Racial discrimination alive and well in reproductive healthcare

This article was originally published on The Hill.

This week, U.S. experts from the Center for Reproductive Rights (CRR) and SisterSong Women of Color Reproductive Justice Collective will testify before the United Nations’ Committee to End Racial Discrimination in Geneva, sharing a report that describes the experiences of American women of color and immigrant women who pay with their health and even their lives for the race and gender discrimination that tirelessly persists in our health system.

The meeting is part of the U.N.’s periodic review process that evaluates how signatories to the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) are progressing in addressing and dismantling racism. The United States ratified ICERD in 1994 and during its last review in 2008, the U.N. committee expressed concern about the continued disparities in sexual and reproductive health. Unfortunately, not much has changed in the last six years.

Racial and socioeconomic inequities are driving a maternal health crisis for women of color and immigrant women, many of them poor. While the U.S. as a nation has been sliding backwards on maternal health — and is in fact one of only seven countries in the world to see increasing maternal mortality rates (MMR) over the past decade — the situation is particularly dire for women of color and immigrant women. Washington, D.C.’s population, which is 50 percent black, has an MMR of 41.6 per 100,000 women, compared to the national average of 28. African-Americans in Fulton County, Ga., home to Atlanta, have an MMR of 94, and for women of color in Chickasaw County, Miss., it is 595 — higher than Kenya and Rwanda.

Similarly, immigration status dictates women’s ability to access to healthcare. Non-citizens are three times as likely as U.S.-born citizens to lack health coverage, and immigrant women are 70 percent more likely to not have coverage. This is not surprising, given a five-year waiting period for Medicaid eligibility for documented immigrants and laws that bar undocumented immigrants even from purchasing private insurance with their own money on the newly created exchanges. This leaves immigrant women reliant on publicly funded clinics for affordable reproductive health services. This is particularly problematic in states like Texas, where even immigrants who have fulfilled the five-year waiting period are barred from accessing Medicaid and publicly funded clinics are being closed left and right.

The report — a collaborative effort of CRR, SisterSong and the National Latina Institute for Reproductive Health — lifts up the all too often-unheard voices and experiences of women from Atlanta, Jackson, Miss., and the Rio Grande Valley in Texas. There are young women who encountered such stigma accessing contraception that they no longer use family planning. Women whose doctors neglected routine pregnancy care. Women who went through active labor in the hallways of overcrowded hospitals and were told not to push because there was no delivery room available. Women who experienced unwanted and medically unnecessary cesarean sections, only to wind up with infections that went undetected. Women who have breast lumps, cervical pain and bleeding but have no way of accessing care. Women who have no local providers and cannot travel long distances to visit another clinic. And women under serious stress after returning to work a mere one to three weeks after birth.

Given these stories, we should find even more concerning the Guttmacher Institute’s new report that indicates that the number of women needing publicly funded family planning is rising at the very time that states are restricting family planning funding and regulating reproductive health providers out of existence. From 2000 to 2012, the number of women in need of publicly funded family planning increased by 22 percent (3.5 million additional women), while the number of women served by publicly funded providers decreased by nine percent (from 6.7 to 6.1 million). This is exacerbating the reproductive health crisis described in the stories above.

The CRR report before the U.N. this week provides a series of recommendations that would enable the U.S. to meet its obligations under CERD and ensure the human rights of women of color and immigrant women: increasing health coverage for low-income women and improving access to reproductive and sexual health care; improving data collection and strengthening accountability mechanisms on maternal mortality; and repealing provisions of the Affordable Care Act that exclude many immigrants from coverage.

There is no quick fix to the pervasive U.S. health disparities. But there are solutions before us — increasing funding for Title X (the nation’s family planning program) and participating in Medicaid expansion — and there’s no good excuse for failing to implement them. They would go a long way to increasing access and improving health outcomes among the women in greatest need. As Angela Hooten of CRR said, “Health insurance is the most significant barrier to health care and the principal driver of health care disparities in the U.S.” Indeed, it is. Why then, are 21 states — many of them those with the highest rates of poverty, uninsured people and maternal mortality — refusing to expand Medicaid?

Hooten notes, “For too long, these women, their families, and their communities have been shut out of this country’s health care system. A woman’s race or immigration status should never determine whether she will survive childbirth or access critical cancer treatments. The United Nations must hold the U.S. government accountable for these grave injustices.”

This week’s meeting is an important opportunity to ask the federal government to acknowledge and address the human rights violations that too many women in this country face. It is also a chance for us to call attention to the ways that state lawmakers are allowing politics to trump women’s lives, and to demand a change.