COVID-19 Exposed Racial Inequities in Reproductive Health
By Eilisha Manandhar, Sophie Brown, Lois McCloskey | June 9, 2022
The current Dobbs v. Jackson Supreme Court case has raised the visibility of the fight over abortion rights. As reproductive justice leaders of color have long stressed, abortion rights are only a piece of the broader reproductive health challenges people face in the United States. These challenges are even more apparent today, as the COVID-19 pandemic exposed the gaps in the health care and public health systems that have left women and birthing people, especially Black, Indigenous, and people of color (BIPOC), behind for generations. COVID-19 has proven that the demand for comprehensive and accessible reproductive health care does not lessen during a time of crisis. The pandemic underscored: the critical need for holistic support during and after pregnancy, the need to protect and increase access to abortions services, and the need to address racial and geographical disparities in birth and maternal health outcomes.
COVID-19 and pregnant people’s need for support
A pregnant person’s mental health status is critical because it directly impacts the health of the pregnancy and of the baby. Maintaining mental wellbeing amid a global pandemic, economic crisis, and social unrest, while being pregnant was more than simply challenging. Birthing people had to navigate being disconnected from their crucial support systems and services, like friends, family, daycare, and school. Stay-at-home and social distancing measures also worsened rates of abusive relationships and domestic violence. These factors amplified stress on birthing people and increased the risk of negative birth outcomes, such as preterm birth and maternal mortality. The negative outcomes were even greater for BIPOC birthing people, who already experience disproportionately negative birthing outcomes due to the impacts of systemic racism.
Birthing people and their families also felt unsupported in the labor and delivery process. Hospitals limited the number of people who could be present during labor and delivery, leaving many birthing people isolated. While unavoidable at the height of the pandemic, these restrictions highlighted the necessity of support during childbirth. Doulas could close this gap through the individualized assistance they provide clients. In response to the isolation imposed by hospitals, interest in out-of-hospital births rose, increasing the demand for midwifery services. Certified Professional Midwives were stretched to their limits, driving many states to lift restrictions on midwifery practice, allowing Certified Nurse Midwives to practice independently.
Permanently removing these restrictions in all states would benefit practicing midwives and increase access to these resources for communities who deeply mistrust medical providers due to the impacts of medical racism.
COVID-19 endangered access to abortion care
One of the most striking lessons from the pandemic was how easily a crisis can be used to push political agendas, even against public health guidelines. Many states attempted to halt all abortion procedures during stay-at-home orders, arguing that they were non-essential medical procedures. These actions forced pregnant people to forgo or delay abortions, or to travel to other states for care, increasing their COVID-19 exposure risk. Though courts eventually blocked these executive orders, they underscore the political power held by those who deem abortions merely elective. This belief, along with the unchecked limitations imposed by Mississippi only a few years ago, have emboldened states to enact stricter abortion restrictions, like those in Texas, Idaho, and Oklahoma that ban all abortions after six weeks of pregnancy, and those in Kentucky, Arizona, and Florida that ban all abortions after 15 weeks of pregnancy.
While the pandemic prompted greater use of telehealth, access to medical abortion remains restricted. Despite evidence to support the safety and efficacy of accessing medication abortion through telehealth, no states have implemented changes to increase or protect access to abortions via this method, while 28 states require at least one in-person visit with a provider to access medication abortion.
Where Do We Go from Here?
As we continue to navigate the pandemic and seek to rebuild, coordinated action at the federal level is needed to address racial, ethnic, and geographical disparities in birth and maternal health outcomes. The following policy proposals could make a difference;
Pass the Black Maternal Health Momnibus Act
The Black Maternal Health Momnibus Act of 2021 is a bill package that contains multiple pieces of legislation designed to address maternal health disparities and promote maternal health equity. In addition to the interventions listed below, the Black Maternal Health Momnibus Act would create a task force made up of federal agencies to coordinate efforts to address maternal health disparities.
Address Maternal Health Disparities and the Impacts of Racism
- Invest in community-based organizations to improve Black maternal health outcomes
- Initiate a study to determine how to prevent bias, discrimination, and racism in maternal healthcare
- Provide funding to form maternal mortality review committees in local communities
Expand Telehealth Coverage
- Integrate telehealth coverage into all federal insurance programs
- Provide grants to increase the use of technology and telehealth in maternal healthcare
Address Social Determinants of Health
- Create housing grants for pregnant people
- Extend Supplemental Nutrition Assistance Program benefits to 24 months postpartum
- Create additional grants for childcare services
Increase Access to Doulas and Midwives
If we truly want to improve maternal health outcomes, then it is crucial that we also increase access to support systems, such as doulas, Nurse Midwives, and Certified Professional Midwives.
- The Midwives for MOMS Act, would expand educational opportunities for midwives across the country and build up the midwifery workforce
More is needed, such as pay equity for midwives, and the removal of state restrictions that limit midwives from providing their full scope of practice to birthing people.
The impact of the pandemic on women’s mental health will be long lasting. A comprehensive plan of action includes increasing access to mental health services, the number of BIPOC mental health providers, screening during and after pregnancy, and education around postpartum depression and stigma associated with mental health. The Moms Matter Act, introduced in the Senate in early 2021, would clearly address these issues by establishing grant programs to address maternal mental health and substance use disorder.
Protect & Expand Abortion Rights
To protect everyone’s access to the full scope of reproductive health services, the United States needs to pass legislation that protects the right to abortion for everyone, in all 50 states. The Women’s Health Protection Act of 2021 would do just that, along with protecting the rights of healthcare providers to provide abortion services. Access to medication abortion through telehealth and mail services would also greatly increase abortion access. In December 2021, the FDA updated their regulations to allow abortion drugs mifepristone and misoprostol to be prescribed without having to see a provider in person, meaning that these drugs can be prescribed via telehealth and mail services in any states that allow it. Federal legislation to ensure access to these drugs would benefit everyone and prevent states from passing laws that ban telehealth abortion services.
The COVID-19 pandemic unveiled the impact of systemic and medical racism and its impact on BIPOC women and birthing people. Centering and improving the experience of BIPOC women and birthing people will inherently improve the conditions for all birthing people. It is crucial that we support the work of BIPOC reproductive justice leaders and advocates who have been trying to gain national attention for these issues for decades.
Lois McCloskey is Chair ad Interim of the Department of Community Health and Director of the Center of Excellence in Maternal and Child at the Boston University School of Public Health.
Eilisha Manandhar (MPH, Boston University School of Public Health) is the Senior Association Director of Hunger Prevention for the YMCA of Greater Boston.
Sophie Brown (MPH, Boston University School of Public Health) is a Junior Consultant with the Public Consulting Group.