Black youth face gaps in maternal & reproductive care. We must do better.
As Black Maternal Health Week comes to a close, it’s vital we continue to address and improve supports for Black youth who are pregnant and/or parenting
By Cindy Cruz, Director of the Reproductive Health Equity Project for Foster Youth (RHEP) at the National Center for Youth Law
When the state of California released a landmark report last fall on maternal health outcomes for young people in the state’s foster system, at least two truths were immediately made clear: 1) the state is in several ways failing Black youth in its care who are pregnant and/or parenting, and 2) we must do better.
The first-of-its-kind report, which was the result of years of advocacy by the National Center for Youth Law and others, is a blueprint that other states can and should follow. Collecting and analyzing this data is a critically important first step. Now, it’s on all of us to use this information to help build a better, healthier future.
As 2024’s Black Maternal Health Week — observed April 11–17 — wraps up today, we must ensure we continue to keep focus on developing and implementing the strongest supports and programs we can to close the health gaps that continue to plague Black youth, in particular, who are pregnant and/or parenting.
Inequities revealed in state report
The 2023 report — released by the California Department of Social Services as mandated by the 2021 Healthy Futures for Foster Youth Act — highlighted some promising findings, such as that youth in foster care are generally doing well when it comes to annual health visits, but also some areas of major concern.
The report disaggregates data by race and ethnicity — an important element that was pushed for by the National Center for Youth Law — which is a big help in highlighting where inequities exist, and can provide great insight when developing policy. For example, the report found that Black youth in foster care were more likely to access prenatal care than other youth in care, but Black youth both in and and out of foster care across the board had lower rates of postpartum care.
Somewhere between prenatal appointments and postpartum appointments, we’re losing youth, which may be pointing to the discrimination they’re experiencing. Without the data collection triggered by the report, trends like this risk going uncovered — and ultimately unaddressed.
Among other alarming data points revealed by this disaggregation:
- Black youth in foster care gave birth to low-weight infants at a significantly higher rate (12.4%) than other youth in care (9%) and among the same-age Medi-Cal population (8%); and
- Black youth not in care also have much higher rates of low-birthweight infants than youth overall.
Importantly, the report flags these discrepancies as concerning, recommending that “efforts to increase postpartum care should focus on young Black/African American birthing people overall, regardless of foster status.” This acknowledgement is key, but with Black youth comprising an oversized share of foster youth, we must continue to keep close focus on this population, in particular.
These issues are incredibly important. Low-birthweight, in particular, can lead to severe health and developmental difficulties. A baby weighing 1,000 grams or less at birth, for example, faces a higher than 20% risk of death within the first year, along with significantly higher costs for delivery and care.
How can we improve these outcomes?
The best way to begin shoring up these inequities is to listen to what young people are experiencing and to really prioritize their voices in policy-making discussions.
Members of the Youth Advisory Board for the Reproductive Health Equity Project for Foster Youth (RHEP) offered pointed feedback to the report released last year. They noted how stigma and past trauma can prevent some foster youth from seeking care, and highlighted the need for accessible services that don’t feel punitive.
One Youth Advisory Board member remarked:
“With pregnant and parenting youth, especially young people in foster care, it’s like if you miss one step you kind of have all of these consequences that can affect the rest of the steps you take.”
Another commended the data collection and stressed the importance of follow-through:
“It helps us to know, ‘OK, we need to spend more time allocating more resources [to a given area] and like helping give access to that kind of care.’ … I feel like [the report is] kind of a way to help hold people accountable of like, ‘OK, you’re saying you’re doing this and you’re saying you’re helping, but do the statistics show that or not?’”
Members of the Youth Advisory Board have also discussed many of the issues raised in the report on the RHEP-produced Self-Taught podcast, which is an outlet by and for foster youth to discuss sex, health and life.
The fourth episode of Self-Taught’s second season features raw and honest conversation around prenatal and postpartum care. In the episode, members of the RHEP Youth Advisory Board join with a reproductive health advocate to share their own experiences, explore the things that would’ve helped them, and offer tips and resources to benefit others.
The episode page even features a bonus discussion in which the RHEP Youth Advisory Board members delve into the ups and downs of postpartum care and offer relatable and informative insights.
If we are to truly make our communities stronger and healthier, it’s critical that we work to improve outcomes for everyone, including populations that have historically been overlooked. To achieve this, we need states beyond California to begin collecting disaggregated data around reproductive health outcomes for young people.
Most importantly, it’s vital we use that information, coupled with the first-hand expertise of youth, to better understand where and why these gaps exist so that we can build a better future for everyone.
Cindy Cruz is the Director of the Reproductive Health Equity Project for Foster Youth (RHEP) at the National Center for Youth Law, where she works to end inequitable reproductive health outcomes for youth in foster care and support the healthy sexual development and bodily autonomy of young people.
For more information on Black Maternal Health Week 2024, read this proclamation from the White House.
