LOUISVILLE, Ky. - Racial gaps persist in pregnancy- and childbirth-related deaths across the state, and advocates say solutions to the problem lie beyond the doctor's office.
According to the latest state data, 50% of maternal deaths were pregnancy-related in 2017, and 46% involved a substance-use disorder. Nearly 80% of cases were deemed to be preventable.
Obstetrician & Gynecologist and President and CEO of Physicians for Reproductive Health Dr. Jamila Perritt said maternal mortality is a key indicator of a state's health and has a long-term impact on other community health factors.
"Black and indigenous women have an increased risk of dying during pregnancy and in the postpartum period, as compared to white women," said Perritt, "even when you control for things like education and economic status."
Death certificates show maternal deaths appear to be higher among Black women in the two largest urban areas in Kentucky, Lexington and Louisville.
Perritt noted the White House has issued the first presidential proclamation marking this week Black Maternal Health Week.
"The U.S. Department of Health and Human Services marked this week by announcing actions to expand access for maternal health more broadly," said Perritt, "to improve outcomes."
The nation's maternal mortality rate continues to be highest in the developed world. Perritt said a holistic approach involving community groups, food and housing advocates, and social scientists is needed to tackle the crisis.
"So when we look at solutions, the solutions really have to be focused on addressing those root causes," said Perritt. "And often that leads right back to how we shape our systems and structures so that there aren't disparities in access to care."
Black, American Indian and Alaska Native women are two to three times more likely to die from pregnancy-related causes than are white women, and Black infants die at more than twice the rate of white infants, according to the Centers for Disease Control and Prevention.
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Vending machines commonly found in workplace break rooms generally contain soft drinks or snacks but one machine in Indianapolis dispenses unconventional items at the turn of a knob.
The Plan B morning-after pill, pregnancy tests and condoms are displayed in a clear glass case inside a colorful blue and orange dispenser. The items provide easy access to protection against an unwanted pregnancy and are free of charge.
Melissa Gruver, organizing director of the feminist organization Indiana Task FORCE, said it operates like a traditional vending machine.
"You just push whenever you want and it falls down, and you reach your hand through the little door and you pull it out, take it with you," Gruver explained.
A 2022 Indiana Department of Health Termination Report indicated 9,600 pregnancies were aborted, with Marion County recording the highest number of unwanted pregnancies. The report also noted the average age of a woman in Indiana who sought an abortion was 27, and 67% of all terminated pregnancies occurred within four to eight weeks of conception.
The state's contentious near-total abortion ban, which was upheld by the Indiana Supreme Court last year, has stoked fears lawmakers may begin restricting a woman's choice of birth control.
Indiana Task FORCE and reproductive health groups All-Options and the Midwest Access Coalition want the emergency contraceptive vending machine to serve as a gathering spot for community conversations on reproductive rights and sexual health.
"We've long been organizing our communities to bring about reproductive justice, which we didn't have before and we definitely don't have it now," Gruver pointed out. "But what we know to be true is that there are more of us that want access to reproductive care than those that try to stop it. We're excited to continue to work to meet this need now, and to organize for a better community."
Gruver hopes to have one dispenser in every Indiana region in the future to add to the single machine currently in an eastside Indianapolis grocery store. She added some universities in the state already have vending machines offering similar contraception products but users have to purchase the items.
This story is based on original reporting by Mary Claire Molloy for Mirror Indy.
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On Tuesday, the Arizona Supreme Court upheld an 1864 ban on nearly all abortions, except in situations when it is necessary to save the life of a pregnant person. It makes abortion a felony punishable by two to five years in prison for anyone who performs one or helps someone obtain one.
Arizona's near-total abortion ban will be one of the harshest in the country, along with Alabama, Mississippi and Texas.
Gov. Katie Hobbs said the law, written well before Arizona became a state or women had the right to vote, is placing lives in danger.
"I've personally experienced the anguish of losing a pregnancy," Hobbs noted. "I know it's outrageous to have the government tell you that the best decision for your health or future could now be considered a crime."
On the social media platform 'X,' Gov. Hobbs described it as a "dark day for Arizona." But anti-abortion advocates are celebrating a big win, even as some Republican lawmakers think the ban should be repealed. The Arizona Supreme Court put its decision on hold for 14 days as additional constitutional challenges are cleared up.
The ruling has rattled Democrats, including mother and nurse practitioner Sen. Eva Burch, D-Mesa. Just a couple of weeks ago, Burch announced on the state Senate floor she had an undergone an abortion procedure. She contended Arizonans of any political affiliation do not want an abortion ban.
"Somebody took care of me. Somebody gave me a procedure so I wouldn't have to experience another miscarriage; the pain, the mess, the discomfort," Burch stressed. "And now, we're talking about whether or not we should put that doctor in jail. This is outrageous."
Kris Mayes, Attorney General, said in a statement as long as she is in office, no person or doctor will be prosecuted under what she called a "draconian law."
Vice President Kamala Harris is set to visit the Grand Canyon State later this week to champion reproductive rights. And Arizona pro-choice advocates recently secured enough signatures for a ballot measure to enshrine abortion rights in the state Constitution.
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Nevada reproductive-rights advocates are breaking down the importance of two looming Supreme Court abortion cases.
In Moyle v. United States, access to the abortion drug mifepristone could be restricted - and in Idaho v. United States, a federal law known as the Emergency Medical Treatment and Labor Act (EMTALA) could be upended.
It requires hospitals to provide care in serious emergency situations that could warrant an abortion.
Alexis Salt is a Las Vegas-based teacher who experienced a difficult pregnancy herself and gave birth to a severely premature daughter.
She said she was able to receive the care she needed and wanted, but is sharing her experience to shine light on the importance of abortion in life-threatening situations - which she says is currently at stake.
"When you are pregnant, it can absolutely - 100% - kill you," said Salt. "It almost killed me, and so when people, particularly men, tell you that this is what your body is supposed to do, 'don't worry about it,' you can't listen to that."
The Alliance Defending Freedom is a conservative organization representing the State of Idaho - and says when the Supreme Court overturned Roe, it returned the issue of abortion to individual states, allowing pro-life policies to be passed.
It contends that the Biden administration is "misusing" federal law to "override" state law and allow abortions to be conducted. The Supreme Court will hear the case on April 24.
Margardia Jorge is executive director of the grassroots health-care advocacy organization Health Care for America Now.
She said she is by no means a legal expert - but adds that the Supreme Court justices are "unpredictable," and worries about the actions the conservative majority on the high court could take with these two high-stakes cases.
"We have seen this court reverse past precedent," said Jorge. "We have seen them rule on things that roll back all kinds of functions and features of government. We have seen them, time and time again, take the wrong side or use these court cases as an opportunity to impose their own ideology. "
Jorge said there is a lot more work to do to make abortion health care, which she contends impacts everyone, from pro-life to pro-choice.
She said the biggest challenge will be for people to see abortion in that light and to get it out of the political sphere.
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