Transcultural Perspective: Maternal Health at the Margins

by Patricia Burke, PhD, CNE, RNC, Lisa Roberts, DrPH, MSN, FNP-BC, CHES, FAANP, FAAN and Carmen Kiraly. Members of the Transcultural Nursing Society attended CSW70 as part of our NGO delegation.

Introduction

The authors were chosen as delegates for TCNS to attend the 70th session of the United Nations (UN) Commission on the Status of Women (CSW70), held in New York from March 9 to March 19, 2026. Bringing together Member States, UN agencies, civil society organizations, and grassroots advocates, CSW70 served as a key platform for reviewing progress, shaping international commitments and representing the largest global forum dedicated to advancing gender equality and the rights of women and girls

The priority theme for CSW70 “ensuring and strengthening access to justice for all women and girls” centered on addressing structural inequalities embedded in legal systems, policies, and institutional practices. Discussions throughout CSW70 highlighted that women worldwide continue to experience significant gaps in legal protection and access to justice, with systemic barriers limiting their ability to seek redress or exercise fundamental rights. While access to justice was broadly defined, maternal health was not explicitly presented as a core dimension of gender equality, despite its critical role in determining women’s survival, dignity, economic and bodily autonomy.

This analysis draws on selected global, national, and local initiatives to evaluate how maternal health is prioritized, highlighting specific successful strategies that have demonstrably improved maternal health outcomes. Maternal health is a vital, yet too often overlooked, dimension of justice, encompassing the right to survive pregnancy, access quality care, and exercise autonomy. These priorities align with the United Nations Sustainable Development Goals (SDGs), particularly SDG 3.1 and 3.7. Specifically, SDG 3.1 calls for promoting healthy lives and well-being for all and reducing the global maternal mortality ratio to less than 70 per 100,000 live births. SDG 3.7 seeks to ensure universal access to sexual and reproductive health-care services and integrate reproductive health into national strategies by 2030. In the United States, Healthy People 2030 similarly prioritizes improving maternal health outcomes and reducing maternal mortality rates. Persistent preventable maternal morbidity and mortality reflects systemic failures in policy, resource allocation, and social accountability. Advancing justice for women requires a transcultural, systems-based reframing that places maternal health as a core justice issue embedded within legal, economic, and cultural systems, and fully integrated into both global and national gender equality agendas.

Nationally, the United States presents a contrasting landscape, where maternal mortality rates remain elevated despite high healthcare expenditure. More than 700 women die annually from pregnancy-related complications and racial and ethnic disparities persist. States with the highest maternal mortality rates per 100,000 live births include Tennessee, Louisiana, Mississippi, Arkansas, and Alabama. Differences across states reflect disparities between rural and urban areas, with reproductive health deserts adversely impacting maternal morbidity and mortality. These geographic disparities are closely tied to structural inequities, including reduced access to comprehensive maternity care, higher rates of uninsured women, and limited access to skilled providers. Importantly, these same states have more restrictive reproductive health policies and reduced access to services, with evidence suggesting that states with greater abortion restrictions tend to have fewer maternity care providers and poorer maternal health outcomes.

The CDC’s “Hear Her” campaign highlights the importance of communication, awareness, and patient-centered engagement in reducing maternal mortality in the United States (Behm et al, 2022).  Launched in 2020, the campaign emphasizes the early recognition of urgent maternal warning signs, timely diagnosis, and access to quality care as critical to preventing avoidable deaths. A central strategy is the use of storytelling, featuring women’s lived experiences to humanize clinical risks, amplify marginalized voices, and motivate action among patients, families, and providers. Disseminated through digital platforms, social media, public service announcements, and strategic partnerships, the campaign achieved substantial national reach within its first year.

We can learn from the States with the lowest maternal mortality rates; California, Minnesota, Massachusetts, and Utah. These States demonstrate that achieving improvements in maternal health requires a coordinated, approach aligned with SDG 3 and the CSW70 priority of access to justice for women and girls. Some initiatives such as expanded health coverage, continuity of care, access to skilled providers, community health workers and doulas are associated with positive maternal health outcomes (The Commonwealth Fund, 2024). Evidence-based initiatives in California and New Jersey, such as extended postpartum coverage, standardized quality metrics, and interdisciplinary care coordination, offer models for reducing maternal mortality nationwide.

With the lowest maternal mortality rate in the nation, California’s Maternal Quality Care Collaborative (CMQCC) provides an example of a successful statewide initiative. The program uses comprehensive data systems to track outcomes, compare evidence-based protocols, and support continuous quality improvement across maternity care settings. Through this initiative, standardized toolkits and protocols were developed to address leading causes of maternal morbidity and mortality, including hemorrhage, preeclampsia, sepsis, and cardiovascular disease. Emphasis is placed on early recognition and timely intervention (Samara et al., 2026).

Public health initiatives such as the NIH-funded retrospective research in Arkansas, Louisiana, and Mississippi evaluates the impact of extended Medicaid to cover the postpartum period (Louisiana, Mississippi) and mental health screening mandates (Louisiana) on maternal health outcomes, as compared to Arkansas (Alam, 2024).

Nursing and healthcare professions can play an active role in bringing maternal health into focus within global gender equity forums.  By advocating for leadership in global gender forums, maternal health discussions can move from the periphery to the main agenda. Transcultural evidence can challenge siloed policy thinking and elevate maternal health as central to gender equality, treating preventable maternal morbidity and mortality as justice failures, not inevitable health outcomes.

Conclusion

Looking ahead, it is essential to advocate for the integration of maternal health in future CSW themes, highlighting successful programs and accountability mechanisms. Maternal morbidity and mortality should be treated as preventable justice failures, not unavoidable outcomes, and women’s health across the life course should be recognized as a justice priority.

Elevating maternal health, especially for those most marginalized, is critical to advancing gender justice. Without it, the promise of global equality remains incomplete. Ultimately, placing maternal health at the center of global and national policy frameworks would do more than improve outcomes. It would help turn the principles of justice, dignity, and equity for women into a lived reality.

References

Alam, S., Nandi, U., Scarborough, S., McNeill, E., Callison, K., Shi, L., & Gamble, A. (2024). Maternal health legislation enacted in three southeastern states in the United States between 2018-2023: policy surveillance. Journal of the Mississippi State Medical Association, 65(5-6), https-jmsma. https://pmc.ncbi.nlm.nih.gov/articles/PMC11270647/pdf/nihms-2008103.pdf

Behm, B., Tevendale, H., Carrigan, S., Stone, C., Morris, K., & Rosenthal, J. (2022). A National Communication effort addressing Maternal Mortality in the United States: Implementation of the Hear Her Campaign. Journal of women's health (2002), 31(12), 1677–1685. https://doi.org/10.1089/jwh.2022.0428

Commonwealth Fund (2024). https://www.commonwealthfund.org/publications/issue-briefs/2025/jul/maternal-mortality-united-states-2025

Samara, M. N., Harry, K., & Barua, A. (2026). Addressing the US maternal health crisis: a systematic review of healthcare access barriers, disparate outcomes, and effective interventions. Frontiers in Public Health, 14, 1814063. file:///C:/Users/Patricia%20Burke/Downloads/fpubh-14-1814063.pdf

United Nations Population Fund. (2024). Interwoven lives, threads of hope: ending inequalities in sexual and reproductive health and rights (I. McFarlane, Ed.). UNFPA. https://www.unfpa.org/sites/default/files/pub-pdf/swp2024-english-240327-web.pdf

World Health Organization. (2023). Sustain, Accelerate and Innovate Strategies” for reducing maternal, newborn and child mortality (CC BY-NC-SA 3.0 IGO).

World Health Organization. (2025). Trends in maternal mortality 2000 to 2023: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. https://www.who.int/publications/i/item/9789240108462.

Acknowledgement:

“This work is disseminated in partnership with the Transcultural Nursing Society (TCNS), a Non‑Governmental Organization in Special Consultative Status with the United Nations Economic and Social Council (ECOSOC) since 2025. The author served as a delegate from TCNS to the United Nations Commission on the Status of Women (CSW70), held March 9–19, 2026. The perspectives presented here are grounded in TCNS’s mission to advance transcultural nursing knowledge, practice, research, and global health equity.”