The Antitrust Battle Against the U.S. Maternal Mortality Crisis

A federal jury convicted Eduardo “Eddie” Lopez of Las Vegas for participating in a conspiracy to fix the wages for home health care nurses in Las Vegas between March 2016 and May 2019. The jury found that Lopez, who oversaw hiring, recruitment, and retention in three different home health agencies in Nevada, conspired with competing agencies to artificially cap nurses’ wages.

Similarly, in United States v. VDA OC, LLC, the Department of Justice ensured a guilty plea against a nurse staffing agency for allegedly having agreed with competing employers to fix nurses’ wages from October 2016 until July 2017. Other wage-fixing cases have taken place in Troy, New York, and Detroit, resulting in large settlement payouts.

In all these instances, the conspirator-employers not only deprived hundreds of nurses of a decent wage but harmed their health as well. Because the majority of nurses in the United States are female workers, any anticompetitive agreement among employers that harms nurses’ wealth, harms their maternal health as well.

The correlation between the social determinants of health and maternal health explains why this is case. Indeed, public health research indicates that stable housing and nutritious food improve maternal health. Women receiving artificially suppressed wages lack the financial resources to fully invest in these vital resources, which worsens their health and subsequently increases their risk of maternal morbidity and mortality.

Consider unaffordable housing. When women are forced to spend most of their disposable income on rent due to their limited wage, they often lack the necessary resources to invest in healthy food and health care — factors that have a positive effect on an individual’s well-being and maternal health. Low wages may even lead to eviction and homelessness. Experiencing eviction during pregnancy deteriorates women’s health as well, leading to adverse birth outcomes.

Women living in emergency shelters face high barriers in accessing health care and they are at high risk of several health complications during pregnancy, including hemorrhage. Being homeless is associated with increased rates of depression, anxiety and substance use disorder — factors that can prevent a healthy pregnancy.

Women with lower wages may also be more likely to be exposed to environmental pollutants linked to their neighborhood.People living in highly polluted areas are at a higher risk for asthma which is associated with several pregnancy-related complications such as preeclampsia and gestational hypertension.

Being deprived of access to healthy food during pregnancy negatively impacts both fetal and maternal health. For example, malnutrition is often linked with obesity, which is associated with multiple complications during pregnancy including macrosomia, preeclampsia, and diabetes.

Unfortunately, women with lower wages face higher odds of being deprived of healthy food during pregnancy compared to higher-income women. This deprivation often stems from living in food deserts, areas where only low-quality, high-calorie, nutrient-poor food is available as a result of limited access to grocery stores and farmers markets and easier access to convenience stores and fast foods. Due to their limited financial resources, women with lower wages have no choice but to purchase cheaper food rich in synthetic fats, rather than fresh vitamin-rich foods like fruits and vegetables. This contributes to the higher rates of maternal morbidity and mortality vulnerable communities frequently face.

Importantly, the economic, gender, and health disparities created by wage-fixing agreements in the nursing industry present disproportionate harm to Black nurses. Although Black female workers are more overrepresented than any other race in the health care sector, they are primarily concentrated in the lowest-paid and most physically demanding jobs. This is especially the case for home health care nurses. Due to the nature of the work, home health care nurses face one of the highest rates of workplace injuries nationwide, yet 20 percent of them live below the federal poverty line compared to 7 percent of all U.S. workers. Because the majority of home health care workers are Black nurses, any agreement among employers suppressing home health care nurses’ wages disproportionately harms the economic opportunity and wealth of Black women.

Given that the Black and Hispanic communities are disproportionately affected by the maternal mortality crisis that is plaguing the United States, increasing antitrust enforcement in the home care nursing industry could not be timelier. Data show that in 2021, the maternal mortality rate for Black communities was almost 70 deaths per 100,000 live births, 2.6 times the rate for white women. Somewhat ironically, by being forced to provide care for others at below-market wages due to employer collusion, home health care workers are unable to adequately care for their own health.

Hence, by allocating their resources in detecting any anticompetitive agreement among hospitals, nursing homes, and home health agencies that artificially suppresses nurses’ salaries, the U.S. antitrust enforcers help millions of female workers, especially women of color, to improve their maternal health as well.