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Excerpted From: Arianna M. Rappy, The Maternal Healthcare Crisis: Expanding the Scope of Postpartum Care and Minimizing the Racial and Ethnic Gap, 43 Women's Rights Law Reporter 243 (Fall/Winter 2021) (140 Footnotes) (Full Document)


AriannaRappy“When disaster strikes, it tears the curtain away from the festering problems that we have beneath them.” While the coronavirus pandemic casts a dark shadow over the past year, it illuminates a long-neglected tragedy: the maternal health crisis. Although the journey to motherhood could be a meaningful and joyous time in a woman's life, the weeks, months, and even years post-delivery remains a critical yet overlooked phase of maternity care. The postpartum period, often referred to as the “fourth trimester,” reflects a time of physical and emotional vulnerability as a woman transitions into motherhood. While the maternal health crisis encompasses complications arising from all facets of the reproductive experience, including pregnancy and childbirth, the postpartum period often receives less attention from healthcare professionals.

The quality of postnatal care is a strong predictor of maternal and infant mortality, morbidity, and mental health outcomes. Research indicates that access to health care during the postnatal period is essential for the prevention and detection of potentially fatal pregnancy-related complications. Unfortunately, the United States severely lacks access to vital maternity health care services and consequently holds one of the highest maternal mortality rate in the developed world. While there is an estimated 17.4 deaths per 100,000 live births in the United States, research shows that up to 60% of pregnancy-related deaths are preventable. Moreover, the risk of maternal mortality among Black women is alarmingly 3-4 times higher than that of White women, reflecting the one of the largest racial disparities in women's health. Although nearly all women are covered by insurance during the time of delivery, pregnancy-related coverage through Medicaid terminates after 60 days. Following this period, women who reside in states that have not expanded maternity coverage after this period under the Affordable Care Act (ACA) are deprived of access to essential postpartum care. Thus, expansion of this legislation during the postpartum period in addition to the implementation of community-based programs and medical training centered around implicit-bias is critical in reducing maternal mortality, morbidities, and accounting for racial disparities within the maternal health crisis.

Part I of this paper provides a general overview of complications associated with the postpartum period, such maternal mortality, morbidity, and mental illness. This Part also describes the extent to which Medicaid provides postpartum maternal health coverage and explores racial and ethnic disparities in maternal care through a historical lens and as a pervasive barrier to crucial medical support. Part II sheds light on the U.S.'s failure to meet domestic obligations to fulfill the promises of the Equal Protection Clause of the Fourteenth Amendment, as well as the protection of human rights under international law. Further, this Part critiques past legislative measures. Finally, Part III proposes solutions to increase access to maternal health care, suggesting potential paths toward institutional reforms by addressing barriers and expanding coverage through the adoption of federal legislation.

[. . .]

All women have a right to safe maternal care. The existence of laws, policies, and institutional practices that foster poor maternal health outcomes and barriers to essential care during the most medically vulnerable period of pregnancy deprive women of that right. While maternal mortality and morbidities during the postpartum period are preventable, hundreds of mothers and infants die each year. Thus, the nation's maternal health crisis must be comprehensively addressed through the enactment of legislation and community-based programs that account for women's experiences, racial disparities, and the role of structural racism in shaping the practices of medical institutions. As the global pandemic fades into the darkness, an opportunity for positive change is on the horizon.

J.D. Candidate, Brooklyn Law School.

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