Background on Black Maternal Health 

The Centers for Disease Control and Prevention (CDC) estimates that Black women are over three times more likely to die during or after childbirth than white women, often facing life-threatening complications from early pregnancy to postpartum. Unfair treatment and lower quality of care contribute to these disparities, with more than 80% of pregnancy-related deaths among Black women being preventable. For every maternal death, 100 Black women experience near maternal death, highlighting the broader maternal health crisis for Black women in the U.S.

Structural racism and various social determinants of health (SDOH), such as access to quality healthcare, safe housing, nutrition, and socioeconomic conditions, shape maternal health outcomes. Both implicit and explicit provider biases worsen these disparities. Research suggests the accumulated experiences of interpersonal racial discrimination across life can negatively impact Black women’s pregnancy outcomes, increasing the risk of complications. Further, surveys that sampled more than 2,500 women in the U.S. showed that Black women were more likely than white women respondents to report experiencing discrimination during childbirth, communication barriers with providers, and a lack of emotional support. Additionally, many Black mothers report feeling unheard or pressured into medical decisions, which can sometimes be attributed to providers’ implicit racial biases around pain tolerance and treatment. 

The Momnibus

The Black Maternal Health Momnibus Act of 2021, introduced by Congresswoman Lauren Underwood [D-IL], is still in the early stages of the legislative process and has been stuck in committee since April 2021. The bill targets multiple agencies’ efforts to improve maternal healthcare, particularly among ethnic and racial minority groups, veterans, and other vulnerable populations. The bill is a comprehensive package of several individual bills that support investments in: 

1. Social determinants of health that influence maternal health outcomes 
2. Expanding WIC eligibility for postpartum and breastfeeding parents
3. Funding for community-based organizations
4. Maternal healthcare for veterans and incarcerated moms
5. Growing and diversifying the perinatal workforce
6. Improving data collection processes and quality control measures 
7. Maternal mental health
8. Digital tools like telehealth and innovative payment methods
9. Access to maternal vaccinations

Arguments in Support of the Momnibus

Proponents of the Black Maternal Health Momnibus Act argue that systemic racism and healthcare inequities drive the higher maternal mortality rates among Black women, and that the Act is a necessary intervention. While racial health disparities were once wrongly attributed to biological differences, research now shows that systemic racism affects social determinants of health (SDOH) – specifically access to nutrition, clean water, and safe housing. These inequalities, along with fewer healthcare facilities, food deserts, and environmental hazards in Black neighborhoods, restrict access to essential prenatal care, proper nutrition, and timely medical interventions. Compounding these issues, Black women often experience gaps in Medicaid coverage and limited access to quality birthing hospitals. Proponents assert that the Momnibus Act’s investments will improve these conditions, thereby supporting better outcomes for Black mothers. 

Supporters of the Momnibus Act also argue that expanding access to comprehensive prenatal and postpartum care is crucial for addressing disparities that disproportionately affect Black mothers. They contend that programs like extended Women, Infant, and Children (WIC) eligibility for up to two years postpartum ensure consistent access to essential nutritious foods during critical recovery and developmental periods. Advocates highlight that limited prenatal care and late entry into antepartum care often correlate with lower attendance at postpartum visits, which leaves vulnerable Black women without vital health monitoring. They hold that expanding the availability of these services throughout the care spectrum – from preconception to postpartum – is therefore essential to ensure mothers receive the monitoring and support needed for positive health outcomes. 

Proponents also praise the Momnibus for its provisions to address gaps in the healthcare workforce, arguing that diversifying the perinatal workforce is crucial in addressing the maternal health crisis among Black mothers. Although Black Americans make up 13% of the U.S. population, they represent only 5.7% of physicians, with Black women making up just  2%. Studies show that Black patients experience better health outcomes, including lower infant mortality when treated by Black doctors or culturally competent providers. This may be due to the shared experience of facing racism, which fosters trust and understanding between patients and providers. Supporters of the Momnibus Act praise its investments in measures such as implicit bias and anti-racism training to ensure culturally responsive care, viewing these steps as essential for improving health outcomes for Black mothers.  

Arguments Against the Momnibus

Critics argue that while the Momnibus Act brings essential attention to maternal health disparities, it may fall short of fully addressing the root causes of Black maternal health crisis. They argue that the Momnibus will necessitate large-scale government expenditures, increase taxes, and add to the national debt without delivering sustainable solutions. Critics contend that many provisions of the Momnibus do not account for the broader socio-economic factors contributing to Black maternal mortality, such as healthcare deserts, insurance coverage, and institutionalized racism that cannot be eliminated with bias trainings. Research suggests that policies focused on race and maternal health fail to yield positive outcomes without provisions to address institutional racism in areas like housing, employment, and education as well, so critics hold that addressing maternal health alone is insufficient. They argue that broader reforms across these areas are essential and emphasize the need for a robust, structural approach to truly address health disparities. 

Many opponents specifically question the effectiveness of implicit bias training included in the Momnibus Act, suggesting that implicit bias is deeply ingrained in the healthcare system and cannot be eliminated via occasional trainings. Without robust, systemic reforms – such as building quality healthcare facilities in low-resource communities and providing long-term maternal health support – they believe the Act’s provisions will yield only temporary improvements leaving underlying inequalities largely unchallenged. 

Conclusion

The Black Maternal Health Momnibus Act seeks to address racial disparities in maternal health by investing in prenatal and postpartum care, diversifying the perinatal workforce, and investing in social determinants of health. Supporters argue these measures are essential for reducing maternal mortality among Black women, while critics question whether the Act alone can tackle deep-rooted systemic issues. The future success of the bill’s central goal may depend on securing federal support and enacting comprehensive, structural changes beyond healthcare.