In June 2016, the Center for Reproductive Rights (the Center) released a new resource on maternal health called Black Mamas Matter: A Toolkit for Advancing the Human Right to Safe and Respectful Maternal Health Care. The toolkit is part of a broader effort ̶- by the Center, SisterSong Women of Color Reproductive Justice Collective and a growing network of partners ̶- to use the human rights framework to eliminate profound racial disparities in U.S. maternal mortality.
Bridging local and international dialogues
While most other countries have substantially reduced maternal deaths over the past two decades, the U.S. has become the only developed country with a rising maternal mortality rate . Despite all the money and technology that flows through our health care system, women in the U.S. are still losing their lives during pregnancy, childbirth and postpartum. Racial inequality is driving many of these poor maternal health outcomes. Black women are three to four times more likely to suffer maternal mortality than are White women, and they are twice as likely to suffer severe maternal morbidity. These are not just public health issues; U.S. maternal health has become a human rights crisis of global concern.
In 2014, the center partnered with SisterSong to elevate concerns about U.S. maternal health at the international level. Along with the National Latina Institute for Reproductive Health, these organizations submitted a joint report to the Committee on the Elimination of Racial Discrimination (CERD). (CERD is a body of independent human rights experts who monitor implementation of a human rights treaty aimed at ending racial discrimination. The U.S. has ratified the treaty and has agreed to incorporate its content into domestic law). The report presented data on maternal health disparities, and included insights from the experiences of Black women in the U.S. In preparing for the report, SisterSong hosted storytelling circles with Black women in Mississippi and Georgia, documenting their experiences with sexual, reproductive and maternal health. Those stories provided CERD with crucial context about the barriers to health that southern Black women face ̶̶ before, during and after pregnancy.
After completing its review of the U.S., CERD recognized the rising maternal mortality rate as the human rights crisis that it is. The committee called on the U.S. government to step up its efforts to eliminate racial disparities and specifically recommended improving data collection and accountability mechanisms, such as maternal mortality review boards. Since then, the United Nations Human Rights Council and two other independent human rights expert groups have urged the U.S. to take action that ensures equality and nondiscrimination in maternal health and survival.
Facilitating cross-sectoral collaboration
Recognizing that maternal health is a complex and multifaceted issue, the center and SisterSong followed up on the CERD report by co-hosting a multi-sector convening of maternal health experts in 2015. During this convening, public health professionals, researchers, service providers, policy experts and reproductive justice advocates identified their major challenges as well as innovative strategies for improving Black maternal health. Among the many ideas generated, participants identified a need for advocacy tools that would inform, engage and empower new leadership.
Providing advocacy tools
Working closely with the convening participants and other leaders on Black maternal health, the center developed a set of materials that will support the work of state maternal health advocates as they mobilize their communities and communicate with state policy leaders. The Black Mamas Matter toolkit, released in June 2016, takes a human rights-based approach to maternal health, identifying the rights of pregnant and birthing women and the corresponding role of government to ensure safe and respectful maternal health care for all. It emphasizes the need to address root causes of health disparities and to ensure the participation of marginalized communities in decisions that will affect their health. In an effort to center those most affected by poor maternal health, the resources highlight issues of particular concern to Black women living in the South.
The toolkit includes: (1) a human rights brief on maternal health; (2) a summary of maternal health research; (3) an overview of policy solutions proposed by multi-sector stakeholders; (4) talking points for state and national advocates; and (5) a list of resources for those working on maternal health in the U.S. All of these materials can be found at BlackMamasMatter.org.
Encouraging community engagement
Good maternal health outcomes depend on the full realization of human rights, within and beyond our health system. For Black women, multiple and intersecting forms of discrimination ̶ on the basis of race, gender and often socioeconomic status ̶ create obstacles to achieving the highest attainable standard of health. A human rights-based approach provides a framework for ensuring that all of our efforts to improve maternal health outcomes promote access and quality, but also accountability, dignity, nondiscrimination, autonomy, empowerment, participation and equality.
As the Black Mamas Matter network continues to grow, its members are using the human rights framework to highlight the leadership of Black women, to ensure the inclusion of marginalized voices and to generate community-oriented responses to the problem of poor maternal health. Ultimately, Black Mamas Matter is demonstrating that Black women have solutions. What these leaders need most right now are platforms for sharing ideas and access to the funding, partnerships, technical resources and institutional supports that will make their solutions sustainable. State health agencies are well positioned to play a powerful role in nurturing these community leaders and the community-based solutions they generate.
State health agencies can also strengthen partnerships with the communities they serve by: (1) recognizing the thought leadership that exists in those spaces; (2) building meaningful collaborations with community members who are most impacted by poor maternal health outcomes; and (3) incorporating the human rights framework into health agencies' own work. For example, as maternal mortality review processes continue to generate new findings, state agencies must ensure that Black women and their communities have meaningful opportunities to participate in the translation of data into policies and programs, including implementation and monitoring of any recommendations.