‘Beyond any touch of mercy’: Black and Indigenous maternal health in Minnesota

As mothers, people from communities most impacted by maternal deaths, and professors who know the data and lead this research, we know all too well what is at stake for people who are pregnant and their families here in Minnesota and across the country. We have served on Minnesota’s maternal mortality review committee, reading the painful accounts of maternal death in our state, discussing ways to prevent future deaths, and holding space for the pain and suffering that can never be reversed.  Each lost mother is a person stolen from a family and a community, and someone who was loved.

In Minnesota, the maternal mortality rate for U.S. born Black people is 2.8 times higher when compared to white people who give birth. The Indigenous (American Indian/Native American) maternal mortality rate is approximately eight times higher than that for white people who give birth. This means that while just 6.4% of Minnesotans are Black, they represent 15% of maternal deaths in our state. And while Indigenous people represent 2% of those who give birth in Minnesota, 12% of all Minnesotans who died during pregnancy, childbirth or the postpartum year are Indigenous.

We see similar heartbreaking statistics for babies. Among Black and Indigenous people in Minnesota who survive pregnancy and childbirth, they still face the reality that their newborns are two times more likely than white newborns to die before they celebrate their first birthday.

This disproportionate burden of loss is staggering. Tragically, this keeps with the historical precedent set by Minnesota’s first governor, Henry Sibley, whose actions and words dehumanized Dakota people, “Oh the fiends, the devils in human shape! My heart is hardened against them beyond any touch of mercy.” (Henry Sibley, 1858) Dehumanization and racism have hurt Indigenous and Black Minnesotans for centuries.

The tragic effects continue today, as Minnesota’s Black parents are haunted by the killing of our Black children at the hands of law enforcement. Police brutality is traumatic for entire communities, harming pregnant people and families. Our research shows that here in Minneapolis, pregnant people who live in neighborhoods with disproportionate police presence are at greater risk of giving birth to babies too soon (before 37 weeks gestation), putting them at risk for a host of serious short and long-term challenges.

Minnesotans — and the entire United States — face a maternal health crisis. Nationally, maternal morbidity and mortality rates are rising. Maternal mortality rates in the United States now exceed that of any other developed country; our maternal death rates are on par with Saudi Arabia, Latvia, and Uruguay.

Katy Backes Kozhimannil

Yet the shame of international comparison obscures the deeply unjust inequities in maternal mortality among historically marginalized communities. Nationally, Black, Indigenous, poor and rural people face greater risks during pregnancy, childbirth and postpartum. A focus on ensuring the safety and vitality of Black and Indigenous communities is urgently needed here in Minnesota and across the country.

On Tuesday, Dec. 7, the White House announced the first ever Day of Maternal Health Action, highlighting commitments that the federal government, private sector and Congress have made to improve maternal health and reduce inequities. For example, the federal Build Back Better Act invests in mothers.  It includes a provision that would extend pregnancy-related Medicaid coverage for a year after childbirth, reducing insurance disruptions that are common among low-income postpartum people.  The Build Better Act includes provisions from the Black Maternal Health Momnibus Act, which would expand and diversify the perinatal workforce, address the social determinants of health, invest in research and data collection and expand access to digital health tools.

Rachel R. Hardeman

In Minnesota, the Dignity Pregnancy and Childbirth Act will support antiracism and anti-bias training for maternity care clinicians across the state. But more work is needed. It is essential that efforts to support racial justice here in Minnesota include investments directly in the communities most affected by poor outcomes — Black and Indigenous people — and to ensure representation by those groups in decisions. Racial justice is not possible without reproductive justice, and passing the Protect Reproductive Options Act (PRO Act), which establishes Minnesotans’ fundamental right to make their own decisions about their reproductive health care, is a necessary step to improve maternal and infant health. Pending Supreme Court decisions threaten to undermine the constitutional right to abortion, so states must act.

Maternal death disrupts the cycle of life in a way that is deep, violent, tragic and destructive; it affects us across generations. Personally, our life and work are shaped by the memory of those we have lost. We are all touched by the historical traumas our ancestors have faced.

Our legacy toward Black and Indigenous families in Minnesota does not need to be defined by the words of Henry Sibley. Minnesota’s racial inequities in maternal mortality demonstrate that historical trends persist into contemporary reality. But the time for change is now. The health and well-being of pregnant Minnesotans and their families should not be “beyond any touch of mercy.”

Katy Backes Kozhimannil, PhD, is Distinguished McKnight University Professor at the University of Minnesota School of Public Health, director of the University of Minnesota Rural Health Research Center and Rural Health Program, and senior adviser to the Center for Antiracism Research for Health Equity. Rachel R. Hardeman, PhD, MPH, is Blue Cross Endowed Professor of Health and Racial Equity and founding director of the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health and a 2021 Bush Fellow.