The Best Time to Improve Black Maternal Health is Before Pregnancy

Kinika Young | April 2022

Most people have heard the disturbing statistics by now – the United States has the highest rate of maternal mortality among industrialized countries, and Black women are three times more likely to die of pregnancy related complications than White women (regardless of education or income). We also know there are several factors driving this disparity, including structural racism, discrimination and implicit bias from providers, underlying chronic conditions, and inadequate access to quality health care.  

Black Maternal Health Week (April 11th-17th) provided a good opportunity to talk about strategies to improve health outcomes for Black moms and babies. We should now follow up on these conversations with action. One of those strategies is increasing access to pre-conception health care. A woman’s health before she becomes pregnant is critical to pregnancy outcomes for her and her infant. Preexisting health conditions, such as depression, hypertension, diabetes, and obesity, can be exacerbated during pregnancy and lead to complications. The ability to manage such conditions before, during, and after pregnancy can improve outcomes for both parent and child. Therefore, providing access to health care for those who may become pregnant is especially important.   

In Tennessee, it is estimated that 31,000 women of reproductive age, including 8,000 Black women, are in the coverage gap. This means they don’t qualify for TennCare (Tennessee’s Medicaid program) or subsidies to help purchase insurance on the marketplace that was set up under the Affordable Care Act (ACA). The ACA provided for Medicaid expansion, which is an option for states to use federal tax dollars to cover more people on Medicaid. The Tennessee legislature has refused this option for purely political reasons, despite the overwhelming evidence that our state and Tennesseans’ health would benefit from it.  

A lesser-known option to expand coverage is the “family planning” expansion. Through a state plan amendment (a permanent change to the state’s Medicaid program), Tennessee could obtain federal funding to provide family planning services to individuals who are not pregnant and do not otherwise qualify for Medicaid. The benefit package focuses on preventive care services that can help avoid many negative health outcomes, such as cervical cancer, HIV and other sexually transmitted infections, infertility, and preterm and low-birth-weight births.  

Tennessee is one of only three states (the other two are Kansas and South Dakota) that has not adopted Medicaid expansion AND has not adopted the family planning expansion. This decision contradicts the “pro-life” stance that many leaders proclaim and has left low-income Tennesseans without affordable access to health care. All of the states surrounding Tennessee, even our conservative neighbors in Alabama and Mississippi, cover family planning services for women and men (because it does take two), which can improve their health and pregnancy outcomes if they choose to have a family. By simply checking a box, Tennessee could help improve maternal and infant health outcomes and create healthier families.   

Kinika Young, J.D., is the Senior Director of Health Policy and Equity at the Tennessee Justice Center.  

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