‘Racism is Still a Public Health Crisis’
Planned Parenthood CEO Alexis McGill Johnson on the Black maternal mortality crisis and what it would take to change things.
In 2020, when I first moved to the United States from Europe, I read an article about the country’s maternal mortality crisis. I was floored. Women in the U.S. are far more likely to die from complications related to pregnancy or childbirth than women in almost any other high-income country in the world.
According to U.S. federal data, the maternal mortality rate for 2024 — the most recent year for which figures are available — was 17.9 deaths per 100,000 live births. Maternal deaths, which are defined as deaths during pregnancy or within 42 days after the end of pregnancy from any cause related to or aggravated by the pregnancy, are far more common in the U.S. than in most other wealthy nations. In the U.K, where I lived before the U.S., the rate is about eight per 100,000 live births, according to the World Health Organization. In Australia, it’s around two.
In the U.S., the numbers are even worse when race enters the picture. Research shows that Black women are at least three times more likely to die from a pregnancy-related cause than white women, and experts say that policies implemented by the Trump administration — to, for example, restrict reproductive health care and abortion rights — could make the statistics even worse.
In January, the cost of this crisis was laid bare when Janell Green Smith, a Black woman and a midwife, died less than a week after giving birth in South Carolina. Her death cast a stark light on the barriers that women — and most notably Black women — continue to face in the American healthcare system, from medical paternalism to systemic neglect. If this could happen to a certified nurse-midwife and doctor of nursing practice, then what did this say for everyone else?
One of the most prominent organizations pushing for a future in which giving birth is safer for all, is the Planned Parenthood Federation of America. And the person behind that push? Alexis McGill Johnson, the organization’s CEO. In her almost seven-year tenure, McGill Johnson has placed intersectionality at the center of the organization’s strategy.
“The maternal health crisis and the abortion crisis are both public health crises,” she says. “But we also have to recognize that racism is still a public health crisis, too.”
McGill Johnson spoke to The Persistent about the roots of America’s maternal health crisis, the politicization of healthcare, and what it would take to reverse course.
The conversation has been condensed and lightly edited for clarity.
The U.S. is one of the wealthiest countries in the world, yet Black women are three times more likely to die from a pregnancy-related cause than white women. Help us understand this.
In my prior life, I started an institute called the Perception Institute, a consortium of neuroscientists, social psychologists, and researchers who translate brain science around how our bodies operate on race, gender, and other identities.
We looked at implicit and explicit bias, patient stereotype threat, and how those dynamics affect interactions between doctors and patients.
For example, the information a patient feels comfortable sharing — or the kinds of questions a doctor asks if they’re experiencing a high degree of racial anxiety — those dynamics all play out in the exam room.
Often we treat these issues as the result of an individual doctor’s personality. We build systems that rely on the goodness of doctors rather than understanding that these dynamics are systemic; that they are rooted in how our brains take cues from society.
While it saddens me that we haven’t moved further in addressing this crisis, it’s not surprising.
Emma Haslett
Once we understand that the problem is systemic, how can we start to address it?
There is an incredible body of research available about systemic racism and its effects, and yet the problem persists — even though there are straightforward solutions. One such solution would be to embed practices into clinical checklists, which doctors already use regularly to avoid missed questions or oversights.
Unless we transform systems, we won’t see meaningful change. And unless we acknowledge—even in this anti-DEI climate—that bias still exists and that our brains are shaped by societal cues, we won’t get there.
The goal isn’t to make people feel bad about themselves. It’s to achieve the highest level of care every patient deserves, including Black women.
The goal isn’t to make people feel bad about themselves. It’s to achieve the highest level of care every patient deserves, including Black women
In terms of maternal mortality today, what do the statistics tell us?
It’s difficult to say right now. Many states with the highest maternal mortality rates have also disbanded their maternal morbidity review committees. Without those structures, we lose critical data.
Nationally, Black women are three to four times more likely to die from pregnancy-related causes than white women. In some cities, like New York or Los Angeles, that gap can reach seven or even eight times.
But the accuracy of the data depends on whether states and cities continue collecting it — and whether they are willing to treat this as the public health crisis that it is.
That said, when you look at systemic trends — particularly in the South and in states with strict abortion bans — it’s hard to imagine the situation improving.
Abortion bans make pregnancy more dangerous, and those same states are seeing OB-GYNs, especially high-risk specialists, leave the profession or relocate.
So systemically we’re already seeing the loss of expertise and training pipelines. Given that this is a systemic problem, the broader trends suggest the situation is likely getting worse.
You’ve said that Black women have been the driving force behind the movement for reproductive freedom and maternal health equity. Can you explain that?
Planned Parenthood is a reproductive rights organization that began more than 107 years ago with advocacy for birth control at a time when contraception was illegal.
Then, in the early 1970s, a group of Black women deeply involved in broader freedom movements developed the framework of reproductive justice. That framework connected reproductive rights with the broader social conditions that shape people’s lives.
Black women face barriers that go far beyond access to contraception. Historically they’ve also navigated inequities in transportation, housing, education, employment, and pay — the list goes on. Those structural inequities shape health outcomes.
Reproductive justice recognized that reproductive freedom isn’t just about access to contraception. It’s about whether people have the conditions necessary to raise families safely and with dignity.
As the leader of Planned Parenthood, keeping the lived experiences of our patients at the center of our work is essential. It’s an antidote to both the public health crisis and the political crisis we’re facing right now. Healthcare should not be this politicized.
Emma Haslett
To what extent is America’s health insurance system part of the problem?
It certainly is part of the problem. Reimbursement structures themselves often reflect inequities, and there’s longstanding bias in reimbursement, especially around conditions that primarily affect women.
There’s also bias in research. It’s only in the past couple of decades that we’ve seriously tried to correct the lack of equity in women’s health research.
Historically, men were treated as the default standard, and women’s health was treated as a variation on that model. Now we’re beginning to center women’s health in its own right — but even that requires more intersectional research.
Historically, men were treated as the default standard, and women’s health was treated as a variation on that model
Different groups of women experience different environments, stressors, and stereotypes, all of which can affect health outcomes.
To truly deliver quality care, we need research that intentionally includes diverse communities so we understand those differences.
If policymakers were serious about addressing the maternal mortality crisis, what immediate changes would you want to see — from healthcare systems, governments, or insurers?
Even in today’s anti-DEI climate, we can look at how medicine has handled other conditions.
For example, clinical checklists for cardiovascular care often include reminders that women can present heart attack symptoms differently than men — such as nausea instead of chest pain.
These prompts help clinicians recognize that symptoms can present differently across populations. Similar prompts can help physicians recognize patterns like how hypertension presents differently in Black patients.
That kind of training helps interrupt automatic assumptions and encourages more intersectional clinical thinking. We also need stronger training around pain management and ensuring that patients’ pain is taken seriously.
And we need much stronger policies around postpartum care. In many European countries, postpartum care can last a year, with regular home visits to check on both physical and mental health.
In the U.S., many complications arise months after delivery. New parents expect to feel exhausted and overwhelmed, so they may not recognize when something is medically wrong. Expanded postpartum care — especially community-based care — could address that.
For Black patients in particular, the highest vulnerability often occurs three to six months postpartum and can extend up to a year. Many of the most serious complications happen outside the delivery room.
You’ve spent much of your career at the intersection of race, gender, and policy. What — if anything — keeps you hopeful in a moment when reproductive rights are under intense pressure?
One thing that gives me hope is the work happening inside Planned Parenthood.
In 2022 we received a grant from MacKenzie Scott shortly before the Dobbs decision.
Our goal is to become something like the Cleveland Clinic [a nonprofit medical center] of sexual and reproductive healthcare.
But it’s not just about building beautiful, comprehensive women’s health centers. It’s about centering the people who have historically been pushed to the margins of healthcare.
If we can identify and eliminate the barriers that prevent them from receiving the best care, then we improve care for everyone.
Josie Cox
