Policy Brief

The United States has the highest maternal mortality rate of any high-income country, more than doubling between 1999 and 2019, with Black women experiencing the worst outcomes. In New Jersey, this situation is particularly profound. More than 90% of pregnancy-related deaths in New Jersey from 2016 through 2018 were preventable, according to the New Jersey Department of Health’s New Jersey Maternal Mortality Review Committee (NJMMRC) report.

Birthing deserts (also referred to as maternity care deserts) are areas in which access to maternity health care services are limited or absent, either through lack of services or barriers to a woman’s ability to access that care within that area. Maternal toxic zones (or materno-toxic areas) is defined by the National Perinatal Task Force as being an “area where it is literally unsafe to be pregnant or parenting; any area where you yourself would not feel comfortable being pregnant, breastfeeding or parenting.” Maternal toxic zones are not solely characterized based on geographic location rather it is the “toxicity of implicit and explicit biases, racism, classism and sexism” demonstrated by the existence of birthing deserts; the absence or inaccessibility of food, services, resources or support; and the lack of investment in securing culturally congruent providers and staff in health care settings that constitute maternal toxic zones.

The history of Black midwifery dates back over 400 years when enslaved Africans were brought to America. Historically, Black midwives were tasked with providing this standard of culturally congruent care which rested on the understanding and awareness of the clients’ cultural needs and sensitivities, but also their ability to provide the necessary supports and services. The demise of Black midwifery in the United States is the result of the commercialization of health care and systemic racism created by predominantly white healthcare institutions. Birthing deserts and maternal toxic zones are just a few examples of the ways in which implicit and explicit bias and systemic racism materialize within the maternal health care space and how they have played a major role in the disparate outcomes for Black women. Studies have shown that Black women fare better when they are treated by Black physicians or midwives, thus, the dominance of predominantly white institutions over Black birthing outcomes must be diminished if wellness, equity, and justice are to be realized.

Salvation and Social Justice’s (SandSJ) approach has been to listen to the very women these institutions do not. By utilizing SandSJ’s platform as a creditable messenger, we have been able to amplify the needs and concerns of these women bringing them to the attention of those stakeholders and lawmakers in a position to begin pursuing substantive policy changes. Essential to this approach is extending SandSJ’s advocacy to ensure that the community and those with lived experiences are present at the decision-making table when policies are being discussed and advanced. SandSJ has found that Black women desire care led by Black people. Therefore, we recommend increasing the number of Black midwives and Black-led birthing centers so Black women have culturally congruent options.