Women”—is reproduced below.

Good afternoon, Chairwoman Maloney, Ranking Member Comer, and members of the committee, thank you for the opportunity to testify on structural racism and Black maternal health. I serve as the director of health care reform and senior fellow at The Century Foundation—a 100-year-old progressive think tank that conducts research, develops solutions, and drives policy change to make people’s lives better.

According to the CDC, Black women are dying of pregnancy-related causes more than any other racial or ethnic group. We are also most likely to experience severe maternal morbidity. Poor maternal health outcomes among Black women cannot solely be attributed to social determinants, such as poverty or educational attainment. Rather, structural racism is the main culprit.

Racism cannot be understood as simply interpersonal bias and animus. It is a powerful social condition that has its roots in a centuries-long system of oppression and devaluing of Black people, and Black women, in particular. It not only persists today in our health care policies and practices—it has real, significant impacts on people’s health.

According to the Aspen Institute, structural racism is defined as a system where public policies, institutional practices and cultural representations work to reinforce and perpetuate racial inequity. Much of American history and culture, in which “whiteness” is privileged and “color” is disadvantaged, squarely fits this definition. The Aspen Institute also affirms that structural racism has been a mainstay in the social, economic and political systems in which we all take part. Health care is one of those systems.

Throughout history, Black women have endured abuses by some in the medical profession. Enslaved Black women were forced to undergo experimental surgeries to advance the study of obstetrics and gynecology. Low-income Black women have been subject to forced sterilization. Our bodily pain has been diminished or outright ignored. There are too many examples to list.
These events have lasting implications for the health care challenges Black women face today. Harmful institutional practices and negative cultural representations have led to trauma-inducing pregnancy and birthing experiences, and even death for some women.

This has to change, and, fortunately, it can be done. For one, health care providers must be trained in ways that afford them the opportunity to recognize and address racism and bias in their interactions with Black patients. Practitioners should be equipped to ensure safety protocols and offer quality care that respects and values Black life.

Public policy, which also can perpetuate racial inequity, needs to change, as well. The ground-breaking report Unequal Treatment, published by the Institute of Medicine in 2003, asserted that health disparities not only emerge from how health care systems operate, but also from the legal, regulatory, and policy climate within which health care is delivered.

One example of this is how some policy decisions make it harder for Medicaid enrollees—a program that disproportionately serves women of color—to access the health care they need. Almost half of all births in this country are covered by Medicaid. But for women who enroll in pregnancy-only Medicaid, coverage ends just sixty days after giving birth.

The American Rescue Plan Act takes steps to remedy this shameful policy, by giving states a time-limited option to extend coverage for new mothers up to one year. The act also includes incentives for Medicaid expansion in states that have yet to do so, states which are largely concentrated in the South, where about half of African Americans live. And while both of these provisions are progress, we desperately need long-term fixes to support the health care needs of Black women and birthing people. This means all states expanding Medicaid, mandatory extension of postpartum coverage to at least one year, and passage of the Black Maternal Health Momnibus. Failure to take these steps will only further limit coverage for women of color and perpetuate racial inequity.

We all have a role to play in dismantling structural racism, which is a key contributor to racial disparities in maternal health. It is past time to implement policies and health care practices to ensure quality health care that is equitable and respectful of Black women and birthing people. In addition to my testimony, I will be submitting my article, “Structural Racism and Maternal Health Among Black Women” as published in the Journal of Law, Medicine and Ethics, for the record. Thank you again for the opportunity to testify and I look forward to your questions.