The World Health Organization recently reported a global decline in the maternal mortality rate over the past 20 years—but pregnancy related deaths in the United States more than doubled across the same two decades.
Why is motherhood such a precarious state in a prosperous country like ours?
As a social work researcher and educator, I believe we must move beyond persistently blaming women’s individual health behaviors. There has been a rise in medically unnecessary cesarean sections, and there are persistent issues with women receiving adequate and timely prenatal care—but there is more to this story for U.S. women, and much more to the story for black women in particular, who bear physical and emotional witness to persistent racial disparities in maternal, fetal and infant mortality.
These dismal statistics reflect what social workers call a bio-psycho-social-spiritual perspective, asserting that most human phenomena have complex biological, psychological, social and spiritual underpinnings. To put it simply: Until we address the unfair rules of engagement for women, and especially for women of color, we are never going to win this game.
According to the National Center for Education Statistics, during the same two decades in which women earned more graduate and professional degrees than men in most major disciplines, especially in our public colleges and Universities, the greatest employment disparity between men and women occurs during prime reproductive age—when 90.5 percent of men and 75.3 percent of women are actively participating in the labor force. Women may be highly trained for professional workforce participation, but a lack of supportive workplace policies often force women into difficult and stressful choices.
Many women work part-time positions, which promise flexibility but fail to deliver benefits like health insurance. Even for women privileged with solid employer benefits, the transition back to work occurs during this high risk time for women’s health. If a woman’s employment ends, so do her employer-sponsored health benefits, leaving unmet physical and mental health needs compounded by the expenses of purchasing health insurance in the private marketplace.
The working-caregiving-insuring-healing-coping cycle is fraught with stress and social pressure, and the postpartum woman stands in the middle of it all.
The Centers for Disease Control (CDC) report that almost 80 percent of women experience some degree of “baby blues” following pregnancy and an estimated 15 to 20 percent experience postpartum onset major depression. Mental health can be debilitating to mind, body, social and occupational well-being at any time, but the time during and around pregnancy poses particular risks along with opportunities for intervention. While there are evidence-based treatment options, services must be accessible, affordable and available, which is not the case in many communities across the country.
Social expectations are embedded into the fabric of our lives: moms who juggle work and caregiving; who balance budgets and breastfeeding; who are barraged for what they do and what they don’t do everywhere from social media to the grocery line. As a society, we feel empowered to tell new mothers how to parent as we feel they should, imposing cultural and familial values onto complete strangers; we critique mothers who work and vilify those receiving public assistance.
We create a social conundrum where it is often virtually impossible for a woman to feel like a “good mother” without sacrificing her health, mental health and well-being. It doesn’t have to be this way.
We are able to take a stand on women’s health and support meaningful family leave policies, and to decide that women’s lives are worth the price of providing a full year of health and mental health services during and around the time of pregnancy. We are able to refocus our efforts on naming and undoing the racism, classism and sexism that pervade life in the United States and which continue to put women’s lives at risk.
As my profession teaches me, bio-psycho-social-spiritual issues can be undone by taking any part of the system to task. That means improving access to health care and addressing the lifespan effects of persistent racism on maternal and infant health (biological); providing universally accessible services for postpartum depression and mental health promotion (psychological); adding resources for occupational and social support for women in industry, schools, offices and community (social) and believing in the capacity of women to enact meaningful choices which allow them to be capable mothers and caregivers (spiritual).
We can change the outcome of this game. But we have to remake the rules if we’re going to win the opportunity for all our sisters to live healthy lives as they give birth to future generations.