Better Life Lab is a partnership of Slate and New America

When she was 19, Cherisse Scott lost her baby.

The pregnancy was unplanned, but there was no doubt in her mind that she would have the baby. She laid awake at night worrying about raising a child alone, keeping up at work, and hopefully finishing college someday. The anxiety and stress compounded with uncertainty about whether she would be able to afford the next month’s rent and food. Nonetheless, Scott celebrated her pregnancy.

Scott planned to sacrifice as much as she could to raise a healthy child. She prepared to leave school and move into the house of her then-boyfriend’s mother, although her partner was slowly growing distant and unsupportive. With a job that didn’t offer health care or workplace flexibility, and unaware of any campus services that might have been available to support her, Scott’s emotional, physical, and mental stress began to grow.

When the bleeding started, it was terrifying and painful. After losing her pregnancy, Scott left the emergency room with no tangible medical reason for the loss of her child and an incredibly large medical bill that she would spend the next seven years paying off.

Later, fueled by her personal experience, Scott founded Sister Reach, a member of the Black Mamas Matter Alliance, one of the dozens of local organizations taking on the infant mortality and maternal health crisis in American cities. Black women are 2–3 times more likely to die from pregnancy-related complications than white women. The infant mortality rate for non-Hispanic black mothers is roughly twice that of non-Hispanic white mothers, 11.11 to 5.06 respectively. Infant mortality rates in the U.S. are higher than comparable high-income countries, and black infant mortality rates in particular rival the infant mortality rates of some war-torn countries, such as Libya and Bahrain. The stressful steady battle to defend their right to motherhood and family, and make enough to survive, yields poor outcomes for black mothers and the children they might have had.

Although politicians often tie these poor outcomes to drug use or poverty in black communities, a study done by the American Public Health Association showed that those traditional risk factors do not predict the racial differences in low birth weight, a health factor often linked to infant mortality. In other words, black mothers are not to blame for the loss of their own children, as politicians and local media outlets might claim. So what is?

An article published last year in the Nation posits racial discrimination as a possible explanation, because studies of infant mortality across socio-economic status and education have found that black infant mortality rates were still higher than white infant mortality rates when other factors were held equal. How does racial discrimination produce these effects? One underexamined factor is how the deteriorating conditions of work, and the benefits workplaces should be offering but aren’t, create excess stress for black mothers.

In her book How All Politics Became Reproductive Politics, author Laura Briggs points to the rigorous demands of the American workplace as a cause of this racial inequality, saying, “The more the workplace demands of everyone, the more it specifically demands of African Americans to prove that they are not imposters, not slackers, not thugs, or entitled incompetents.” Toxic work culture demands black women survive and succeed through stressful conditions and high expectations with little to no support in the workplace.

Here are just a few aspects of the American workplace that particularly burden black women and might be linked to these maternal and infant health outcomes:

Access to health care that is tied to the vastly unequal workplaces in the U.S.

The U.S. remains a place where the vast majority of workers obtain their health insurance through their employer, but not all employers offer this benefit. In addition, because of privatized or employer-based health care, white professional women often have access to reproductive technology meant to support fertility, while low-income black women with Medicaid can only access contraceptives.

On top of this unequal access to health insurance, even black women with higher levels of educational attainment, a marker of more access to and knowledge of health care, still experience a disproportionate amount of stress, some of which is caused by the experience of seeking health care itself. Medical professionals often treat black women differently, for example by diagnosing breast cancer later or assuming they are able to manage incredible amounts of pain. Briggs suggests that “Two people can go to the same prenatal care provider and have very different experiences. Part of the story is physician and health provider racism.”

Lack of workplace benefits

Black mothers are disproportionately the sole provider and caretaker of their households. Since the U.S. offers minimal social support programs compared to most industrialized countries, Americans rely on their jobs for basic wellness programs. Black women are more likely to occupy minimum wage jobs, and low-wage work is connected to high-stress environments. Briggs argues, “We can put those pieces together and say that Black women’s jobs are almost certainly contributing to the high rates of Black infant mortality in Black communities.” Low wages, it goes without saying, also come with inadequate access to food, safe housing, and a host of other necessary resources.

Black mothers often have jobs without benefits like flexibility, sick days, and paid family medical leave. The inability of these mothers to take time off to care for themselves and their infants only exacerbates the health and wellness gaps black mothers experience.

Lack of workplace protections

Along with the absence of a workplace safety net, federal protections like the Pregnancy Discrimination Act have proven ineffective at protecting mothers’ safety on the job. In a recent case, Young v. UPS, two lower courts failed to protect a pregnant mother seeking simple workplace accommodations that were routinely given to men with back pain, forcing the plaintiff to petition her case through to the Supreme Court. Another workplace protection, the Equal Employment Opportunity Commission, or Title VII, does not reliably investigate or fine employers of black women who say they were fired from their jobs because of pregnancy-related discrimination. And black Americans (as well as Hispanic Americans) are disproportionately subject to injury and death on the job. All these kinds of insecurity and danger will inevitably manifest themselves during pregnancy.

Unequal treatment and outright discrimination

Racial discrimination also manifests itself in the workplace through physical and emotional unequal treatment. Even when black women have good jobs, health insurance, and benefits, they often are expected to do more than white colleagues, constantly facing assumptions that they are unqualified, a phenomena documented by black university professors and demonstrated across every education level. Black women endure the highest levels of harassment through compounded effects of sexual and racial harassment in the workplace. As a result, black women experience a disproportionate amount of stress in the workplace, regardless of socio-economic standing.

According to Scott, “Black women are always juggling stress in work and life. American culture, where people are driven by the accumulation of wealth and success, is a toxic culture for motherhood.” Scott continued, “America has never been a safe place for a Black woman to raise a child. It seems even more dangerous now for a Black woman to even consider having a child, yet Black women continue showing up and doing more to help everyone despite being treated as though our lives, our health and wellness is not important.”

According to Briggs, “If what corporations call ‘work-life balance’ and sociologists call the ‘crisis of care work’ was unsolvable for [white professional women], it certainly wasn’t solvable for women with less power and fewer resources.”

The ramifications of work-life imbalance are stressful for women with resources and power, but for black women and their children, it can be deadly. Many policies that benefit black moms—comprehensive and universal health care, fair wages, predictable work hours—benefit everyone else too. Scott, and many black advocates, have been saying it for years: “It’s old news. Let’s be real about the economic condition Black women have now and have had for years. We had to figure out how to survive for our kids. We need help, we need equal pay, treatment, and benefits to have an equal experience.”