Republicans have now tried and failed three times to pass health care bills that would dismantle the Affordable Care Act — and potentially cut access to health care for millions. We’ve seen the introduction of hundreds of new reproductive health restrictions and insistent efforts to defund Planned Parenthood. In the midst of the GOP’s attack on women’s health, Charleena Lyles was killed by police. She was a pregnant Black woman who called the cops to her home for protection only to fall victim to their bullets. This is the unique kind of challenge black women face where health and state-sanctioned violence intersect.
Black women face enormous and unique challenges when it comes to our health. The Affordable Care Act (ACA) was a tremendous help to Black women and our families. Under the ACA, President Obama expanded Medicaid meaning more people than ever were able to afford health care. In fact, the uninsured rate fell by 7 percent among Black women. But President Trump and conservative lawmakers are intent on dismantling all its gains.
The health care bill making its way through Congress would repeal essential health benefits including maternal care and pediatric care. According to estimates, about half of U.S. births are covered by Medicaid. Dismantling the ACA could make many of these births cost-prohibitive, per a new report conducted by The State of Black Women and Reproductive Justice. All those who benefited from Medicaid expansions and protections for people with pre-existing conditions will once again be vulnerable. Due to ongoing health disparities, Black women are more likely to fall within that vulnerable population. We suffer disproportionately from chronic health conditions that qualify as pre-existing conditions including diabetes, hypertension, obesity, cancer and STIs including HIV/AIDS.
Within this broad health care battle, Black women’s reproductive health is particularly at risk. Black women are disproportionately likely to experience an unintentional pregnancy and pregnancy-related health complications. We’re also more likely to become seriously ill or to die as a result of childbirth. The U.S. maternal mortality rate is on par with El Salvador and Afghanistan, and Black women bear the brunt of it. We are four times more likely than white women to die of maternity-related causes.
Access to the sexual and reproductive health services black women need is abysmal whether we decide to become parents or not. Legislators across the country have introduced 431 provisions that would restrict further access to abortion services. If Black women overcome numerous economic, social and legal barriers, and manage to access a reproductive health provider, we’re still contending with a history of forced and coerced contraception and sterilization among women of color. Early birth control pills were tested on Black women without our consent. States have been administering non-consensual contraception and sterilizing women against their will — particularly incarcerated women. As a result, many Black women distrust new contraceptive methods, especially long-acting reversible contraception (LARCs) that has come into favor under government-sponsored programs.
Black women also need culturally competent care that addresses the structural injustices we face. Yet only 6 percent of physicians are Black, 4 percent of OB-GYNs are Black and fewer than 4 percent of certified nurse midwives are Black. When it comes to contraceptive equity, the primary challenges are the social disparities that disproportionately prevent Black women from accessing the full range of safe and effective methods.
Of course Black women’s bodies are under threat beyond the scope of any health care services as racialized violence continues to brutalize our communities. When Black women are forced to live our lives in fear of our children being profiled and targeted by police we are deprived of the basic reproductive freedom to be able to raise our children in safety and dignity.
To improve the state of things Black women are taking charge of our own activism and advocacy. We are the most progressive voting bloc, and we must use our power at the ballot box to effect progressive change. Black women must also need run for office in greater numbers and finance Black women candidates. To protect our bodies and our lives, we must raise our voices, from the streets in our neighborhoods to the State legislatures to the halls of Congress.
Marcela Howell is the founder and executive director of In Our Own Voice: National Black Women’s Reproductive Justice.