Report exposes worrisome health trends in Black and Indigenous women of childbearing age

About Margarita Martín-Hidalgo Birnbaum

Margarita Martín-Hidalgo Birnbaum (@mbirnbaumnews) is AHCJ’s Health Equity Core Topic Leader. An independent journalist who has covered health disparities. Birnbaum’s stories have been published by WebMD, American Heart Association News, and American Indian, the magazine of the Smithsonian’s National Museum of the American Indian.

Image courtesy of The Commonwealth Fund

If policymakers don’t work to mitigate the detrimental effects of laws that limit American women’s health services, they will exacerbate already poor outcomes resulting from persistent inequities in social determinants of health that are driving demographic disparities. That’s one of the takeaways from a recent report by The Commonwealth Fund, a nonprofit research institution that focuses on health care policy and practice research. 

Various state-by-state patterns in women’s health were highlighted last week in the annual assessment of population well being and health care published by the institution. 

Among those findings:

• The all-cause mortality rate in women of reproductive age was due in part to medical care limitations to prevent the spread of COVID-19. Women of color were the most affected by reduced access to care. 
• The maternal death rate increased significantly for Black, Native American and Alaska Native women between 2019 and 2021. 
• Many of the states with very poor health trends are limiting or may limit reproductive care, suggesting that women who live there are at risk of being in worse health.
• Because women of color, women of low income and women who live in rural areas are more likely to live in one of the 26 states with restrictions on reproductive care, they are likely more affected by those regulations.  

Graphic courtesy of The Commonwealth Fund

To rank all 50 states and the District of Columbia, authors of the “2023 Scorecard on State Health System Performance” looked at 58 indicators of wellbeing including insurance coverage, smoking and access to prenatal care. Most of the data is from 2021, which means that the reproductive care and women’s health trends don’t reflect the effects of abortion bans passed after the Supreme Court overturned Roe v. Wade. They do, however, offer a good baseline for stories about emerging issues related to the abortion bans. The Guttmacher Institute is one of several organizations tracking state legislation and policies that affect access to women’s health services. 

Here are some story ideas, context, and resources you may want to use to write about these findings — and what disparities may be coming down the pike for future generations of American women, especially for women of color. The solutions suggested by the authors for federal, state and local policymakers help narrow down reporting topics for stories to track improvements in women’s health outcomes.

You can also use data from the report to give context to stories about the implications that the Medicaid rollback may have for women enrolled in the program. (Here’s a primer from the Brookings Institution on that topic.)

1. Beyond writing about national and state-specific trends, I’d go after a story about regional trends. The state-by-state snapshots offer highlights of the rankings and include regional comparisons. That makes it easier to compare state rankings and help narrow down story ideas about why some states and swaths of the country are doing better than others.  
2. Consider writing stories comparing states with similar race, ethnic and age demographics. If you go that route, start by pulling census data on American women of reproductive age, defined by the CDC as ages 15 to 44. This age group also has high rates of chronic, preventable conditions such as high blood pressure, obesity and diabetes. The media reps can help you navigate the tables and create maps you can use in your stories.
3. To explain the big picture behind the numbers, look at CDC longitudinal statistics for obesity, diabetes, high blood pressure and other chronic diseases that may make pregnancy riskier. This 2020 analysis is a good resource because the CDC investigators look at several years of data. You can also add women’s health trends in other high-income countries, but I would add context about the race, ethnic and socioeconomic characteristics of women in those nations. In this 2022 Commonwealth Fund report, researchers looked at key health measures in 11 peer countries.
4. Include context on social determinants of health by race and ethnicity. This will help readers understand how factors like income, educational attainment, access to healthy foods, racism and ethnic prejudice in medical care influence access to routine — and quality — gynecological and prenatal services. This 2021 brief from the Kaiser Family Foundation includes findings about contraception use and HIV prevention. For instance, “More than four in ten women (44%) rate their provider’s contraceptive counseling as excellent, but the share rating counseling as excellent is lower among Black (36%) and Hispanic (38%) women, as well as low-income (35%) and uninsured (28%) women.” The University of Wisconsin Population Health Institute’s County Health Rankings & Roadmaps is one of several reports assessing social determinants of health at the county level.
5. Ask public health officials in local and state governments what they are doing to improve the health of women in their states. Find out what initiatives, if any, they have in place or plan to have in place to promote prenatal and postpartum educational services. And ask whether officials are modeling theirs after initiatives used in other states. But don’t take their word for it; look at their budgets and ask them to explain to you how they are funding their programs and awareness campaigns. Then, follow up a year later.

Margarita Martín-Hidalgo Birnbaum (@mbirnbaumnews) is AHCJ’s Health Equity Core Topic Leader. An independent journalist who has covered health disparities. Birnbaum’s stories have been published by WebMD, American Heart Association News, and American Indian, the magazine of the Smithsonian’s National Museum of the American Indian.