Stress Kills: Economic Insecurity and Black Women’s Maternal Health Outcomes

By Elizabeth Dawes Gay
Fifty years ago, President Lyndon B. Johnson announced the War on Poverty, a set of legislation and programs intended to respond to the needs of people living in poverty. Today, many people still need and benefit from War on Poverty programs such as early childhood education, supplemental nutrition assistance (food stamps), work study opportunities, and federal family planning grants.

To commemorate this anniversary, the last few months have seen a kerfuffle of coverage on poverty and economic inequality, opportunity, and growth. Media coverage has also highlighted the connection between economic opportunity and reproductive health in that women need access to reproductive health services to prevent and delay childbearing so they can get further ahead in life, avoid poverty, or lift themselves out of poverty. This is very important. Indeed, data show that women reap substantial social and economic benefits when they are in control of their childbearing; but, that is only one way that economics and reproductive health outcomes intersect. We also understand that economic inequality and injustice can affect the human body and lead to negative health outcomes.

When we hear “stress kills,” we often imagine a wealthy business executive dying of a heart attack in their early 50s because they put in too many long nights at the office. But stress also kills pregnant Black women and their babies in a more surreptitious way. Economic inequality—simply described as the gap in wealth or income between people—takes a toll on health, even when people have health insurance coverage and access to important health-care services. The chronic stress of living in poverty—of knowing a missed paycheck could leave you in dire straits, of not having enough to make ends meet—is killing Black women who choose to become pregnant and give birth.

The negative maternal health outcomes many low-income women and women of color experience—including maternal mortality—often result from conditions exacerbated by economic instability. Research shows that chronic stress causes cardiovascular changes that increase blood pressure, which must remain stable during pregnancy and labor. Hypertension, or high blood pressure, is a risk factor for pregnancy complications such as preeclampsia, low birth weight, pre-term birth, and damage to the mother’s internal organs and other adverse conditions. Chronic stress could also lead to unhealthy coping behaviors such as overeating (leading to obesity), smoking, and alcoholism—all of which increase the risk of adverse pregnancy outcomes. Being financially insecure and experiencing financial hardship is stressful, and Black women are more likely to be poor during pregnancy than women of other races.

The reality of the economic hardships of Black women in the United States is a hard pill to swallow. A 2013 report by the Center for American Progress summarizes the concerning statistics:

i) Black women earn, on average, 55 cents to the dollar that white men earn. The statistic of 77 cents to the dollar for American women just doesn’t hold true for communities of color.

ii)  Black women are more likely to hold low-wage jobs with few benefits and less job security.
iii) The poverty rate for Black women is 28.6 percent compared to 10.8 percent for white women.
 

The most telling of this data is that single Black women have a median wealth of $100, compared to a median wealth of $41,500 for single white women. That’s a huge disparity. Low wealth is indicative of financial insecurity. For example, a single woman earning $40,000 a year with no savings, investments, or assets is essentially living paycheck to paycheck and is at risk of going into debt and falling into poverty even though her income is far above the federal poverty level. Based on our median wealth, Black women are extremely financially insecure, and thus subject to the chronic stress that accompanies that insecurity.

It’s clear that if we want to see better maternal health outcomes for Black women, reproductive health and justice advocates must also work to achieve economic justice. Health happens at the intersection of various parts of our lives and is influenced by where we live, work, and play. We must support policies and action that are outside of the traditional scope of reproductive and sexual health in order to achieve the improvements we seek in a range of health outcomes.

In particular, we must take action and support policies that improve economic security, increase pay, and promote the accumulation of wealth in the Black community. The rhetoric of the War on Poverty may be antiquated but the underlying theme of greater economic security and opportunity is still relevant. In fact, the War on Poverty set a precedent of economic policies that improve pregnancy outcomes. A 2011 analysis concludes that the food stamp program helped to increase infant birth weight, particularly among Black mothers living in high-poverty areas, by increasing the financial resources available to families. If supplemental nutrition programs can help increase birth weight, imagine what strategic and concerted efforts to reduce financial hardship can accomplish.

Researchers and advocates have pointed to a few key opportunities to improve the economic experience, and health outcomes, of people living in the United States over the next 50 years:

Education That Leads to Economic Opportunity

Black people must be better prepared to compete for well-paying jobs that ultimately increase economic and social equity. Specifically, reforming public school funding to more equitably distribute financial resources could go a long way. Currently, public K-12 schools may be funded by the state or local government and property taxes from the school’s surrounding area. What we have seen as a result is under-funded schools in lower-income areas and disparities in quality of education from neighborhood to neighborhood and state to state. As you might have guessed, underfunding is more likely to impact students of color. And school funding has been directly linked to the quality of education and student outcomes.

It is imperative that all children receive a high-quality education that prepares them to enter institutes of higher education or enter the workforce with the skills necessary to compete for higher-paying jobs. Reproductive justice advocates must actively support meaningful attempts to address the way our schools are funded. We know that other issues also plague our schools—the school to prison pipeline, cultural incompetence, and inconsistent instruction and curriculum—but achieving equality in funding is a good place to start.

At Least a Living Wage

Earning a low income and living in impoverished areas not only directly impedes access to health-care services, but indirectly affects health outcomes through the stress of financial insecurity. The Center for American Progress asserts that “the best ticket out of poverty is a job that pays a living wage.” According to the White House, raising the minimum wage to $10.10 would affect 28 million Americans and boost the economy. While a minimum wage of $10.10 an hour would be a good start, it falls far short of a living wage—especially for families with at least one dependent.

Raising the minimum wage is an absolute necessity, but advocates must not be content with that. A living wage must be the new minimum and the work shouldn’t stop there. We should support people in prospering from their work and growing wealth. Wealth can serve as a personal safety net, reducing financial insecurity and increasing health.

Adequate Leave to Enhance Job Security

Finally, people must have sufficient and generous personal leave so that they can take off from work when they are sick, take care of their families and personal responsibilities, and rest and relax without having to worry about losing their jobs. Sufficient leave provides job and financial security. Moreover, adequate maternal, paternal, and family leave policies not only have an immediate benefit, but help create a culture that respects the reproductive decision-making of individuals rather than punishing them for creating the families they want. Reproductive health and justice advocates’ participation in pushing for better leave policies is essential.

So, where do we begin? Forming partnerships between reproductive justice and economic justice advocates is a good place to start. Coalitions that cross traditional lines to begin thinking and working across issues will be important for any forward momentum. Strong Families is an example of a network of activists and advocates across movements who collaborate and amplify each other’s work to create meaningful policy and culture change. But, this intersectional collaboration requires the participation of actors at all levels and in various fields, importantly policymakers. For example, the American Public Health Association published guidance to encourage state and local governments to incorporate health into all policies. Incorporating health into all policies is an approach to provide real opportunities for people to achieve and maintain their best health and improve the health of our nation.

Economic inequality produces the stress that manifests as illness in our communities. Advocates, policymakers, scholars, and community representatives must combine forces to address the inequality that hurts Black women and their families, and ultimately our society. Economic injustice makes it nearly impossible to survive and there’s nothing more stressful than that.

STARTING a career: Values the industry demands

By Clive M. Siachiyako
In addition to relevant skills, the job market seeks employees who have personal values, characteristics, and personality traits that spell success. Good personal values are what make the foundation for a good professional. Below are the top ten qualities employers look for:
 

1. Strong Work Ethic: 

The labour market values employees who understand and possess a willingness to work hard. In addition to working hard it is also important to work smart. This means learning the most efficient way to complete tasks and finding ways to save time while completing daily assignments.

It’s also important to care about your job and complete all projects while maintaining a positive attitude. Doing more than is expected on the job is a good way to show management that you utilize good time management skills and don’t waste valuable company time attending to personal issues not related to the job. Downsizing in today’s job market is quite common so it’s important to recognise the personal values and attributes employers want to improve your chances of job security (and career development) should a layoff occur.

2. Dependability and Responsibility:
The labour market values employees, who come to work on time, are there when they are supposed to be, and are responsible for their actions and behavior. It’s important to keep supervisors abreast of changes in your schedule or if you are going to be late for any reason. This also means keeping your supervisor informed on where you are on all projects you have been assigned. Being dependable and responsible as employees shows your employer that you value your job and that you are responsible in keeping up with projects and keeping them informed of the things that they should know about.

3. Possessing a Positive Attitude:
Employers seek employees who take the initiative and have the motivation to get the job done in a reasonable period of time. A positive attitude gets the work done and motivates other to do the same without dwelling on the challenges that inevitably come up in any job. It is the enthusiastic employee who creates an environment of good will and who provides a positive role model for others that also makes the job more pleasant and fun to go to each day.
 

4. Adaptability:
The job market seeks employees who are adaptable and maintain flexibility in completing tasks in an ever changing workplace. Being open to change and improvements provides an opportunity to compete work assignments in a more efficient manner while offering additional benefits to the corporation, the customer and even the employee. While oftentimes employees complain that changes in the workplace do not make sense or makes their work harder, oftentimes these complaints are due to a lack of flexibility.
Adaptability also means adapting to the personality and work habits of co-workers and supervisors. Each person possesses their own set or strengths and adapting personal behaviors to accommodate others is part of what it takes to work effectively as a team. By viewing change as an opportunity to complete work assignments in a more efficient manner, adapting to change can be a positive experience. New strategies, ideas, priorities and work habits can foster a belief among workers that management and staff are both committed to making the workplace a better place to work.
 
5. Honesty and Integrity:
Employers value employees who maintain a sense of honesty and integrity above all else. Good relationships are built on trust. Successful businesses work to gain the trust of customers and maintain the attitude that “the customer is always right”. It is the responsibility of each person to use their own individual sense of moral and ethical behavior when working with and serving others within the scope of their job.

6. Self – Motivated:
 Employers look for employees who require little supervision and direction to get the work done in a timely and professional manner. Supervisors who hire self-motivated employees do themselves an immense favour. Once a self-motivated employee understands their responsibility on the job, they will do it without any prodding from others. Employers can do their part by offering a safe, supportive, work environment that offers employees an opportunity to learn and grow and that will provide them a better sense of accomplishment and increased self-esteem.

7. Motivated to Grow & Learn:
In an ever-changing workplace, employers seek employees who are interested in keeping up with new developments and knowledge in the field. It has been noted that one of the top reasons employees leave their employers is the lack of opportunity for career development within the organisation. Learning new skills, techniques, methods, and/or theories through professional development helps keep the organisation at the top of its field and makes the employee’s job more interesting and exciting. Keeping up with current changes in the field is vital for success and increased job security.

8. Strong Self – Confidence:
Self-confidence has been recognised as the key ingredient between someone who is successful and someone who is not. A self-confident person is someone who inspires others. A self-confident person is not afraid to ask questions on topics where they feel they need more knowledge. They feel little need to have to impress others with what they know since they feel comfortable with themselves and don’t feel they need to know everything.

The self-confident person does what they feel is right and is willing to take risks. Self- confident people can also admit their mistakes. They recognize their strengths as well as their weaknesses and are willing to work on the latter. Self-confident people have faith in themselves and their abilities which is manifested in their positive attitude and outlook on life.

9. Professionalism:
Employers value employees who exhibit professional behaviour at all times. Professional behaviour includes learning every aspect of a job and doing it to the best of one’s ability. Professionals look, speak, and dress accordingly to maintain an image of someone who takes pride in their behaviour and appearance.
Professionals complete projects as soon as possible and avoid letting uncompleted projects pile-up. Professionals complete high quality work and are detail oriented. Professional behaviour includes all of the behavior above in addition to providing a positive role model for others. Professionals are enthusiastic about their work and optimistic about the organization and its future. To become a professional you must feel like a professional and following these tips is a great start to getting to where you want to go.

10. Loyalty:
The job market values employees who are trusted and exhibit their loyalty to the company. Loyalty in the workforce has taken on a new meaning. Gone are the days when employees plan on starting out and retiring with the same company.

More companies today encourage employee feedback and offer employees an opportunity to lead in their area of expertise. This gives employees a greater sense of satisfaction and a sense of control over their job. Empowerment encourages employees to do their best work since companies are displaying a trust and expectation that they believe in their employees to do a good job.

Aligning an employee’s values with the goals of the organisation will foster loyalty and a bond between employer and employee. Fostering good relationships within an organisation and offering constructive ways to handle conflict provides a win – win situation for both employer and employee.

Creating an organisation that values loyalty within the organisation can also work to its benefit by using the same techniques and strategies to establish loyalty with customers; and loyalty from customers ultimately makes for a successful business.

Therefore, as a career seeker, shape your destine according to the labour market needs. Align your personality with values and qualities that benchmark you as the class A employee the job market is looking for. As you plan and pursue your career, be a trail blazer in your specialty, make the impact and grab what the labour market has for you.  Extract from the 2011 Career Expo for Zimbabwe. Courtesy of Penny Loretto