Commentary Race

Report: Racial Discrimination Severely Undermines Black Women’s Health

Elizabeth Dawes Gay

The stories of women who participated in focus groups led by SisterSong, included in a new report, convey the gross under-education and discriminatory treatment of Black women living in the South, in particular, where sexual and reproductive health education is nonexistent and stigma is rampant.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

On Wednesday, August 13, the United Nations Committee on the Elimination of Racial Discrimination begins a two-day review of the United States government’s efforts, or lack thereof, to address pervasive racial discrimination in law and practice. When the United States ratified the International Convention on the Elimination of All Forms of Racial Discrimination in 1994, it consented to a periodic review by human rights experts of its progress toward meeting the goals in the treaty. The last time such a review was conducted was 2008, when the committee expressed specific concern about persistent and worsening disparities in sexual, reproductive, and maternal health in the United States—particularly for Black women—and offered recommendations about how the country could reduce those disparities.

It’s no secret that Black women are more likely than others to experience negative maternal health outcomes, such as preterm birth or stillbirth, to suffer from conditions like preeclampsia, and to die at higher rates from pregnancy-related causes. A new shadow report, Reproductive Injustice: Racial and Gender Discrimination in U.S. Health Care, by the Center for Reproductive Rights, the National Latina Institute for Reproductive Health, and SisterSong Women of Color Reproductive Justice Collective shares some alarming data on maternal health outcomes as well as disturbing firsthand accounts of the racial discrimination experienced by Black women.

The stories of women who participated in focus groups led by SisterSong included in the report convey the gross under-education and discriminatory treatment of Black women living in the South, in particular, where sexual and reproductive health education is nonexistent and stigma is rampant. Women in the focus groups shared how they turned to friends or “the street” for information, but found it was often incorrect. When asking health-care providers for information, many were met with stigma about their sexuality and sexual decision making, and were lectured rather than offered helpful information. The women also encountered providers who made assumptions about their ability to utilize health information, undermining the quality of reproductive health care they received and jeopardizing their health.

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In one such interview, for example:

Aaliyah from Jackson [Mississippi] said her doctor had assumed she would not or could not effectively use contraception: “After I had the baby, and I went back for my checkup … [the doctor] told me, ‘I’ll see you in six weeks.’ I said, ‘Why?’ He said I’d be pregnant again.”

She sought the care she wanted to plan her family, but her provider refused to counsel her about contraceptive options and help her make an informed decision.

Tiffany, also from Jackson, Mississippi, tells the story of how she was forced to wait in a public hospital’s hallway during labor because there were no available beds, and how she was ignored until the baby crowned. Even then, she was told not to push until they could get her a room, endangering her health and the health of her baby.

Aaliyah, a Medicaid patient, explained how she received what can only be described as substandard prenatal care. A week before she was due, her doctor realized she had not received an ultrasound since she first found out she was pregnant. When an ultrasound was finally performed, they found low amniotic fluid and her labor was induced. Her baby suffered complications and remained on breathing tubes for three weeks.

These women are far from alone. Millions of women in the United States share these experiences and a million more suffer the consequences. While maternal deaths are rising all across the country, Black women are disproportionately affected. In rural Chicksaw County, Mississippi, the maternal mortality ratio is 595 women per 100,000 live births—worse than that of war-torn and developing nations like Kenya and Rwanda (400 and 320 per 100,000 live births, respectively). In Detroit, the ratio is 58 per 100,000 live births, although data shows the ratio in Michigan state could be as high as 391 per 100,000 live births among Black women who often experience a delay in receiving prenatal care.

This has not happened by chance. Rather, this is a direct result of political disinterest in helping the most vulnerable in our society, an unwillingness to acknowledge and address racial discrimination as a major factor in health outcomes, and a refusal to invest in health and well-being beyond insurance access to health care. Increased health care spending and newer technology hasn’t improved maternal health for all women in the United States, and definitely not for Black women.

Black women are victims of something much worse than stigma, judgment, and discrimination: We are victims of a system and society that abrogates our basic human rights, including the rights to health, life, and non-discrimination. It is apparent in stories of the women in the SisterSong focus groups who were fortunate enough to survive their pregnancies, and also reflected in data (some of which can be found here, here, here, and here) from the U.S. Department of Health and Human Services. The United States is the only industrialized nation to have an increase in maternal mortality over the past decade—now triple the rate of that in the United Kingdom. We’re sliding backward when we should be making progress, not just in science and medicine or the slow crawl toward health equity, but in achieving better health for all. Why is this?

We could blame the problems for being too complex, for the multiple factors that feed into these outcomes, and for solutions that require levels of coordination and partnership that seem daunting. But, are these problems insurmountable? I believe, as many of you might, that although the problems that lead to negative health outcomes for Black women are certainly complex and undoubtedly challenging, they can be overcome by investing appropriate attention and resources. The U.S. government’s own report to the committee acknowledges that more can be done, but it doesn’t outline a plan for changing the situation.

Fortunately, the Reproductive Injustice report offers some key recommendations, which include providing comprehensive sexual education, addressing racial and gender stereotypes that promote stigma, improving the quality of maternal health services for women relying on the public health system, providing paid parental leave, and ensuring access to remedies for those who experience discrimination. These recommendations mirror those included in Amnesty International’s report, Deadly Delivery: The Maternal Health Care Crisis in the USA, and there is little doubt that women and families will benefit when these recommendations are fully implemented. For example, researchers have proven the benefits of high-quality prenatal and maternal health care for both mother and baby.

Finally, international organizations have identified political commitment as a precondition for reducing maternal mortality and improving health outcomes. Clearly, change will not happen without political will and thoughtful decision making at the federal, state, and local levels, and in all levels of government. The United States made a commitment to address racial disparities, but it hasn’t followed through. Now we need answers, not excuses. It’s time for lawmakers to act. The lives of women across the nation depend on it. 

News Human Rights

What’s Driving Women’s Skyrocketing Incarceration Rates?

Michelle D. Anderson

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

Local court and law enforcement systems in small counties throughout the United States are increasingly using jails to warehouse underserved Black and Latina women.

The Vera Institute of Justice, a national policy and research organization, and the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge initiative, released a study last week showing that the number of women in jails based in communities with 250,000 residents or fewer in 2014 had grown 31-fold since 1970, when most county jails lacked a single woman resident.

By comparison, the number of women in jails nationwide had jumped 14-fold since 1970. Historically, jails were designed to hold people not yet convicted of a crime or people serving terms of one year or less, but they are increasingly housing poor women who can’t afford bail.

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

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Overlooked: Women and Jails in an Era of Reform,” calls attention to jail incarceration rates for women in small counties, where rates increased from 79 per 100,000 women to 140 per 100,000 women, compared to large counties, where rates dropped from 76 to 71 per 100,000 women.

The near 50-page report further highlights that families of color, who are already disproportionately affected by economic injustice, poor access to health care, and lack of access to affordable housing, were most negatively affected by the epidemic.

An overwhelming percentage of women in jail, the study showed, were more likely to be survivors of violence and trauma, and have alarming rates of mental illness and substance use problems.

“Overlooked” concluded that jails should be used a last resort to manage women deemed dangerous to others or considered a flight risk.

Elizabeth Swavola, a co-author of “Overlooked” and a senior program associate at the Vera Institute, told Rewire that smaller regions tend to lack resources to address underlying societal factors that often lead women into the jail system.

County officials often draft budgets mainly dedicated to running local jails and law enforcement and can’t or don’t allocate funds for behavioral, employment, and educational programs that could strengthen underserved women and their families.

“Smaller counties become dependent on the jail to deal with the issues,” Swavola said, adding that current trends among women deserves far more inquiry than it has received.

Fred Patrick, director of the Center on Sentencing and Corrections at the Vera Institute, said in “Overlooked” that the study underscored the need for more data that could contribute to “evidence-based analysis and policymaking.”

“Overlooked” relies on several studies and reports, including a previous Vera Institute study on jail misuse, FBI statistics, and Rewire’s investigation on incarcerated women, which examined addiction, parental rights, and reproductive issues.

“Overlooked” authors highlight the “unique” challenges and disadvantages women face in jails.

Women-specific issues include strained access to menstrual hygiene products, abortion care, and contraceptive care, postpartum separation, and shackling, which can harm the pregnant person and fetus by applying “dangerous levels of pressure, and restriction of circulation and fetal movement.”

And while women are more likely to fare better in pre-trail proceedings and receive low bail amounts, the study authors said they are more likely to leave the jail system in worse condition because they are more economically disadvantaged.

The report noted that 60 percent of women housed in jails lacked full-time employment prior to their arrest compared to 40 percent of men. Nearly half of all single Black and Latina women have zero or negative net wealth, “Overlooked” authors said.

This means that costs associated with their arrest and release—such as nonrefundable fees charged by bail bond companies and electronic monitoring fees incurred by women released on pretrial supervision—coupled with cash bail, can devastate women and their families, trapping them in jail or even leading them back to correctional institutions following their release.

For example, the authors noted that 36 percent of women detained in a pretrial unit in Massachusetts in 2012 were there because they could not afford bail amounts of less than $500.

The “Overlooked” report highlighted that women in jails are more likely to be mothers, usually leading single-parent households and ultimately facing serious threats to their parental rights.

“That stress affects the entire family and community,” Swavola said.

Citing a Corrections Today study focused on Cook County, Illinois, the authors said incarcerated women with children in foster care were less likely to be reunited with their children than non-incarcerated women with children in foster care.

The sexual abuse and mental health issues faced by women in jails often contribute to further trauma, the authors noted, because women are subjected to body searches and supervision from male prison employees.

“Their experience hurts their prospects of recovering from that,” Swavola said.

And the way survivors might respond to perceived sexual threats—by fighting or attempting to escape—can lead to punishment, especially when jail leaders cannot detect or properly respond to trauma, Swavola and her peers said.

The authors recommend jurisdictions develop gender-responsive policies and other solutions that can help keep women out of jails.

In New York City, police take people arrested for certain non-felony offenses to a precinct, where they receive a desk appearance ticket, or DAT, along with instructions “to appear in court at a later date rather than remaining in custody.”

Andrea James, founder of Families for Justice As Healing and a leader within the National Council For Incarcerated and Formerly Incarcerated Women and Girls, said in an interview with Rewire that solutions must go beyond allowing women to escape police custody and return home to communities that are often fragmented, unhealthy, and dangerous.

Underserved women, James said, need access to healing, transformative environments. She cited as an example the Brookview House, which helps women overcome addiction, untreated trauma, and homelessness.

James, who has advocated against the criminalization of drug use and prostitution, as well as the injustices faced by those in poverty, said the problem of jail misuse could benefit from the insight of real experts on the issue: women and girls who have been incarcerated.

These women and youth, she said, could help researchers better understand the “experiences that brought them to the bunk.”

Commentary Politics

Milwaukee Officials: Black Youth, Single Mothers Are Not Responsible for Systemic Failings—You Are

Charmaine Lang

Milwaukee has multiple problems: poverty, a school system that throws out Black children at high rates, and lack of investment in all citizens' quality of life. But there's another challenge: politicians and law enforcement who act as if Black youth, single mothers, and families are the "real" reasons for the recent uprising and say so publicly.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

On the day 23-year-old Sylville Smith was killed by a Milwaukee police officer, the city’s mayor, Tom Barrett, pleaded publicly with parents to tell their children to come home and leave protests erupting in the city.

In a August 13 press conference, Barrett said: “If you love your son, if you love your daughter, text them, call them, pull them by the ears, and get them home. Get them home right now before more damage is done. Because we don’t want to see more loss of life, we don’t want to see any more injuries.”

Barrett’s statement suggests that parents are not on the side of their sons and daughters. That parents, too, are not tired of the inequality they experience and witness in Milwaukee, and that youth are not capable of having their own political ideologies or moving their values into action.

It also suggests how much work Milwaukee’s elected officials and law enforcement need to do before they open their mouths.

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Barrett’s comments came after Smith fled a traffic stop and was shot by authorities on Milwaukee’s northwest side. The young Black man’s death sparked an urban uprising in the Sherman Park neighborhood, an area known for its racial and religious diversity. Businesses were burnt down, and the National Guard was activated in a city plagued by racism and poverty.

But Milwaukee parents and families need more than a directive thinly disguised as a plea. And Mayor Barrett, who was re-elected to a fourth term in April, should know well that Milwaukee, the nation’s most racially stratified city, needs racial equity in order for there to be peace and prosperity.

I live in Milwaukee, so I know that its residents, especially its Black parents, do love their children. We want more for them than city-enforced curfews and a simplistic solution of returning to their homes as a way to restore calm. We will have calm when we have greater investment in the public school system and youth services; easy access to healthy food; and green spaces, parks, and neighborhoods that are free from police harassment.

In fact, according to staggering statistics about Milwaukee and Wisconsin as a whole, Black people have been consistently denied their basic human rights and health. Wisconsin has the highest rate of incarceration of Black men nationwide; the Annie E. Casey Foundation has found it is the worst state for racial disparities affecting Black childrenand infant mortality rates are highest among Black women in the state.

What we absolutely don’t need are public officials whitewashing the facts: that Milwaukee’s young people have much to protest, including Wisconsin’s suspending Black high-school students more than any other state in the country.

Nor do we need incendiary comments like those coming from Milwaukee County Sheriff David Clarke, who drew national attention for his “blue lives matter” speech at the Republican National Convention and who is a regular guest on CNN and Fox News. In an August 15 op-ed published by the Hill, Clarke has called the civil unrest “the rule of the jungle,” “tribalism,” and a byproduct of “bullies on the left.”

He went even further, citing “father-absent homes” as a source of what he calls “urban pathologies”—leaning on old tropes used to stigmatize Black women, families, and the poor.

Single mothers are not to be blamed for young people’s responses to a city that ignores or criminalizes them. They should not be shamed for having children, their family structure, or for public policy that has made the city unsafe for parenting.

Creating justice—including reproductive justice—in Milwaukee will take much more than parents texting their teens to come home. The National Guard must leave immediately. Our leaders must identify anti-Black racism as a root cause of the uprisings. And, lastly, creating justice must start with an end to harmful rhetoric from officials who lead the way in ignoring and dehumanizing Milwaukee residents.

Sheriff Clarke has continued his outrageous comments. In another interview, he added he wouldn’t “be satisfied until these creeps crawl back into their holes so that the good law-abiding people that live in the Milwaukee ghetto can return to at least a calm quality of life.”

Many of Milwaukee’s Black families have never experienced calm. They have not experienced a city that centers their needs and voices. Black youth fed up with their treatment are not creeps.

And what hole do you think they should crawl back into? The hole where they face unemployment, underemployment, police brutality, and racism—and face it without complaint? If that’s the case, you may never be satisfied again, Sheriff.

Our leaders shouldn’t be content with Milwaukee’s status quo. And asking the citizens you serve to be quiet in the ghetto is an insidious expectation.


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