It has been over six months since the Supreme Court issued its decision in Dobbs v. Jackson Women’s Health Organization, overturning Roe v. Wade and eliminating the federal right to an abortion. The loss of this right is a public health crisis—causing widespread fear and confusion, especially for the Black community. Since July, roughly 5.8 million Black women, or 56.7% of the reproductive-age Black women in the U.S., face new barriers to abortion access.
With abortion access now left up to individual state governments, many companies have pledged their commitment to helping their employees get access to the reproductive healthcare they need, including abortion care and the cost of travel—if needed.
This weekend was the 50th anniversary of Roe v. Wade. It now marks a reminder of what has been lost and what uncertainty there is to come. What’s left in the wake of Roe is opportunity: to be creative, to be bold, and to be persistent as we collectively reimagine a future that centers those historically left behind and create a more equitable healthcare landscape for all.
In this spirit, here is an overview of the state of the maternal mortality crisis in the U.S., and what employers can do:
The state of the maternal mortality crisis
A recent study by the Commonwealth Fund found that compared to states where abortion is accessible, states that have banned or otherwise restricted abortion have fewer maternity care providers; more maternity care “deserts”; higher rates of maternal mortality and infant death, especially among women of color; higher overall mortality rates for women of reproductive age; and greater racial inequities across their healthcare systems.
Compared to the 10 richest countries in the world, the U.S. comes in last place when it comes to maternal mortality. Notably, the U.S. maternal mortality rate is exceptionally high for Black women—more than double the national average rate and nearly three times higher than the rate for white women. The severity of these exceedingly disparate outcomes are unique to the U.S. because they are tied to a healthcare system that has historically devalued and exploited Black women. Furthermore, these inequities are the tragic result of a healthcare and health insurance system that have been shaped by structural racism and the unequal allocation of opportunities and resources based on race and geography.
In the maternal health policy space, it has long been well documented that Black women have historically faced numerous systemic obstacles to receiving comprehensive reproductive healthcare, free from coercion and discrimination. In the case of the Black maternal health crisis, public figures have more recently begun demanding a reckoning within the U.S. healthcare system. Investments from philanthropic foundations and, what I consider to be virtue signals—such as public hearings, long-term studies, and stakeholder roundtables—from both Congress and the Biden-Harris administration have put on record a public commitment to improve the state of Black maternal health.
Now more than ever, there is a broader understanding of how impactful structural factors, like the social determinants of health, are on maternal health outcomes. Late last year, the Government Accountability Office published a report on the impact that COVID-19 has had on maternal mortality and morbidity over the past few years. The findings suggest that COVID-19 has contributed to 25% of the 2,000 maternal deaths between 2020 and 2021. More specifically, Black women experienced 68.9 deaths per 100,000 live births, as compared to 27.5 maternal deaths per 100,000 live births among white women. The Department of Health and Human Services and key stakeholders determined that the impact of COVID-19 on inequities in social determinants of health—such as the ability to access care, employment dips, lack of transportation, hospital restrictions in delivery rooms, and environmental stressors—as well as racism were responsible for worsening maternal health outcomes.
Impact of Roe on maternal health and access to fertility care
The data is out there. Abortion restrictions place an incredible burden on access to reproductive healthcare and that burden falls heaviest on the most marginalized among us—Black women, other people of color, people living with disabilities, young people, and those struggling to make ends meet. Abortion restrictions have far-reaching consequences, both deepening existing inequities and worsening health outcomes for pregnant people. While most people will go on to have healthy pregnancies and deliveries, some will experience complications or conditions where pregnancy can cause serious health problems. When abortion is difficult or impossible to access, complicated health conditions can worsen and even result in death. Maternal health advocates have been sounding the alarm on the harm that abortion restrictions have already had and we are now beginning to see how things will continue to worsen as more states adopt harsher restrictions.
The impact of the fall of Roe also cannot be understated for those with hopes to become pregnant and who may need the assistance of reproductive technology (often referred to as ART). Patients currently going through the in vitro fertilization (IVF) process and those beginning to have recommended consultations have expressed fear of uncertainty, given the wording of some state abortion bans that have been enacted since the Supreme Court’s decision. The worry is that vague language and the open interpretation of these laws will make IVF less accessible. Of particular concern are laws that could be strictly interpreted as giving frozen embryos—a common part of the IVF process—“personhood” status, as well as conflicting legal definitions of what constitutes “conception.”
With this loss of bodily autonomy, the threat to maternal health has never been more dire. It is vital to keep in mind that pregnancy, abortion, and infertility do not exist in silos. An individual can experience challenges becoming pregnant and need access to fertility care; be pregnant and need access to abortion care; be pregnant and need access to respectful maternal health care; or be pregnant and experience a miscarriage and need access to prenatal, birth, and postpartum care.
What employers can do
In this country, nearly half of Americans receive their healthcare through employer-sponsored plans, meaning health insurance is inextricably linked to one’s employment and/or economic status. Due to Congressional inaction to protect federal abortion rights or strengthen maternal health policies, employers now have an immense opportunity to help bridge some of the gaps in access to care (for those with employer-sponsored insurance). However, this approach is a Band-Aid fix to a chronic structural problem because employer-sponsored health care is a privilege of many, but not all. Simply put: Neither your ZIP code nor your employer should be able to determine the outcome of your pregnancy.
Recognizing this, the following 10 policy solutions are intended to promote equitable access to the full spectrum of reproductive healthcare:
1. Ensure that all employees are able to access resources about company-wide abortion and maternal health insurance benefits.
This information should be made available in multiple languages, both online and in print at an accessible reading level.
2. Extend paid parental leave to at least 12 paid weeks and encourage flextime.
Work with insurance payers and healthcare providers to integrate the services of doulas and midwives into your health plans.
Consider extending maternal health care benefits to part-time employees as well.
3. Provide abortion coverage benefits.
This should include coverage for the cost of travel for employees who are forced to leave the state for abortion care.
4. Promote and strengthen mental health services and provide resources for employees.
Offer self-care days or hours for treatment/testing/appointments/rest.
5. Proactively align pregnancy accommodations with those in the Pregnant Workers Fairness Act ahead of the law going into effect this June.
This is considered the gold standard for supporting and protecting the rights of pregnant employees and relies on a reasonable accommodation framework already familiar to employers accustomed to the ADA’s requirements. It will provide real solutions to those workers currently being asked to choose between their pregnancy and their paycheck. It will also require that employees are educated about pregnancy accommodations and their right to request them.
6. Provide inclusive fertility benefits.
These should accommodate the needs of LGBTQ employees and single people.
7. Ensure that lactation policies comply with federal and state regulations.
Monitor compliance and ensure that all employees have access to the same level of support and accommodations.
8. Provide inclusive bereavement leave.
Bereavement leave should align with the Support Through Loss Act, which would require employers to provide at least three days of paid leave for employees who have experienced a pregnancy loss, as well as partners of those who have experienced loss. The benefit would also be available to those who have had a failed adoption/surrogacy experience, as well as those who have had an unsuccessful assisted reproductive technology procedure, and those who have received a medical diagnosis or had a medical event that impacts pregnancy or fertility.
9. Provide childcare or after-school care (on-site if available).
This could also include creative partnerships such as discounts with local childcare providers or employee stipends.
10. Commit to diversifying the birth worker field.
The imperative to diversify the healthcare workforce is evident: Increased diversity contributes to the overall health of our nation. Given persistent racial and ethnic disparities in birth outcomes, workforce diversity is particularly urgent in the context of clinical and supportive care during pregnancy and childbirth.
This can be achieved by providing incentives or discounts to eliminate financial barriers to entry in the birth worker field. The financial burden of midwifery school, doula training, subsequent testing, and necessary accreditations are known to be the greatest barriers to entry for birth workers of color.
Alise Powell is a reproductive justice advocate and a senior policy analyst at the National Birth Equity Collaborative.
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