At Monday’s 2020 Iowa Brown & Black Presidential Forum in Des Moines, one question kept coming up: “What do you all do to save our lives?”
That's how Lastascia Coleman, a founding member of the Black Women's Maternal Health Collective, put it. And other audience members and moderators also asked their own versions of it to the Democratic candidates at the minority-focused event.
Across the United States, black women are three to four times more likely than white women to die during pregnancy or childbirth. But in Iowa, where VICE News presented the forum, the danger facing black women is even more extreme. They may be as much as six times more likely to die while pregnant than white women, according to a recent study from the Iowa Department of Public Health.
Not all of the candidates’ answers were created equal; some were far more eloquent and specific than others.
Colorado Sen. Mike Bennet, the first candidate to take the stage, was also the first to be asked about the crisis. He told an audience member that he wanted to expand health care in general, and initially tried to link the high rates of black maternal mortality to economic inequality. He told the audience, “The poorest people always had the shortest end of the stick, and people of color have even the shorter end of the stick and women of color have an even shorter end of the stick.”
American maternal mortality rates are more than three times higher than those in Canada or the United Kingdom. (Those two countries also far spend less on health care.) But no matter their social class or level of education, the risks of dying remain disproportionately high for black expectant and new moms. In 2016, the New York City health department reported that college-educated black mothers are more likely to have severe complications from pregnancy or childbirth than white women who didn’t graduate from high school.
The "weathering" effect
Research indicates that a constellation of factors contribute to these deaths. Some are explicitly related to the healthcare system, like the fact that black women are more likely to give birth in hospitals that have higher rates of complications. Others, however, are due to the daily and cumulative stress of racism and sexism, a phenomenon known as “weathering” that might even lead black women’s cells to age faster than white women’s.
When the audience member reminded Bennet that the maternal mortality rates have been adjusted for socioeconomic status, Bennet pivoted to talking about how “our whole system” is shot through with racism.
At the beginning of the 2020 Democratic primary, more candidates had stronger records on the crisis. California Sen. Kamala Harris was the lead sponsor of the Maternal CARE Act, which devotes millions of dollars to fighting racial bias in health care; New Jersey Sen. Cory Booker introduced the MOMMIES Act to expand Medicaid coverage for pregnant women. (Neither bill has moved out of committee in the Senate.)
But Harris and Booker have since given up on their White House 2020 dreams. Massachusetts Sen. Elizabeth Warren, who co-sponsored both bills, remains in the race, as does Vermont Sen. Bernie Sanders, who lent his support to Harris’ legislation.
At the Brown & Black forum, Sanders agreed that he would expand access to health care in general. When asked about why he doesn’t have a plan to solve the crisis, unlike his rival Warren, Sanders said he does have one: his signature piece of legislation, Medicare for All.
“We need a health care system which has a simple function, and that function is to provide healthcare to all people as a human right, not make billions of dollars in profit for the healthcare industry,” Sanders went on. “When you are running a nonprofit system designed to provide healthcare to all, you’re gonna focus on some of the major crises.”
Medicare for All, he added, would also empower more people of color to become health care providers.
More black doctors
“We do not have enough black doctors, we do not have enough black psychiatrists, psychologists, nurses,” Sanders said. “Under Medicare for All, what we will do is make sure that people can go to medical school and practice the kind of medicine that needs to be practiced without going deeply into debt.”
Throughout the forum, Yang kept bringing his answers back to his plan of giving all Americans a Universal Basic Income, or guaranteed monthly payments of $1,000 to everybody over 18. Though he didn’t namecheck the “UBI” in his answer to questions about the deaths of black moms, Yang was clearly still thinking along the same lines.
“Unfortunately, it’s just more stressful being black in this country than it is being white,” Yang told the crowd. “We make it so that if you’re growing up brown and black in this country, you can still feel like you can make ends meet, your future is secure, you’re less stressed out day to day. And hopefully we can close the disparity between health outcomes of black and white people in this country.”
Yang, Minnesota Sen. Amy Klobuchar, and former South Bend, Indiana Mayor Pete Buttigieg also dove into the need to address racism among healthcare professionals, saying the next president should implement training and standards to fight implicit bias.
Such prejudice is also thought to contribute to the maternal mortality crisis among black moms. More than a third of black women surveyed by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health said that health care providers had discriminated against them because of their race.
Buttigieg, in particular, promised to enact policies that would force “nakedly racist” doctors out of work. He also mentioned many of the themes central to the black women-led “reproductive justice” movement, which pushes not only for access to abortion, but for the right of all people to choose when and how to parent in safe, prosperous communities.
“We gotta make sure that we’re dealing with stuff like environmental justice,” Buttigieg said. “Before you even get to the clinical environment, the fact that you may have been red-lined into a neighborhood where there’s more contamination or more air pollution — we’ve seen the statistics on things like asthma, and how much more of a threat that is to black and brown children — means that we gotta be acting literally on the safety of where you live.”
Buttigieg went on, “This is systemic. The harm is systemic. The racism is systemic. Therefore, the solutions have to be systemic.”
Cover: This picture taken on January 21, 2009 shows a Kenyan baby named after US President, Barack Obama, in the arms of his mother Caroline Akinyi, born shortly after the inaguration of the first black US president, at the new Nyanza general hospital in Kisumu. AFP PHOTO/ SIMON MAINA (Photo credit should read SIMON MAINA/AFP via Getty Images)