Confronting reproductive health disparities for U.S.-born black women: Infant mortality and the quest for reproductive justice

This dissertation examines the role of Medicaid and Title X in perpetuating black/white differentials in infant mortality. The two health care provisions are authorized by the federal government and implemented within the states. The provisions are observed in order to ascertain the ways in which the public health care system attempts to meet the reproductive health needs of impoverished black women.;Through public policy analysis, as well as historical investigation, the evidence helps to inform the development of sound public policies that adequately address reproductive health disparities. At the same time, the evidence assists in the development of interventions that may ultimately help to alleviate discrimination in America. This study sheds light on the use of covert racism and how it may produce harmful reproductive health outcomes for black women by applying two theories: institutional racism and black feminism.;Medicaid and Title X, through both public policy and program implementation, were found to perpetuate institutionalized discrimination among impoverished black women. Although the policy changes that have been made over the last several years aimed to expand access of prenatal care and family planning services for low-income women, infant mortality rates and other unfavorable pregnancy-related outcomes showed no deviation. Disparities in key social and health indicators mirror those of infant mortality disparities, meaning that the interventions developed to curb alternate reproductive health outcomes must be multi-factorial. The interventions must address the fundamental social causes of ill health, as well as the ill health itself. For structural and institutional practices, brought on by public policies that limit black women's access to reproductive health care, have exacerbated inequalities and assisted in the maintenance of health disparities. Social constructions of black female imagery, the historical foundations of reproductive injustice in American slavery, as well as the lack of adequate funding for Medicaid and Title X have also contributed to infant mortality and other reproductive health disparities for U.S.-born black women.