Where the Safety Net Won’t Catch Us: How Obamacare Fails Black Women on Maternal Health

The third article in the Echoing Ida health care series is by Elizabeth Dawes Gay, published at RH Reality Check. Her article addresses the major challenges facing Black women when it comes to maternal health, and the ways in which the ACA may fall short in addressing them.

I am what I like to think of as a “young and fun” 20-something. I am a healthy young adult with a decent education and income, and I feel safe in my neighborhood. But the growing sense of my own mortality haunts me. Specifically, what haunts me is that I am a Black woman living in the United States, and I hope to create a family by giving birth some day. As a reproductive health advocate, and someone who is particularly interested in maternal health, I am all too aware of the weight of the evidence against me. When it comes to seamless and successful conception, pregnancy, childbirth, and recovery, the odds are not in my favor.

I am the product of a nation in which Black women—regardless of their income or education levels—are more likely than their white counterparts to experience poor pregnancy outcomes.

• Overall, the rate of maternal mortality among Black women is three times that of white women (28.4 per 100,000 live births and 10.5 per 100,000 live births, respectively).
• The rate of maternal mortality among Black women in New York City, at 79 per 100,000 live births, is worse than that of some of the most under-resourced countries.
• Black women are also more likely to give birth prematurely and to have infants with low or very low birth weight.
• Black women are two times more likely to suffer from severe maternal morbidity than their white counterparts.

Racial disparities in maternal health outcomes are intolerable; yet, they have been tolerated for decades. So while reproductive health, rights, and justice advocates celebrate the October 1 launch of open enrollment in the health insurance marketplace, I cannot help but reflect on how the Patient Protection and Affordable Care Act (ACA) fails me and so many women just like me.

It’s fantastic that ACA will put access to health care in the hands of millions more people and provide important preventive services and products, such as contraception, at no cost to the person seeking care. The renewed commitment to preventive health services via the ACA is important and should be celebrated, but not overestimated. While improving access to prenatal health care and maternal health services, ACA ignores the social, economic, and psychological factors outside of the health system that affect health and pregnancy outcomes. These factors are known as social determinants of health.

Read Elizabeth's full article here.




Echoing Ida is a Strong Families project that uplifts the voices of Black women in the reproductive and social justice movements. Our writers have been published in online media outlets as part of our campaign to provide historical, critical, and candid perspectives on health care just as the Affordable Care Act is rolling out.