Introduction

Throughout Breana Lipscomb’s two-decade public health career, she has had to bear witness to hundreds of deaths each year from the same preventable cause: a lack of quality maternal care. 

The United States has distinguished itself over the past 20 years as one of the only countries where maternal health has gotten worse. While global maternal mortality rates dropped by 40% between 2000 and 2023, U.S. deaths increased. Its maternal mortality rate is the highest of any wealthy country—almost twice the average among countries with comparable economies.  

Among Black and Indigenous women, the numbers rise even further. In 2023, Black women in the U.S. faced a death rate 3.5 times higher than their white counterparts.  

Breana has been fighting to change these statistics for 20 years. Starting off in state health departments, she found health systems that weren’t meeting people’s needs—and governments that weren’t changing them. “For decades, Black and Indigenous people have been forced to give birth in a maternity care system that is failing them,” says Breana. “But few resources were being devoted to dismantling these inequities or to the communities that were disproportionately impacted.”  

In 2017, she joined the Center for Reproductive Rights and now serves as Senior Advisor of Maternal Health and Rights. At the Center, “our work is rooted in human rights,” says Breana, “and we specifically frame it within the context of the Right to Health, which requires that health care goods and services be provided without discrimination.”  

Today Breana works to advance policies that actively address the deep inequities in U.S. maternal health care. She aims to improve not only access to care but the ability of pregnant people to make their own decisions about their bodies.  

“This is a long game,” says Breana. “But for people who look like me, our lives literally depend on this work.”

A war on all fronts

A war on all fronts

Across the U.S., two thirds of maternal deaths take place in the year after birth. But as of January 2020, no U.S. state provided more than 60 days of postpartum Medicaid coverage, the federally mandated minimum. 

With more than 40% of U.S. births covered by Medicaid, this policy failure had serious consequences. And its particular impact on Black and Indigenous people—for whom Medicaid covers two thirds of births—was deepening disparity.  

Looking to develop a solution, Breana and other advocates turned to Georgia, where maternal mortality rates have consistently been among the highest in the country. Black Georgians are almost twice as likely as white Georgians to live in poverty, and 65% of Black women are insured with Medicaid when giving birth.  

With the Center and its partners leading the way, Georgia passed a law in July 2020 extending Medicaid coverage to six months postpartum. It became one of the first states in the country to do so, giving low-income Georgians access to physical and psychological support, help with infant care and feeding, and more. 

By the end of 2022, the state had extended postpartum coverage to a full year, benefiting more than 65,000 people across the state.  

And around the country, other states were following suit. As of today, 49 states plus Washington D.C. have extended postpartum coverage to one year or are in the process of doing so. “This success is a testament to our deep engagement on this issue with state and national partners across the country,” says Breana. “It affirmed that with perseverance—and political will—change is possible.” 

More victories across the country have validated this belief. “In recent years, we’ve seen unprecedented federal and state investments in addressing health inequities in maternal health care,” says Breana.  

Efforts are underway to diversify the maternal care workforce—a crucial step toward inclusive, non-discriminatory care. And states are working to take better stock of the problem via Maternal Mortality Review Committees, which collect, analyze, and share data on maternal mortality.  

Interest in and acceptance of the midwifery model of care is also growing. “Midwifery care has the potential to address many barriers to safe and respectful maternal health care in the U.S. that disproportionately impact low-income, rural, and Black and Indigenous communities,” Breana says. “I am actively working in coalition with midwives and other state and national partners to reform restrictive midwifery laws in states like Georgia and others.”  

There’s already been a major win on that front: In a groundbreaking Center case, a Hawaiʻi court last year blocked a discriminatory law that prevented native Hawaiʻin midwives from providing care in their communities. 

“The conversation about reproductive rights and bodily autonomy is expanding,” says Breana. “People are understanding that bodily autonomy includes one’s ability to make decisions about their childbirth experience—who their provider is, where they will give birth, who they have present, etc. 

Getting personal

Getting personal

Though the maternal health crisis is ongoing, Breana sees the tide beginning to turn. “We are making tremendous progress in several areas, and I believe these successes, compounded, will yield considerable impact for birthing people and their families,” says Breana.  

“As a Black woman, I am who I am fighting for. My sister, my friends, my neighborhood coffee shop owner, my colleagues and co-conspirators in this fight—I see the community I’m fighting for every day.”  

That community is what helps to keep her going. “When challenges arise with a hostile federal administration or an unfavorable Congress or an infuriating SCOTUS decision or a misguided state legislature, I have to press forward. There is no other option.”