A new report out from the National Center for Health Statistics finds that U.S. maternal deaths have increased by an alarming 40% since 2020. The latest federal data suggests that 84% of these deaths were preventable. The maternal death rate is highest among Black women—from 2018 to 2021, Black maternal mortality nearly doubled.

What is the cause of skyrocketing maternal mortality rates? The U.S capitalist system and the racism and sexism built into the core of that system. While the spike in maternal mortality is being attributed to the COVID-19 pandemic, the pandemic simply exacerbated an already existing crisis. The United States’ abysmal maternal death rates can be attributed to many factors but chief among them are: no universal health care, no paid maternity leave, and medical racism and sexism, all problems that are endemic to a system that puts private profits over people’s needs.

The most dangerous high-income country to give birth 

Maternal deaths in the United States have escalated to the highest rates in nearly 60 years, pushing maternal mortality rates to an average of 33 deaths per 100,000 live births and 69.9 deaths for Black women. The COVID-19 pandemic exacerbated the crises of maternal deaths and revealed the failure of the American capitalist health care system in saving women’s lives, especially Black women. Black women are 2.6 times more likely than white women to die each year due to health complications related to pregnancy. Despite Black women only comprising 14% of the total U.S. population, they make up 30% of maternal deaths. 

The high death rates among Black women further reveal the political, social and economic disadvantages that are systemically imposed on working women targeted by racist oppression. This leaves Black women at the bottom of the barrel for receiving access to affordable health care, childcare, housing and quality education. 

Inadequate access to health insurance is one of the primary obstacles to accessing vital health care services. The U.S. is the only high-income country that does not provide universal health care to millions of poor and working women. A little over 1 in 10 women are uninsured, while only 18% of women ages 19 to 64 are covered by Medicaid. Even when women are covered under Medicaid, some states strip the right to coverage for women 60 days after giving birth. 

Privatized health care system that treats childbearers as wombs, not people in need of care

Health department researchers found that 84% of pregnancy-related deaths were preventable. A troubling 53% of maternal deaths occurred well after women left the hospital, between seven days and a year after delivery. The primary causes of later-maternal deaths are mental health and substance abuse. For Black women, cardiovascular disease is the leading cause of death. The majority of later-maternal deaths could be prevented by improved access to health care, including mental health care.

Another factor in the high rates of later-maternal deaths is the fact that the U.S has no paid maternity leave. This “federal policy failure leaves more than 100 million people—80 percent of U.S. workers —without paid time off after the birth or adoption of a child,” according to the National Partnership for Women and Families. Among the 25 percent lowest-paid workers, most of whom are women and people of oppressed nationalities, only 9 percent had access to paid family leave in 2020.  

Research shows that fewer than eight weeks of paid leave is linked to a reduction in women’s overall health status and increased depression. For women who are able to take paid leave, their chances of being re-hospitalized are reduced by 51 percent. These statistics make clear that the government’s unwillingness to legislate paid leave at the federal level is causing women to die. 

Women who live in rural areas have also been left behind by the American profit-driven health care system. Hospitals across the country have closed down their obstetric units in several rural and impoverished areas because “childbirth doesn’t pay, at least not in low-income communities.” The closure of rural hospitals have a disproportionate impact on Native American women who also experience very high rates of pregnancy-related deaths. 

The Dobbs v. Jackson decision impacts maternal health  

Since the overturning of Roe v. Wade, states that have banned or restricted abortion access also have higher rates of maternal mortality and infant death. The 2021 American Rescue Plan introduced expanded Medicaid coverage—up to one year postpartum—but less than one-third of the states with abortion bans have opted into this new federal coverage. The same states that have banned or attempted to ban abortion refuse to offer their residents necessary health care coverage to address the physical and mental health complications mothers face that contribute to maternal deaths. It is unsurprising that the reckless decisions by state lawmakers to attack the reproductive health care system only further widen the disparities women and disproportionately Black women face.  

The role of racism in the U.S. health care system balloons the crisis of maternal mortality rates by driving up the racial and health disparities, revealing the effects of what Claudia Jones called “triple oppression.” Under capitalism, the high rates of maternal deaths are inextricably linked to the deeply rooted nature of racism that plagues the U.S. health care system. Many reports reveal that Black women who experienced health complications during pregnancy and after birth were frequently disregarded by their medical providers. Reports further depict racist mistreatment that occurs on the hospital floor throughout the duration of a Black woman’s pregnancy including medical providers shouting, scolding and refusing requests for help. 

The U.S. capitalist system has always disregarded the lives of working-class Black women and women of other oppressed nationalities. This is the same system that medically experimented on female slaves without anesthesia and forced compulsory sterilizations and hysterectomies, all while building a two-tiered, profit-driven health care system. Black and Native women’s reproduction have been policed, controlled and regulated since the founding of the United States.

We need a new system that prioritizes reproductive health and welfare of millions of working women 

The fact that 84% of pregnancy-related deaths are preventable is an indictment of the racist and sexist capitalist health care system and its blatant attacks on women’s lives. Hospitals and OB-GYN departments close down in the communities that face the highest levels of poverty and racial oppression because they are not profitable. The COVID-19 pandemic and the Dobbs decision further reveal to millions of working class women that the capitalist system chooses to prioritize lining the pockets of private hospital CEOs while attacking essential public health care services. 

The rights to survive a pregnancy and birth as well as to have an abortion, adequate health care, paid family leave and essential services for family planning are all part of the struggle for reproductive justice. It is clear that a system that prioritizes profit cannot be the same system that will provide quality, dignified care for working, poor and oppressed people. We need a broad movement for reproductive justice that defends the rights of all working, poor and oppressed women—a movement that catalyzes a revolutionary transformation of the system to guarantee that our basic human rights and needs are met. 

After two different judges issued conflicting rulings on the accessibility of mifepristone, more commonly known as the abortion pill, the Supreme Court weighed in on April 21, temporarily allowing the continued use of mifepristone pending a full appeal.

While the Supreme Court paused far-right Texas judge Kacsmaryk and the Fifth Circuit’s decisions, which severely restricted the use of mifepristone, this only provides temporary relief. The case will now be handed back to the Fifth Circuit and however they rule, the decision will likely be appealed to the Supreme Court.  

The Supreme Court is not a democratic institution. Nine unelected judges, appointed for lifetime terms, proved this when they overturned Roe v. Wade in the Dobbs decision. In temporarily safeguarding mifepristone, they did the bare minimum for human rights by blocking a decision that should not even be coming before the Court. The Court should have dismissed Kacsmaryk’s decision outright rather than staying it pending further review. And even though the decision was stayed, access to abortion pills will still be limited to those states where abortion is legal.

Throughout history, the Supreme Court has made it abundantly clear that it is an enemy of the people. It upheld slavery as a legal institution until the Civil War ended it. It made apartheid and segregation the law of the land in 1896 and today is taking back voting rights for Black people, human rights for immigrants and union rights for workers. Until the mass movement of the LGBTQ community forced the Supreme Court to change, it denied marriage equality and other basic rights. 

So why is the Supreme Court now ruling to temporarily safeguard the abortion pill? 

Had the Supreme Court ruled to uphold Kacsmaryk’s decision banning mifepristone, it would have only served to further demonstrate their illegitimacy as an institution and their enmity to basic human rights. Such a decision would have further exposed the influence of the far-right on the Court, demonstrating that their decisions are made politically rather than based in a neutral application of the law.

We also cannot ignore the role that the pharmaceutical industry, worth billions, played in the Supreme Court’s decision. In undermining the FDA and medical science more broadly, the Texas decision has come into conflict with a significant portion of the establishment. After the Fifth Circuit’s ruling, more than 500 pharmaceutical executives and researchers signed an open letter urging the Supreme Court to rule against Kacsmaryk’s decision, claiming that if the Supreme Court upheld the nationwide mifepristone ban, it would result in “uncertainty for the entire biopharma industry.” The president of the American Medical Association, Dr. Jack Resnick Jr., speaking for the country’s doctors, strongly opposed the Texas ruling, explaining that the case “jeopardized our nation’s 85-year-old drug regulatory system” and risks becoming a precedent for the arbitrary outlawing of many medications on a political basis. The Dobbs decision demonstrated that the Supreme Court is willing to rule against popular opinion, but the mifepristone stay suggests they are more cautious when opposed by corporate interests. 

Justices Thomas and Alito publicly disagreed with the decision to stay the Texas ruling. In his dissent, Alito claimed that there was “no harm” in the Fifth Circuit’s decision, which is wildly out of touch. For working-class people the difference between abortion access at seven weeks and at 10 weeks is a meaningful difference, especially when many women may not know they are pregnant at seven weeks. Additionally, the Fifth Circuit’s decision bans telehealth access, meaning that those seeking abortion care must go to the doctor’s office to receive the pill, which puts an additional burden on poor and working-class people, especially those living in rural areas or states where abortion has been banned or effectively banned. 

Background on the case: A timeline 

On April 7, far-right Texas judge Matthew Kacsmaryk and Washington judge Thomas Rice issued conflicting decisions about the use of mifepristone, one of two pills used for medication abortions and miscarriage care. While Kacsmaryk ruled to suspend the FDA approval of mifepristone, Rice ordered to keep the drug available in 17 states and Washington, D.C. 

After Kacsmaryk’s decision, the Justice Department filed an appeal to the Fifth Circuit Court of Appeals, which largely upheld the decision while only reversing parts of it, namely Kacsmaryk’s ruling that the FDA approval of mifepristone in 2000 was unconstitutional. However, the Court did uphold Kacsmaryk’s decision against the 2016 FDA update to the use of the drug. This update determined that the drug is safe for use up to 10 weeks of pregnancy, whereas the original approval was only up to seven weeks of pregnancy. 

This decision, if allowed to stand, would impose a ban on the abortion pill after seven weeks of pregnancy. It would also ban the distribution of the abortion pill by mail, as part of Kacsmaryk’s ruling is based in the Comstock Act of 1873, which made it illegal to send “obscene” materials through the mail. 

The Fifth Circuit Court’s decision upholds misogynistic and unscientific arguments made by Kacsmaryk like the assertion above. It allows doctors who have not used mifepristone to file lawsuits against the FDA on behalf of women who are too “ashamed” or “traumatized.” Kacsmaryk also argues that the FDA did not consider the “psychological” effect abortion could have on mifepristone users, and that “‘the abortion pill involves the termination of a human life,’ elevating the rights of a fetus above those of a pregnant person.” 

None of these reasons are based on scientific evidence; Kacmaryk’s ruling is clearly a set of extreme far-right talking points. And the Fifth Circuit Court is no better. Although they have been framing their ruling as a compromise decision, it is clear based on what portions of Kacsmaryk’s decision they upheld that they too are trying to overturn abortion rights nationwide.

The struggle over medication abortion is far from over 

Decades of science has already proven that mifepristone is safe, with more than 100 studies conducted on the topic and over twenty years of the drug’s usage. Not only is mifepristone effective for medication abortion and approved in 19 countries, but it is also used extensively for women experiencing miscarriages. There is absolutely no evidence that the drug is dangerous or that the FDA rushed its approval, and for the Supreme Court to rule against the FDA in an appeal would set a legal precedent and have drastic consequences for women.

We cannot let the Supreme Court’s decision lull us into complacency. The Supreme Court should have thrown the case out — instead, women’s access to a safe, effective, life-saving drug continues to be the subject of political football. Abortion is popular, but that didn’t keep the Court from eviscerating federal protection of abortion rights. Far-right elements of the ruling class will continue to roll back our rights as long as they can get away with it; and the Democrats are either unwilling or unable to stop them. It is only the people — organized in an independent movement — who can secure abortion rights and all our human rights once and for all.