Imagine that each year six U.S. passenger jets crashed, killing all passengers on board. Imagine that every person who died on those planes was a woman who was pregnant or recently gave birth. Instead of offering interventions and regulations that might prevent more planes from falling from the sky, lawmakers attempted to defund and repeal the very programs meant to improve air safety. That, in a nutshell, is the maternal mortality crisis in the United States. Today, more U.S. women die in childbirth and from pregnancy-related causes than at almost any point in the last 25 years. The United States is the one of only seven countries in the entire world that has experienced an increase in maternal mortality over the past decade (we join the likes of Afghanistan and South Sudan), and mothers in Iran, Turkey, the United Arab Emirates, Serbia and Greece (among many other countries) have a better chance of surviving pregnancy than do women in the United States. It should be no surprise that maternal mortality rates (MMRs) have risen in tandem with poverty rates. The two are inextricably linked. Women living in the lowest-income areas in the United States are twice as likely to suffer maternal death, and states with high rates of poverty have MMRs 77 percent higher than states with fewer residents living below the federal poverty level. Black women are three to four times as likely to die from pregnancy-related causes as white women, and in some U.S. cities the MMR among Black women is higher than in some sub-Saharan African countries. New research suggests that one of the many factors driving this crisis might be inequality. We may have just celebrated the dawn of 2015, but in terms of economic inequality it might as well be 1929, the last time the United States experienced such an extraordinary gulf between the rich and the, well, everyone else. Today nearly one in three Blacks and one in four Hispanics (compared to one in ten whites) live in poverty, and in certain states those percentages are even higher. Since the 2008 financial crisis, the net worth of the poorest Americans has decreased and stagnant wages and increased debt has driven more middle class families into poverty. Meanwhile, the wealthiest Americans have enjoyed remarkable gains in wealth and income. Those in the top one percent have seen their incomes increase by as much as 200.5 percent over the past 30 years, while those in the bottom 99 percent have seen their incomes grow by only 18.9 percent during that same time. As the financial well-being of the majority of Americans has eroded, so too has their health. A recent study conducted by Amani Nuru-Jeter from University of California, Berkeley shows that inequality has very different impacts on Black and white Americans. The study found that each unit increase in income inequality results in an additional 27 to 37 deaths among African Americans, and – interestingly – 417 to 480 fewer deaths among white Americans. Nuru-Jeter and her colleagues were surprised to discover the inverse relationship between inequality and death for whites, and suggested that more research is needed to better understand it. "We do know that the proportion of high-income people compared to low-income people is higher for whites than for African Americans. It's possible that the protective effects we are seeing represent the net effect of income inequality for high-income whites," she said. The research shows us that rising tides might lift some boats, but it sinks others. And it is unclear if the boats of poor whites actually rise, or if it just appears like they rise because of the higher concentration of people benefitting from inequality in white communities compared to black communities. Either way, we know that the boats of women of color have certainly not been rising in recent years and these recent findings beg us to ask how inequality is impacting U.S. mothers specifically. After all, we know that women of color have been disproportionately impacted by the economic downturn. Today the poverty rate for black women is 28.6 percent, compared with 10.8 percent for white women. A 2010 study found that the median wealth for single Black and Hispanic women was only $100 and $120 respectively, while the median wealth for single white women was just over $41,000. And in the years following the recession Black women represented 12.5 percent of all American workers but accounted for more than 42 percent of jobs lost by all women. Black women have an unemployment rate nearly double that of white women. Given these grim statistics, it should be no surprise that inequality and maternal-related deaths have increased on parallel tracks over the last decade. But while inequality – and its threats to the economy and the wellbeing of average people – has recently gained long overdue attention, maternal mortality remains an invisible health crisis (unless, of course, you live in one of the communities where it's all too common for women to die from pregnancy). The media rarely talks about it, foundations aren't collaborating to invest in initiatives to help us understand – let alone improve – the situation, and policy makers aren't even pretending to care about it. In fact, the conservative-dominated Congress seems eager to trim or prevent the very programs that help mothers have a healthy foundation for pregnancy: food stamps, reproductive health coverage and access, and wage increases, just to name a few. The Affordable Care Act is providing much-needed health coverage to many poor women for whom it was previously out of reach and if fully implemented could certainly help stem maternal deaths. But conservative members of Congress are doing their best to make it as ineffective as possible for the people who need it the most. Nearly 60 percent of uninsured Black Americans who should qualify for Medicaid live in states that are not participating in Medicaid expansion. And a recent study found that as a result of conservative opposition to expansion, 40 percent of uninsured Blacks who should have Medicaid coverage will not get it (compared to 24 percent of uninsured Hispanics and 29 percent of uninsured whites). Nuru-Jeter's research shows us that we will need a host of strategies to tackle deaths in the Black community, and maternal deaths are certainly no exception. Better understanding how inequality might be driving unnecessary deaths among women of color would better enable us to identify exactly what those strategies should be and how they should be implemented. And perhaps we wouldn't get all boats to rise immediately, but it just might get them all to float. It's sad we aren't even trying to accomplish that much.
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