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Markkula Center for Applied Ethics

Closing the Coverage Gap to Better the State of Black Maternal Health

A Black, female health care worker takes the blood pressure of a Black female patient.

A Black, female health care worker takes the blood pressure of a Black female patient.

Brianna Mireku ’22

Hush Naidoo Jade Photography/Unsplash

Brianna Mireku ’22 is a senior majoring in psychology and minoring in public health and Spanish. She is also a 2021-22 health care ethics intern at the Markkula Center for Applied Ethics. Views are her own.


According to the Centers for Disease Control and Prevention (CDC), in the United States, approximately 50,000 people each year experience pregnancy complications that result in temporary or long-term health ramifications. 700 of these individuals suffer severe consequences that develop and lead to their unfortunate and untimely death. 

Within these jarring statistics lie serious racial disparities, as a majority of these women that are subject to death are people of color (POC). More specifically, Black women are three to four times more likely to experience a pregnancy-related death than white women. This has become a human rights crisis that is linked to several different factors within the social determinants of health. Not only is the implicit bias of health care providers detrimental to patient outcomes but studies have shown that lack of access to health care is one of the largest contributors to preventable maternal mortality. 

Prenatal care can significantly improve the quality and outcome of a pregnancy; visiting a healthcare provider consistently can reduce the risk of developing pregnancy complications that may consequently harm the fetus. Through prenatal care, physicians not only provide women with a plan for the duration of their pregnancy but give them valuable information on how to stay healthy. 

Obstetricians physically monitor the health of their pregnant patients along with the health of their unborn child with blood tests, ultrasounds, screenings for various diseases, etc. Postpartum care is an equally essential part of an individual’s pregnancy journey as many complications can occur after childbirth. This kind of care is centered around an individual’s physical, psychological, and social well-being.

Access to this type of medical care is heavily influenced by health insurance. This has barred many women from receiving the perinatal care that they deserve in order to protect their pregnancy. Private health insurance can be very costly and unrealistic for women who have a lower socioeconomic background. Even though there are alternative forms of health insurance such as Medicaid, which helps cover the costs of medical services for those with limited income, the system is still flawed.

There are gaps in Medicaid coverage that make affordable care impossible for many. These gaps are created by restrictions mandated by the federal and state government regarding how economically disadvantaged an individual must be to qualify for Medicaid. Each state has determined what it considers to be its federal poverty level based on family size and annual income. 

People who fall outside of this set threshold and into the coverage gap are those whose income is higher than their state’s Medicaid eligibility but below the poverty level. Approximately 2.2 million people in the United States fall into this coverage gap and are left uninsured; 59% of these individuals are those from minority groups as Black people have a higher probability of being uninsured than white people.

Although many states across the nation have decided to expand Medicaid through the Affordable Care Act, twelve states are still operating on strict guidelines and have not yet increased their eligibility threshold. These states are mostly located in the South which has a larger population of Black women. Statistically, these women already face significantly poorer health outcomes so not having access to insurance is incredibly damaging. 

Even those with access to health insurance through Medicaid still face serious barriers. As I mentioned previously, postpartum care is a critical part of the health of new mothers. In a study conducted in 2017, researchers found that 34.5% of maternal deaths take place more than six days postpartum. But among Black women, 14.6% of deaths occur more than 41 days postpartum. Many low-income pregnant individuals on Medicaid lose their access to coverage only 60 days after their delivery. These statistics show that coverage is needed far beyond the 60 days that Medicaid already provides for pregnant people; the current system is disruptive and unrealistic. 

The cost of not expanding Medicaid has led to and will continue to result in the preventable deaths of Black women across the country. In states that have already implemented expansions, uninsured rates have decreased and more pregnant people are receiving the care that they need. These decisions have also been associated with decreased rates of maternal mortality and morbidity. Extending postpartum coverage would be another significant step forward to advance the quality of medical care pregnant individuals receive. Providing comprehensive coverage should be a priority as this would undoubtedly improve maternal health outcomes, especially within the Black community.  

These actions are important because everyone deserves the right to health care. Historically, Black women have stood unprotected and stripped of their basic human rights. It is unfair that members of this community are subject to the repercussions of practices such as slavery and redlining which have contributed to their current position and treatment in society. Black women are often an afterthought and the needs of white individuals have always been prioritized, especially in medicine. 

These individuals should not have to face these barriers because they are dehumanizing. The medical ethical principles of beneficence and non-maleficence say to “act for the benefit of the patient” and to “do no harm.” How can we respect these principles and expect them to be upheld when there is an entire population of people who are dying due to the manner in which our health care system is designed. Many patients are experiencing harm because the decisions that have been made regarding their healthcare are not for their benefit. The lack of concern for the lives of these women is frightening and against the principles that make up the foundation of healthcare.


Jun 3, 2022

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