Food Justice is a Black Maternal Health Imperative

This week we are celebrating Black Maternal Health Week, organized by Black women-led organizations devoted to supporting all Black people in living lives filled with sexual and reproductive freedom and joy. At the National Birth Equity Collaborative, our clarion call for sexual and reproductive wellbeing is ending the Black maternal health crisis, which continues to despair Black communities unjustly. Despite unparalleled healthcare spending, the United States has the worst maternal mortality rate of any high-income nation, disproportionately claiming the lives Black and Indigenous women. According to the Centers for Disease Control and Prevention (CDC), Black and Native American women are two to three times more likely to die from pregnancy-related causes than white women.

The root causes are clear—gendered racism and other oppressions conspire to deny opportunity and resources, including within healthcare systems, over the life courses of Black birthing people affecting their reproductive health. Black birthing people continue to needlessly lose their lives; approximately 60% of pregnancy-associated deaths are preventable. Leading causes of maternal death are often driven by the increasing number of pregnant women with chronic diseases like hypertension, diabetes and heart disease.


The leading causes of maternal mortality and morbidity in the U.S. are byproducts of structural racism within our neighborhoods and environments, yet policy and research discussions often minimize a key organizing framework--food justice. For example, many Black birthing people experience iron-deficient anemia due to fibroids or hemorrhaging during and after childbirth.


Black moms have the greatest prevalence of iron deficient anemia at hospital admission for birth (8.2%) and blood transfusion during hospitalization (4.3%), the leading contributor for severe maternal morbidity. Iron deficient anemia is also associated with increased risk for cesarean delivery, transfusion, prenatal bleeding, preeclampsia, placental abruption, poor maternal thyroid status, poor wound healing, cardiac failure, hemorrhage, and maternal morbidity and mortality.

Clinical guidance continues to let Black mamas experiencing anemia to fall through the cracks due to inaccurate, debunked ideas about biological differences between the races. For example, the American College of Obstetricians and Gynecologists (ACOG) recommends lower hemoglobin cutoffs for Black women compared to non-Black women. This means that Black women must have a more extreme level of anemia before treatment is considered. Even once anemia is diagnosed, the medical interventions are less than ideal. Oral iron supplementation is the most common therapy for iron deficiency, but unpleasant side effects and poor absorption are common, causing patients to often stop taking the medication. Intravenous iron has been shown to be safe and effective but can be inaccessible due to varying clinical guidelines.


There is a direct correlation between the Black maternal health crisis (exacerbated by

chronic conditions) and structural racism within food systems, which prevents communities of color from accessing the nutrients needed for healthy pregnancies. Access to healthful food has been systematically depleted from Black communities. A litany of racist policies and procedures have limited access to healthful foods that can help prevent or mitigate poor birth outcomes. From access to land and capital for Black farmers to economic disinvestment via redlining policies, the US government has actively hindered access to healthful foods in the Black neighborhoods. For example, the USDA discriminatorily denied loan applications to Black farmers, hindering access to land in the Black community. Additionally, predominantly Black neighborhoods have less access to grocery stores in part due to disinvestment and outdated zoning policies, including parking requirements.


These policies have resulted in what some have deemed “food deserts.” However, a more appropriate term that captures the intentional deprivation of food access is food apartheid, which racial and food-justice activist Dara Cooper describes as the “systematic destruction of black self-determination to control one’s food, hyper-saturation of destructive foods and predatory marketing, and blatantly discriminatory corporate controlled food system that results in [communities of color] suffering from some of the highest rates of heart disease and diabetes of all time.”


These policies have resulted in what some have deemed “food deserts.” However, a more appropriate term that captures the intentional deprivation of food access is food apartheid...”

Black women are claiming their power in both the reproductive justice and food justice movements both grounded in Black autonomy, liberation and human rights. If inequitable environments can be manmade, that means they can be rebuilt just the same. Black birthing people have always been an integral part of agriculture and food system labor and advocacy. The last time you purchased food at a supermarket, farmers market or drive through, you likely received your food from a young woman of color. That means we have the lived experience to generate innovative anti-racist solutions. Our collective wisdom, knowledge, and experiences can be leveraged to shift not just narratives but policies, wealth and health. Fortunately, there are amazing organizations engaging in this work to build capacity and redefine and redistribute ill-gotten wealth in service of Black communities. Let’s join in with the acknowledgement that the quest for food justice is part of the journey towards birth justice.


About the Contributors

Tonni Oberly is an NBEC research scholar. Tonni is pursuing her PhD in City and Regional Planning at The Ohio State University with a focus on the intersectional impact of place, racism, and gender on maternal and infant health outcomes in the Black community. Tonni also holds a Master’s in Public Health with a specialization in health behavior and health promotion from the Ohio State University along with Bachelors degrees in biology and women’s, gender, and sexuality studies from Emory University. Tonni is also a doula, supporting Black women and women of color through pregnancy, labor and delivery, and the postpartum period. She is a Certified Lactation Counselor as well as a Certified Health Education Specialist with expertise in program planning, implementation, and evaluation. She has professional experience managing public health programs and research projects at the city and state levels.


Kelly Davis, MPA is currently the Vice President of Global Birth Equity and Innovation at the National Birth Equity Collaborative (NBEC), which creates solutions to optimize Black maternal and infant health through training, research, policy advocacy and community-centered collaboration. Prior to joining NBEC, Ms. Davis led a series of innovative initiatives for the NYC Department of Health and Mental Hygiene and served as one of the founding members of the Center for Health Equity, where she conceptualized the Family Wellness Suites, community respite and healing spaces for parents and children. Ms. Davis spearheaded planning, implementation and oversight of several special initiatives, including supporting maternity hospitals in a long-term institutional transformation process addressing structural racism, bias, resilience and trauma and catalyzing the City’s first HIV public awareness campaign totally focused on women. Ms. Davis holds a Bachelor of Arts degree from Princeton University, where her senior thesis explored how women of color experienced contraception in the 20th Century, and a Master of Public Administration degree from New York University’s Wagner Graduate School of Public Service.


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