"Maternal mortality ratios tell us how well a country's healthcare system in general is functioning. In America, our maternal mortality rates are a stark reminder of how little we actually value women's health." - Anushay Hossain, The Pain Gap

Despite spending more on healthcare than any other developed nation, the U.S. maternal death rate is the highest among its peers and rising. Black women are 3 times more likely than white women to die from pregnancy-related causes, revealing deep inequities. Systemic bias, social determinants of health, and the erosion of reproductive rights all contribute to this crisis.

Section: 2, Chapter: 6

"Dealing with racism in our daily lives is a major factor in our health and well-being. The experience of racism makes Black people sick, whether it's mental and emotional health or even physical health." - Jamila Taylor, reproductive rights advocate

Many of the Black women interviewed spoke of how the cumulative stress of racism, on top of the trauma of pregnancy loss, felt like a double burden. Some hesitated to become pregnant at all, afraid they wouldn't survive the experience in a medical system stacked against them. Their losses were also more likely to be dismissed or met with stereotypes about their ability to handle hardship. As one woman put it: "The checklist doesn't exist...you can't be safe if you are a Black birthing person."

Section: 2, Chapter: 8

"The issue, I think, and why confusion is the norm is that the procedures and medications that we use to treat pregnancy loss or miscarriage or fetal loss that someone did not choose are the same as treatments and medications that we use to treat and provide abortion care—which in this case means a pregnancy that ends because someone makes a decision to end it." - Dr. Lisa Harris, ob-gyn and miscarriage specialist

Many patients are shocked to learn the same pills and procedures are used for voluntary abortion and miscarriage. Heartbeat bills, which ban abortion after electrical cardiac activity is detected (around 6 weeks), make no exception for pregnancies that are already miscarrying with a doomed "heartbeat." This forces patients to carry dead or dying tissue, risks sepsis, and shatters trust that doctors are making decisions based on medical best practices rather than shifting political winds.

Section: 3, Chapter: 10

"Politicians without medical expertise are setting unworkable standards that put pregnant people in danger."

Section: 3, Chapter: 10

"With no cultural script to follow, the burden is on grieving women to make their own meaning - an extra layer of emotional labor."

Section: 4, Chapter: 14