Maternal Health in the US

It’s become very clear that access to quality healthcare in the US is largely dependent on socioeconomic status. Maternal healthcare is no exception to this issue. Despite being one of the wealthiest countries in the world, the United States continues to lag behind in maternal health outcomes. The most basic measure of maternal health is the maternal mortality rate, or the number of women who die each year due to pregnancy and birth-related causes. In 2022, 22 maternal deaths occurred for every 100,000 live births in the US; a number two to three times higher than the maternal mortality rates in other high-income countries. Maternal health is not an issue of the US lacking the necessary medical interventions or technology to ensure safe pregnancies. Nearly 80 percent of maternal deaths are preventable in the US. The reality is: poor maternal health outcomes are largely driven by racial, economic, and gender inequality. For women experiencing homelessness, accessing maternal healthcare can be especially challenging, leading to higher rates of birth complications and poorer maternal and infant health outcomes. 

Pregnancy and Homelessness 

Overall, women make up 30 percent of individuals experiencing homelessness in the US. While women account for a smaller portion of single adults experiencing homelessness, they are largely overrepresented in family homelessness. In DC, women comprise nearly 86 percent of adults in families experiencing homelessness. Living without shelter presents a number of challenges that impact women’s ability to have autonomy over their reproductive and maternal health. It is estimated that unhoused women become pregnant at almost twice the rate of the general population and are more than twice as likely to have unintended pregnancies. Many people experiencing homelessness lack health insurance and often cannot afford to pay for contraception or healthcare visits. Additionally, the unstable nature of homelessness can make it difficult to maintain doctors’ appointments and access pharmacies for contraceptive prescriptions. When unhoused women become pregnant, especially unintentionally, this can cause greater strain to their finances and make exiting homelessness even more challenging.

During pregnancy, women experiencing homelessness are significantly less likely to receive prenatal care and are more likely to access emergency service and be hospitalized during pregnancy. Prenatal care is imperative to identifying birth and pregnancy complications early on and has been shown to prevent poor maternal outcomes, including maternal death. Studies have revealed that pregnant women experiencing homelessness are at an increased risk of delivering prematurely, have higher rates of severe birth complications, and are more likely than their housed counterparts to die giving birth in hospitals. The impacts of homelessness are not limited to the health of mothers, but can have devastating and long lasting health consequences for babies. Infants who are born prematurely are more likely to need intensive care and are at high risk of developmental and physical conditions. Poor maternal health outcomes in women experiencing homelessness are a reflection of a healthcare system that places little value on the lives of the most vulnerable women in society. 

Racial Disparities in Maternal Healthcare 

The failings of maternal healthcare in the US are deeply rooted in racial inequality. Black women are three times more likely than white women to die in childbirth. This extreme disparity can be partially linked to differences in healthcare coverage, socioeconomic inequality, and barriers to quality health services. For pregnant women experiencing homelessness, large racial disparities exist as well, with Black and Native American women experiencing the highest rates of homelessness during pregnancy. However, economics alone cannot account for racial disparities in maternal health. When data is adjusted for educational level and income level, disparities persist. One study found that Black women with college degrees have higher rates of maternal mortality than white women without a high school diploma. These findings suggest that maternal health is not solely related to income or healthcare access, but rather an issue of systemic racism. 

The persistence of racial disparities in maternal health is strongly connected to racial biases and differential treatment in healthcare. In the US, we often see misleading headlines linking racial disparities in healthcare to genetic predispositions and biological differences. The reality is that race is a socially constructed category and has no biological basis. While race may not be based in science, the effects of racism have real and devastating consequences in healthcare. Racial biases in healthcare have been well documented and definitively linked to poorer health outcomes for patients of color. Black women are more likely than any group to report unfair treatment by doctors. These claims are supported in maternal healthcare with doctors often performing unnecessary and unwanted procedures against the patient’s wishes. Black women are 25 percent more likely than white women to undergo unneeded cesarean sections, which greatly increases the risk of post-birth complications. 

Prioritizing Maternal Health 

A society’s most fundamental values are reflected in its ability to ensure women are safe throughout pregnancy, birth, and postpartum life. In the US, high rates of maternal death, particularly for Black women, reveals the deep racial, gender, and economic inequities that persist. These challenges are exacerbated further for women experiencing homelessness, many of whom are women of color. Finding solutions to the maternal health crisis begins with prioritizing women’s health and recognizing racial biases in healthcare. On a systemic scale, it is imperative that the federal government invests in maternal health solutions and funds research to identify the gaps in maternal care that lead to wide disparities. Change must also occur at the ground level with the healthcare professionals tasked with protecting the lives of mothers and babies. It is critical to educate healthcare providers about racial biases and to provide training in culturally competent care. 

As affordable housing providers, we have the power to enact change by providing safe and affordable housing and connecting mothers to healthcare services. At Housing Up, the majority of the families we serve are led by Black mothers. At its core, maternal health is family health. We recognize that prioritizing the needs of mothers is critical to our mission of ending family homelessness in DC. Housing is a basic human right and is essential to ensuring safe pregnancies.