M.A.M.A: Mobilizing Activism for Maternal Access in Clifton, Ohio

Abstract

Maternal mortality is a critical issue in the United States, particularly for Black women. This is not solely a medical concern, but rather, a public health emergency rooted in systemic racism, lack of access to care, and decades of inequality. In Clifton, Ohio, a significant portion of the Black female population is facing these barriers, and existing healthcare programs remain insufficient. The purpose of this paper is to better understand the underlying causes of maternal mortality among African American women in Clifton. We reviewed 29 scholarly articles about reproductive care from sources such as PubMed, the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH). In addition, we interviewed leaders from organizations dedicated to maternal health and racial equity. Through this process, we identified four key contributors to Black maternal mortality: limited transportation, inadequate access to care, racial disparities in treatment, and relationship-based challenges. To address these issues, we propose a mobile health bus that will provide free prenatal and postnatal services directly to affected communities. Our goal is to not only help reduce maternal mortality in Clifton but to eventually expand the model to other underserved cities. 

Keywords: Black maternal health, socioeconomic disparities, racial health disparities, public health interventions, prenatal care, mobile health clinics

Introduction

Maternal mortality, defined as the death of a woman during pregnancy or within one year of the end of pregnancy, is one of the clearest indicators of a region’s overall health and commitment to equity. It remains a persistent and alarming public health crisis, even in one of the wealthiest and most medically advanced countries in the world. Each year, hundreds of women in the United States die due to complications related to pregnancy and childbirth, many of which are entirely preventable. Despite advancements in medical technology and hospital systems, gaps in the quality and accessibility of maternal care remain. These gaps disproportionately affect Black women, who are over two times more likely to die from pregnancy-related causes than White women, regardless of income or education (Ohio Department of Health, 2023). Failing to address this issue leads not only to unnecessary deaths, but also severe health consequences (untreated pregnancy complications), social consequences (such as generational trauma and family instability), and financial consequences (such as higher emergency care costs and burdens on Medicaid and community programs). 

Reproductive health encompasses physical, mental, emotional, and social well-being relating to the reproductive system. A key measure of this is the maternal mortality rate, which is influenced by factors like racial disparities, social determinants of health, and maternity care deserts which are areas with little or no access to birthing facilities or providers. Clifton, Ohio, a small neighborhood within Hamilton County, reflects these challenges. Though surrounded by healthcare infrastructure, residents still face barriers such as long travel times, insurance gaps, provider shortages, and limited culturally competent care. The main objective of this paper is to investigate maternal mortality and reproductive health inequities in Clifton through a public health lens. Using the socioecological model, the paper will examine individual, interpersonal, organizational, community, and policy-level influences, in order to propose an intervention: a mobile maternal health clinic that addresses these disparities. From this paper, readers can expect to learn about the roots of reproductive health disparities, the unique challenges Black women face in accessing care, and a locally grounded solution aimed at advancing equity. 

The Importance of a Public Health Lens 

The disproportionately high rates of maternal mortality among Black women in the U.S. are rooted in the social determinants of health, which were shaped by a long history of systemic oppression. In particular, redlining policies in the mid-20th century segregated Black communities and denied them critical investments. This led to lasting disadvantages in healthcare, transportation, and housing. These inequities still persist today, with generational impacts on neighborhoods, environmental conditions, and access to care, all of which contribute to elevated maternal mortality rates. The socio-ecological model helps uncover the deeper layers of these disparities and provides a framework to understand the various causes of maternal mortality among Black women. At the interpersonal level, provider-patient relationships often involve implicit bias and the dismissal of symptoms reported by Black women, leading to inadequate care. Many Black patients report feeling ignored or disrespected by healthcare providers (CDC, 2022). At the organizational level, inadequate postpartum follow-up increases the risk of complications. At the policy level, structural racism in healthcare, housing, and education systems continues to drive poor maternal health outcomes in Black communities. 

Methods

We reviewed and analyzed 29 sources in detail, including peer-reviewed journal articles, government health reports, and local public health documents. Afterwards, our team created a list of organizations that addressed maternal mortality and racial inequity, locally and nationally. We then found the contacts of CEOs, Presidents, PR Heads, etc, and sent emails to schedule an interview. Two stakeholder interviews were conducted. During the interviews, we took notes and applied their insight to our project. Our plan of action was designed based on the patterns and gaps  discovered while completing our literature review and stakeholder interviews.

Literature Review 

Maternal mortality in the U.S. has shifted notably in recent years, declining from 32.9 deaths per 100,000 live births in 2021 to 18.6 in 2023, with rates stabilizing into 2024 (CDC, 2025a; CDC, 2023b). Despite this progress, major racial disparities persist. In 2023, Black women faced a maternal mortality rate of 50.3 per 100,000 live births —over three times that of White (14.5) Hispanic (12.4) and Asian (10.7) women (CDC, 2023a). These gaps exist regardless of education, income, or insurance status, pointing to systemic issues in healthcare access and quality (Njoka et al., 2023). Although mortality rates dropped for most groups between 2022 and 2023, the rate for Black women slightly increased, widening the racial gap (AP News, 2025). Furthermore, over 80% of these deaths are preventable and are often linked to hemorrhage, hypertension, and infection (Oduyebo et al., 2023). 

Maternal mortality also disproportionately impacts older women. In 2023, women aged 40 and older experienced a rate of 59.8 deaths per 100,000 live briths—nearly five times higher than women under 25 (Hoyert, 2023). This elevated risk is not only influenced by chronological age, but also by the long-term effects of chronic stress. Allostatic load, or the cumulative physical toll of chronic stress, accelerates biological aging. As a result, Black women can age biologically up to 10 years faster than White women, placing them at a greater maternal risk even at younger ages. (Katella, 2023). Additionally, 65% of maternal deaths occur postpartum, when risks of complications like severe bleeding, infection, and cardiomyopathy remain high (Gunja et al., 2024). Alongside this, compared to other countries, U.S. women receive limited postpartum care, with few home visits and no guaranteed paid leave, increasing the risk of maternal mortality overall. 

Economic stability and access to quality healthcare also stand out as main contributors to maternal mortality disparities, under the Healthy People 2030 framework. Almost 36% of U.S. counties lack adequate obstetric services, leading to “maternity care deserts,” that disproportionately impact rural and marginalized communities (Adashi et al., 2024). Women living in these areas experience longer travel times, averaging 25 to 33 miles, to access obstetric care, which delays prenatal screening and management (Fontenot et al., 2024). Additionally,  implicit bias from providers, along with structural racism within healthcare settings, significantly contribute to unequal treatment and the dismissal of Black women’s concerns, worsening adverse maternal outcomes (Montalmant & Ettinger, 2024) 

Focusing now on Clifton, Ohio, Clifton is a small community situated in Hamilton County; consequently, public health data specific to this community is limited, and analyses typically rely on broader county or state-level reports. While there is limited direct data for Clifton itself, trends from nearby counties and Ohio help explain the broader reproductive health situation. 

Looking now broadly at Ohio, maternal health outcomes show ongoing disparities. Between 2008 and 2016, the state had a maternal mortality rate of 14.7 deaths per 100,000 live births, with more than half of these deaths being preventable (Ohio Department of Health, 2019). 

Black women in Clifton, Ohio, are most at risk. They are 2.5 to 3 times more likely to die from pregnancy-related causes than White women (Cincinnati Enquirer, 2022). This large gap shows that race plays a major role in maternal health, regardless of personal choices. From 2008 to 2016, the maternal mortality rate for Black women in Ohio was 29.5 per 100,000 live births, compared to 11.5 for White women (Johns Hopkins Center for Maternal and Child Health, 2021). These numbers reflect long-term systemic problems, including racism in healthcare, unequal access to services, and economic inequality. Neighborhoods like Clifton also experience higher rates of poverty and fewer medical resources, making it more challenging for women to get proper care (Cradle Cincinnati Annual Report, 2021). 

Other personal factors such as education, income, and stress all play a role in maternal health outcomes. For instance, black women with less education often start prenatal care late. The CDC reports that only 70% of black women with a high school education or less begin care in the first trimester, compared to over 90% of women with college degrees (CDC, 2022). In Hamilton county, early care makes it easier to address health problems, start treatment, and ultimately prevent complications (March of Dimes, 2023). Additionally, financial stress and food insecurity are linked to serious issues such as hypertension and early pregnancy labor (American Psychological Association, 2023). Lack of transportation and low health literacy also prevent many women in rural areas like Clifton from getting consistent care. 

Support from family, partners, and friends plays a vital role in improving maternal health by helping pregnant individuals attend medical appointments and follow healthcare guidance (WHO, 2023). Without this support system, women often experience increased stress and are more vulnerable to mental health challenges. According to the CDC, approximately 1 in 8 women suffer from postpartum depression (2023), a risk that is amplified in the absence of emotional or practical assistance. In rural or tight-knit communities, stigma surrounding reproductive health may further discourage women from seeking help. Additionally, studies have shown that Black women’s concerns are more frequently dismissed by healthcare professionals, contributing to poorer maternal health outcomes (March of Dimes, 2021). Institutions like hospitals and workplaces also shape reproductive health. Since many counties in Ohio, including Hamilton, are considered “maternity care deserts”, this forces pregnant people to travel long distances to get routine checkups or emergency care, worsening outcomes. On top of this, many workplaces do not offer paid maternity leave or health insurance, making women in these jobs more likely to delay care or miss appointments (Kaiser Family Foundation, 2020). 

In Cincinnati, community groups are working to improve outcomes. Cradle Cincinnati gives free rides to doctor visits, home check-ins, and pregnancy support in neighborhoods like Clifton (Cradle Cincinnati, 2023). Queens Village focuses on building support for Black women and providing mental and reproductive health services (Queens Village, 2023). Local providers like UC Health and the Cincinnati Health Department also help women before and after birth. Many of these programs offer free wellness activities ultimately reducing stress and building a support system during pregnancy. 

Recent policy changes have also assisted in making mild progress. Ohio now provides Medicaid coverage for 12 months after birth (Ohio Medicaid, 2023), giving new mothers more time to access care. Programs like Cradle Cincinnati receive support from local governments to continue their services. While all of this has proven incredibly beneficial, the aforementioned struggles of maternity call for more to be done.  Hospitals could require training to reduce bias, Medicaid could cover doulas, and mental health services could be expanded. These steps would help make maternal care safer and more equitable for all women, especially those most at risks. Which raises the question: How do we transport this care?