Introduction
Maternal mortality in the United States remains unacceptably high, especially among Black
women and birthing people. Despite significant advancements in medical care, Black
birthing people continue to experience disproportionately high rates of death and severe
complications associated with pregnancy and childbirth. This disparity is rooted not in
biological differences but in social justice issues such as structural racism, inequitable access
to care, implicit bias, and intersecting systems of discrimination. As a social worker in a social
justice agency, it is imperative to critically assess this issue, analyze its impact on affected
populations, examine ethical and policy dimensions, and consider advocacy strategies that
drive sustainable change.
Chosen Social Justice Issue and Its Significance
The chosen social justice issue is the disproportionate incidence of maternal mortality and
severe maternal morbidity among Black birthing people in the United States. This is a
significant concern because non-Hispanic Black women die at rates three to four times
higher than non-Hispanic White women, even after adjusting for income and education.
They also experience more frequent life-threatening complications during pregnancy and
childbirth (Montalmant & Ettinger, 2024; Centers for Disease Control and Prevention [CDC],
2023). These disparities reflect systemic failures in healthcare, social, and policy structures
rather than isolated personal choices or behaviors.
Historical and structural factors such as racial segregation, redlining, and under-resourced
hospitals have entrenched inequities in maternal health outcomes (Chambers et al., 2022).
Intersectionality is central to understanding this issue, as race, gender, class, and access to
care interact to amplify risk. Mechanisms of oppression include discriminatory provider
assumptions, implicit bias in obstetric care, and inequitable access to quality healthcare
facilities (Montalmant & Ettinger, 2024). For Black birthing people, this results in heightened
risks of death, severe morbidity such as hemorrhage, cardiomyopathy, eclampsia, long-term
disability, economic instability, and community trauma (Falako et al., 2023). These systemic
injustices persist across generations and highlight the urgent need for structural reform.
Impact on the Identified Community or Subgroup
The effects of maternal mortality disparities on Black birthing people and their communities
are profound and multifaceted. Individually, survivors of severe maternal morbidity often
endure long-term health issues including cardiovascular disease, chronic pain, mental health
disorders, and reduced capacity for family or occupational responsibilities (Montalmant &
Ettinger, 2024). When maternal death occurs, families experience immense emotional,
financial, and social disruption, often resulting in children facing instability and loss of
primary caregivers.
At the community level, persistently high maternal mortality rates erode trust in healthcare
institutions and reinforce historical patterns of neglect. Chambers et al. (2022) found that
discriminatory provider perceptions undermine relationships with Black patients and
exacerbate trauma within healthcare encounters. Communities witnessing high maternal
death rates internalize messages of devaluation, reinforcing systemic oppression. The KFF
issue brief notes that pregnancy-related mortality among Black women is 55.9 per 100,000
compared to 18.1 for White women, even when controlling for socioeconomic factors (KFF,
2024). The resulting mistrust reduces healthcare engagement, weakens social cohesion, and
perpetuates health inequities across generations.
Intersecting Forms of Oppression and Discrimination
Understanding maternal health disparities among Black birthing people requires an
intersectional lens. Race, gender, and class intersect to compound disadvantage, while
structural racism shapes neighborhood conditions, healthcare quality, and socioeconomic
opportunity (Structural Racism and Maternal Health Among Black Women, 2021). Many
Black women live in under-resourced communities with limited access to safe housing,
nutritious food, and comprehensive maternal care, all of which contribute to adverse
outcomes (Montalmant & Ettinger, 2024).
Discrimination within healthcare settings is equally harmful. Providers may dismiss pain
complaints, delay interventions, or assume noncompliance based on racial stereotypes
(Chambers et al., 2022). These implicit biases translate into real health consequences, such
as increased rates of preventable complications and delayed responses to emergencies.
Furthermore, Black women and other marginalized birthing people, including Black
immigrants and LGBTQ+ individuals, experience cumulative discrimination that intensifies
their vulnerability. Addressing one variable, such as income, is insufficient unless
institutional racism and sexism are dismantled within healthcare and policy systems.
Data on Who Is Affected and the Impact
Empirical evidence underscores the disproportionate burden on Black birthing people. The
CDC reported that non-Hispanic Black women had a maternal mortality rate of 69.9 deaths
per 100,000 live births in 2021, more than double the rate for White women (CDC, 2023).
Similarly, the KFF (2024) brief confirmed that disparities persist across income and education
levels, showing that systemic rather than individual factors drive these inequities.
Montalmant and Ettinger (2024) emphasized that structural racism and implicit bias remain
leading determinants of maternal health disparities.
Chambers et al. (2022) further documented that clinicians recognize racism and bias as
contributing factors but lack institutional mechanisms for accountability. Black women
experience higher rates of eclampsia, hemorrhage, and peripartum cardiomyopathy even
after adjusting for comorbidities (Addressing Black Maternal Morbidity and Mortality, 2023).
These findings confirm that disparities are systemic and enduring, demanding urgent
multisectoral interventions.
Ethical Concerns and Implications for Social Work Practice
The NASW Code of Ethics emphasizes principles of social justice, dignity, cultural
competence, and human relationships (NASW, n.d.). The maternal mortality crisis among
Black women challenges these principles by exposing inequities in access, respect, and
representation within healthcare. Ethically, social workers are called to advocate for fairness
and equity, ensuring that clients’ voices are respected and their autonomy upheld. They
must also acknowledge historical trauma and distrust rooted in past medical injustices such
as nonconsensual experimentation and neglect of Black women’s pain.
Practically, social workers must engage in anti-racist practice, embrace cultural humility, and
advocate for system-level accountability. Montalmant and Ettinger (2024) stress the
importance of provider training on implicit bias and equitable care models. Social workers
can collaborate with Black-led maternal health organizations, ensure that clients receive
adequate follow-up care, and support initiatives that track racial disparities transparently.
Ethical action requires addressing structural inequities that limit access to safe, respectful
maternity care.
Social Policies Affecting Well-Being, Service Delivery, and Access
Federal, state, and local policies play critical roles in shaping maternal health outcomes. The
Black Maternal Health Momnibus Act of 2021 (H.R. 959 / S. 346) is a comprehensive federal
policy initiative addressing structural racism in maternal care by funding community-based
programs, diversifying the healthcare workforce, and expanding data collection
([Link], 2021). Several states have also extended Medicaid postpartum coverage and
mandated implicit bias training for healthcare providers, while some localities have
increased funding for doula services and community birth centers in underserved areas.
The Momnibus Act stands out because it explicitly integrates racial equity, community
engagement, and workforce reform, making it particularly relevant for social work advocacy.
Evidence shows that multi-pronged policies combining financial coverage, data transparency,
and community empowerment yield stronger results than narrowly focused medical
interventions (Falako et al., 2023). Sustained investment in such initiatives can transform the
maternal care landscape and close racial gaps in outcomes.
Impact of Current Policies: Assumptions, Consequences, and Assessment
Although current policies such as the Momnibus Act and Medicaid expansions are
promising, their success is shaped by underlying assumptions about access, privilege, and
systemic bias. One common assumption is that expanding coverage alone will resolve
disparities, overlooking the deep structural racism embedded within healthcare institutions
(KFF, 2024). Another assumption is that reforming systems without elevating community
leadership is sufficient, which risks perpetuating paternalistic approaches.
Intended outcomes include increased funding for community-based organizations, improved
data transparency, and enhanced workforce diversity. However, unintended consequences
can emerge, such as superficial compliance with bias training, insufficient accountability, or
the redirection of funds from small grassroots programs (Falako et al., 2023). Evaluation of
existing policies reveals progress in awareness and reporting but minimal change in actual
mortality rates. Real transformation requires power redistribution, sustained funding, and
institutional accountability beyond symbolic gestures.
Advocacy Methods for Change
Effective advocacy requires strategies that operate at multiple levels. Key methods include
legislative advocacy for full funding and enforcement of the Momnibus Act, community
organizing in partnership with Black-led maternal health groups, clinical advocacy through
provider training and care model reform, and public education campaigns to raise awareness
of racial disparities in maternal health.
As a social worker, I would combine these approaches to mobilize affected communities,
influence legislation, and foster institutional accountability. Legislative advocacy enables
large-scale structural reform, while community organizing centers lived experiences and
builds trust. Clinical advocacy addresses immediate gaps in care delivery. However, advocacy
also faces challenges such as limited political will, funding instability, and institutional
resistance. Sustained collaboration and inclusion of Black birthing people’s leadership are
essential for lasting change (Montalmant & Ettinger, 2024).
Reflection on Personal Cultural Values, Beliefs, and Identity
My cultural values of equity, respect for diversity, and belief in systemic justice inform my
perspective on maternal health advocacy. Recognizing my professional privilege, I must
continually assess biases that might influence my perception of the issue. The NASW Code of
Ethics calls for ongoing self-reflection and cultural humility to prevent imposing dominant
perspectives on marginalized clients (NASW, n.d.). If I focus solely on clinical interventions
without acknowledging systemic racism, I risk reinforcing inequities rather than dismantling
them.
By acknowledging the voices and leadership of Black birthing people, I can contribute to
advocacy that is collaborative rather than prescriptive. Personal reflection ensures that
advocacy efforts remain grounded in empathy, respect, and justice, aligning professional
ethics with transformative social change.
Conclusion
The persistent disparities in maternal mortality and morbidity among Black birthing people
represent a profound social justice crisis. These inequities stem from structural racism,
intersectional oppression, and systemic neglect rather than biological or behavioral
differences. Social workers play a vital role in addressing this issue through culturally
competent practice, policy advocacy, and community partnership. The Black Maternal
Health Momnibus Act of 2021 offers a framework for structural reform, but its success
depends on continuous advocacy, accountability, and community-led implementation. Real
progress will come only when Black birthing people’s lives, voices, and leadership are
centered in all aspects of maternal health reform.
References
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