Francisca Shaw said she knew something was deeply wrong as she was rushed into an emergency cesarean for the delivery of her third child, a daughter, at Seattle's University of Washington Medical Center in 2015.

"I remember I told my doctor when I was getting cut: 'I can't breathe," Shaw recalled saying. "She said: 'Oh yeah, you can.'"

Shaw's uterus ruptured during the c-section, causing heavy bleeding. She required a hysterectomy and went into cardiac arrest, according to medical records reviewed by Reuters. She was hospitalized for three weeks after the birth, the records show.

The University of Washington Medical Center did not comment on Shaw's case, citing federal privacy laws, but said it was "committed to ensuring high quality and equity" in all of its patient care.

Advocates are trying to use the Nov. 5 election as a moment to raise awareness about reproductive health inequities impacting Black women, including higher rates of pregnancy and delivery complications and deaths, as well as higher rates of certain cancers.

Democratic candidate Kamala Harris has made abortion rights a central plank of her campaign - and in campaign appearances has blamed Republican Donald Trump for the deaths of two young Black mothers in Georgia, a state with abortion restrictions.

While public opinion surveys rank inflation and the economy as top priorities for Black women, Reuters spoke to 10 activist groups that said they were aiming to mobilize women of color around issues of systemic health care inequities. The effort is part of a 30-year-old movement for "reproductive justice."

Such concerns go beyond abortion rights, an issue that has galvanized women since the U.S. Supreme Court overturned the constitutional right to an abortion in 2022.

Shaw, now 43, works as a certified doula, a non-medical professional who assists women during childbirth in Atlanta, Georgia. She said in an interview that attention to reproductive health is critical to winning her vote.

"Black maternal health and reproductive health has to be a conversation that I hear from any candidate for me to be on board to vote for them," she said.

PREGNANCY COMPLICATIONS

Black women make up 13% of the female population of the United States, but accounted for 41.5% of abortions, opens new tab in 2021.

Black women in the U.S. also face greater risks bearing children. They are three times more likely, opens new tab to die from pregnancy-related causes than white women, according to the Centers for Disease Control and Prevention.

Georgia - where Black people make up 31% of the population - has the eighth highest, opens new tab maternal mortality rate in the U.S. Nearly 16% of women in the state have to travel more than 30 minutes to deliver at a hospital, according to a 2023 report, opens new tab by March of Dimes, a non-profit that works to prevent maternal and infant mortality. Nationally, fewer than 10% of women have to travel that far.

A line chart comparing maternal mortality rates between all women and Black women in the United States between 2018 and 2022

A line chart comparing maternal mortality rates between all women and Black women in the United States between 2018 and 2022

The CDC, opens new taband health experts attribute those gaps to chronic conditions such as cardiovascular disease and hypertension as well as structural racism, implicit bias from healthcare providers and lack of access to quality healthcare.

Leah Wright Rigueur, a history professor at Johns Hopkins University, said abortion restrictions have made it even more difficult for Black women to access emergency care in cases of failing pregnancies or complications from medical abortions.

"The landscape for reproductive health for Black women has gotten far more dangerous in the last two and a half years," she said.

Since March, In Our Own Voice, a national coalition of eight reproductive justice organizations, said it has spent $2 million on digital ads, billboards and mailers about abortion access and reproductive health to voters in 12 states, including the election battleground states. It has also addressed ballot measures on abortion; several states will vote on abortion access on Nov. 5.

Regina Davis Moss, who heads the coalition, said the groups have made more than 1 million voter contacts, targeting young voters, the LGBTQ community and low-propensity voters.

She did not provide a figure for total number of new voter registrations.

Since her ascension to the top of the ticket in July, Harris has given more prominence to abortion than Joe Biden. She has called on Congress to enact a national law codifying abortion access, and end a procedural rule requiring a supermajority in the Senate to pass legislation.

"The previous candidate was not as outspoken," Davis Moss said.

The Harris campaign highlighted Black maternal mortality on a "Reproductive Freedom" bus tour in September and during a roundtable discussion in Michigan with Harris' sister, Maya.

On Saturday, U.S. Representative Nikema Williams, along with healthcare providers and public figures joined the Harris campaign and the Georgia Democratic Party in Atlanta for an event to discuss Black maternal health and abortion bans.

When asked, the Harris campaign did not point to specific policies on Black maternal health.

But during her time in the Senate, Harris was an original sponsor of the 2020 Momnibus Act, a package of 13 measures aimed at expanding access to prenatal and postpartum care for mothers. She also supported funding research into uterine fibroids, which are more prevalent among Black women.

And the Biden administration last year allocated $470 million to improve maternal health, expanding access to healthy food and adequate housing, and funding student loan plans and scholarships to increase the diversity of certified midwives and nurses.

"I'd be very curious if anybody could mention another vice president who has made Black maternal health a priority," said Keisha Lance Bottoms, a former mayor of Atlanta and a senior advisor to the Harris campaign.

On the campaign trail, Trump has taken credit for appointing judges to the Supreme Court who voted to overturn abortion rights. Trump expressed support for a ballot measure in his home state of Florida to overturn a six-week abortion ban and enshrine abortion rights in the state constitution, only to later reverse course.

Janiyah Thomas, a spokesperson for Trump's campaign said in a statement that the former president "has always made the health and safety of Black mothers a priority."

She noted that in 2018 Trump signed into law a measure that authorized $60 million over five years to set up review committees of medical professionals and government health officials to investigate the causes of maternal deaths, particularly among women of color.

HARRIS FACES RISKS

However, some experts believe Harris faces a challenge juggling two different constituencies - for abortion rights and for maternal mortality.

Dr. Nadia Brown, director of the women and gender studies program at Georgetown University, said that white women and Black women historically have different approaches to abortion rights and reproductive health care.

"You won't find Black women saying I'm voting because I want to try enshrine abortion rights, but rather, you would get Black women talking about, I'm voting because I understand that there's a lot of attacks on bodily autonomy, and I want to be able to protect that and thinking about healthcare as a human right -- as a dignity."

And Dr. Joyce Drayton, a board member for the Georgia Black Republican Council, said that many Republican Black women - while opposed to abortion - would welcome stronger comments from Harris on improving outcomes for Black mothers.

"We have absolutely no problem working across the aisle" on improving perinatal health care in rural Georgia, Drayton said.

In the election battleground state of Georgia, which banned abortion after six-weeks in July 2022, the issue of Black maternal mortality has converged with abortion rights.

The state Supreme Court in Georgia this month reaffirmed the ban after it was overturned by a lower court.

Last month, ProPublica reported, opens new tab on the deaths of two Black mothers, Amber Thurman and Candi Miller, who were denied medical treatment after experiencing complications linked to medication abortions.

Harris spoke about the deaths at a campaign rally in Atlanta days later, saying that Thurman would be alive today if she had not waited 20 hours at the hospital for post-abortion care.

Since spring, Naomi Desta-Bell and her colleagues at the Feminist Women's Health Center, a clinic in suburban Atlanta offering contraception, abortion, gender-affirming care and other services, have spent their weekends doing voter registration at arts, music and LGBTQ festivals. They've also partnered with churches.

Desta-Bell said she's found growing interest from voters about the state of Black maternal health and reproductive justice. "There's a lot of passion here."