The United States is facing a crucial moment, one in which more pregnant women are at risk of becoming housing insecure than at any other time in recent history. This leaves an unprecedented number of mothers and babies vulnerable to the associated adverse health risks.  Housing instability – which includes challenges ranging from struggles paying rent to chronic homelessness – harms maternal and neonatal health as much as smoking during pregnancy. The economic effects of COVID-19 threaten to exacerbate the adverse health outcomes associated with homelessness.

As the number of confirmed COVID-19 cases and deaths rise, women are experiencing more anxiety both during and after pregnancy. One-third of all mental health problems are associated with adverse childhood and community experiences—the pandemic is an adverse community experience being felt worldwide.

“This is real,” said Franka Cadée, President of the International Confederation of Midwives (ICM). “And we can no longer get around it. And we can no longer linger.” She spoke at a recent Wilson Center event, in partnership with the United Nations Population Fund (UNFPA) and Johnson & Johnson, launching a new study, Impact of Midwives, published in The Lancet Global Health. If any other intervention could have the same impact as midwives or midwifery, it would be implemented worldwide immediately, she said.

The United States imprisons the most women in the world. Across the United States, approximately 200,000 women are incarcerated—nearly an 800 percent increase since 1980. Women of color are disproportionately affected by the criminal justice system. In 2017, twice as many Black women and 1.3 times as many Hispanic women were incarcerated compared to white women. An often overlooked aspect of the increasing rates of women’s incarceration is the impact on the sexual and reproductive health needs of these women. “Despite being the fastest growing incarcerated population, women and girls are correctional afterthoughts,” writes Kimberly Haven, an activist and formerly incarcerated woman who had to undergo a hysterectomy—a surgical procedure to remove the uterus (and, with it, childbearing possibilities)—after being denied proper menstrual products while incarcerated.

The United States is in the midst of a maternal health crisis. Indigenous and Alaska Native peoples are 2.3 times more likely to die from pregnancy-related complications than their white counterparts. In Alaska, unequal socio-economic status, lack of access to hospitals and quality health services, systemic racism, and a history of colonization drive these disparities in maternal health outcomes. “Weathering”—the deterioration of communal health outcomes caused by persistent socio-economic disadvantages—contributes to many poor maternal health outcomes for Alaska Native women. On top of these systemic problems, climate change impacts threaten to widen the existing disparities for Alaskan Native women.