Giving birth in the United States is life-threatening. For Black families especially, increased risk of complications and even death when expecting or immediately after, is prevalent, aspects of maternal health that Amber Edmunds, the director of civic engagement at pregnancy support organization MAYA, detailed in a Public Source essay.

“I have a friend who lost as many as eight babies, and her doctors never gave her any explanation, much less support. At one point, she had an ectopic pregnancy and lost her ovary. And there was nowhere for her to put her grief. Her experience isn’t uncommon: You hear about it all the time in Black communities. Women talk about loss like it’s grocery shopping,” Edmunds wrote in July.

Amidst this maternal mortality crisis, which disproportionately impacts BIPOC birthing people and families, the White House released its FY 2025 budget plan on March 11, proposing slashing over $90 million funding towards maternal health. The details on how the Biden administration is looking to distribute government funding going forward has caused reluctance amongst reproductive advocates who say it’s left them wanting more.

“At a time when Black women, girls and gender-expansive people are more at risk of maternal mortality than ever, we should be investing more into reproductive health, not less. For so many, true reproductive autonomy is as much about economics as it is about rights, said Regina Davis Moss, president and CEO of In Our Own Voice. “Budget cuts like this tend to exacerbate disparities in access to services based on race, income and geography.”

Madeline T. Morcelle, JD, MPH, senior attorney at National Health Law Program, a nonprofit legal and policy advocacy organization fighting to advance health care for low-income and underserved individuals, told Reckon she feels there are some really good asks to better reproductive health, even with the budget cuts.

Acknowledging the need for more Americans to be able to access healthcare services, the budget proposed a “Medicaid-like coverage” for people with low-incomes, who live in states which have not expanded Medicaid coverage under the Affordable Care Act. According to Georgetown University’s Center for Children and Families, 1.5 million people are currently impacted by this coverage gap.

“In states that have not expanded Medicaid, there often aren’t a lot of opportunities to access care, so closing this gap is really important,” said Morcelle.

Davis Moss told Reckon that called this a crucial policy intervention to address and prevent health complications that are driving the maternal mortality crisis.

“No one experiencing postpartum complications should have to forgo timely, life-saving care because they cannot afford it,” she said.

The budget stresses the importance of services like Title X, a federal program designed to provide affordable birth control and reproductive healthcare to those who cannot afford it.

“Title X clients live in poverty and the uninsured rate of Title X users is twice the national average, making the Title X family planning program a critical part of the public health safety net” says the budget.

As written, the budget includes $390 million for Title X, a 36% increase from the amount enacted in 2023, which can serve about 3.6 million patients, according to the White House. But this is less than the unapproved amount asked for in FY 2024, which was $512 million.

“While it is wonderful to see the President and White House talk about how important maternal mortality and Title X are in the text of the budget proposal, it’s disappointing to see the actual requests go down when the need is on the rise,” said Morcelle, adding that post-Roe, the need for resources to help low-income and underserved communities plan their families on their own term is extremely high.

US maternal mortality rates continue to rise

Health experts have continually stressed their concern for maternal mortality rates. In the U.S., maternal mortality has continued to rise, with maternal deaths doubling over the last two decades, and impacting BIPOC families especially. Black birthing people are four times more likely to die due to pregnancy-related complications than their white counterparts, with experts saying it’s a reflection of medical inequities.

“This issue embodies every challenge we face in healthcare today, from inequitable access to timely and high-quality care, to disparate treatments and outcomes. Black birthing people continue to feel the impact of structural racism and discrimination,”  Christina Harris, MD, vice president and chief health equity officer at Cedars-Sinai said during a June 2023 virtual program on advancing Black maternal health.

This year’s budget includes $376 million for maternal mortality prevention, compared to last year’s ask of $471 million.

“At the same time, maternal and infant mortality rates are climbing, especially for Black families. Reducing resources available to support healthy pregnancies will hit Black families the hardest, given that Black people are disproportionately likely to face pregnancy-related medical complications and discrimination in the health care system,” said Davis Moss.

Morcelle said it’s important to add context to the numbers, explaining why some figures may have decreased.

“It’s important to understand that the new ask is still higher than what Congress appropriated for fiscal year 2023, and we never passed a fiscal year 2024 appropriations package,” she said, inferring that it may be easier to pass a lower figure in a divided Congress.

In the budget, Biden also proposes 12 months post-pregnancy coverage mandatory nationwide. According to KFF’s Medicaid Postpartum Coverage Extension Tracker, 45 states and the District of Columbia currently implement this policy, but should this portion of the budget be approved it would be required of all states.

Because pregnant people covered by Medicaid typically lose their coverage 60 days after giving birth, this extension could aid in decreasing the maternal mortality rates in the country. According to the American College of Obstetricians and Gynecologists (ACOG), many post-pregnancy deaths are preventable and occur after Medicaid coverage ends, and ACOG recommended extending coverage to 12 months with no restrictions.

“The president has made clear that he would like to see this policy made mandatory and implemented nationwide, so that’s excellent,” said Morcelle.

Notably, there was no mention of the Hyde Amendment, a rider which bans the use of federal funds on abortion, in the proposal, though it did include the Weldon Amendment, which Morcelle calls “concerning” from an abortion access standpoint.

Nourbese Flint, president of All* Above All, responded to the budget in a statement released last week, stating that she’s glad to see Hyde eliminated from the budget.

The harm of Hyde is now compounded by the fallout of the Dobbs decision. Ahead of a presidential election where our fundamental freedoms are on the line, Congress must act with urgency to end this cruel restriction once and for all so that no one is denied abortion coverage just because they’re working to make ends meet. Abortion justice can’t wait.”

About 5.5 million women between the ages of 15 to 49 covered by Medicaid live in states where abortion is legal, but the program will not cover it due to the Hyde Amendment, according to KFF.

“It’s really frustrating from an equity standpoint to see the Weldon Amendment included, and it is also very frustrating, absolutely, to see ‘Restoring Roe’ as the focus, when we need to build a future in which everybody who needs abortion can access abortion.”

A commitment to reproductive justice goes beyond restoring Roe

With a bid for reelection heavily campaigning on a slogan that promises to “Restore Roe,” and an Executive Order to support research in women’s midlife health, the president has expressed a commitment to bettering reproductive healthcare access in the country. As the U.S.’s political climate surrounding abortion and family planning continues to resemble a battleground, this budget may indicate where the administration’s current priorities and values lie.

However, reproductive justice advocates have expressed reservations on Biden’s commitment to reproductive justice, especially since adopting the “Restore Roe’’ slogan amidst a presumed reservation to even use the word abortion, as Renee Bracey Sherman, founder and co-executive director of We Testify, an organization dedicated to representation of people who have abortions, told Reckon in January. Additionally, advocates are looking for more protection to reproductive freedom than existed under Roe.

“We don’t view the restoration of the protections of Roe as, you know, the end of the fight here. This is just essentially building back the floor where we were two years ago,” Ryan Stitzlein, vice president of Reproductive Freedom for All, the organization formerly known as NARAL Pro-Choice America, told New Republic earlier this month.

A press release by the White House states that some of the intentions of the budget are to support family planning services, maternal health, and health equity. Congressional leaders announced they reached a final deal on FY 2024 budget on Wednesday, and are now rushing to finalize legislation by Friday, in order to prevent a partial government shutdown. Presumably, once FY 2024 is finalized, Congress can shift their attention to the implications drawn for FY 2025.

“To be sure, the Biden administration has made positive steps toward recognizing Black maternal mortality crisis as an urgent problem, but it must honor its commitment to addressing this issue by supporting full, consistent funding for vital reproductive health care services,” said Davis Moss.