Maternal Mortality is a Racial Justice Issue: the Impact of Policy Packages and City Composition on Aggregate Level Maternal Mortality and Racial Disparities in Maternal Health Outcomes

In this dissertation, I aim to examine how policy packages focusing on improving reproductive conditions impact adverse maternal outcomes at the local level. I use the National Institute of Reproductive Health’s Local Reproductive Freedom Index (NIRH LRFI) to advance scholarship and policy advocacy on how policies included in that index may lessen the overall maternal mortality rate while also perhaps diminishing the disparity in maternal mortality between women of color and white women in 50 major U.S. cities. I argue that policy may be an effective—though under-studied—avenue for reducing the risk of maternal mortality because policies can be used to target specific social factors that research has demonstrated place individuals at higher risk of a negative outcome. However, these policy avenues usefully can be considered as interconnected policy packages rather than merely as single-policy interventions. Additionally, current research in this area suggests that there is a clear need for more research that combines SDH with policies aimed at improving health outcomes for reproducing individuals, particularly for communities of color (Creanga et al. 2015b; Kozhimannil, Vogelsang, and Hardeman 2015; Osypuk et al. 2015). As such, I situate maternal mortality, and specifically racial disparities in maternal mortality, among social determinants of health. Overall, I argue that to successfully decrease aggregate maternal mortality rates and lessen racial disparities in reproductive health, it is essential to center the experiences and needs of women of color and use a critical lens when evaluating measures assessing reproductive freedom.