This article was produced as a project for the USC Annenberg Center for Health Journalism’s National Fellowship Dennis A. Hunt Fund for Health Journalism and the Fund for Reporting on Child Well-being.
HOUSTON — By the third trimester of an already difficult pregnancy, Moriah Ballard faced two new complications: relentless headaches and dizziness.
Over the previous 31 weeks, she had already collapsed three times and noticed blood in her urine. Each episode felt alarming, but on Aug. 8, 2019, her symptoms escalated so severely that a relative rushed her to the hospital near her home just outside Houston. There, a doctor quickly determined that her blood pressure was dangerously high.
Ballard, who was then 22, was diagnosed with preeclampsia — a serious complication of pregnancy that is marked by high blood pressure and elevated protein levels in the urine. It affects fewer than 10% of pregnancies, yet Black women like Ballard face a 60% higher risk of diagnosis compared with their white counterparts.
The exact cause of the ailment is unknown, but Ballard’s prognosis was evident. “The only cure for preeclampsia,” she recalled a physician saying, “is delivery — or death.”
“I just had a headache and felt a little woozy,” she said. “I didn’t know it was this serious.”
The doctor offered two choices: deliver immediately on site, separating mother and child, or transfer Ballard to a specialized hospital to deliver, where she could be close to her newborn. She and her then-husband, Donnell Johnson, chose the latter, a decision that still haunts them.
Four days later, they faced their worst nightmare when Ballard delivered their son, Denim Amari Johnson, stillborn by cesarean section.
“I think I’ve cried all the tears I can cry in this lifetime. Sometimes it still hits me, and I’ll cry randomly,” said Ballard, who is now 28, “But now it’s like changing it into advocacy.”
Moriah Ballard holds photos of her deceased infant son Denim provided by the hospital from a keepsake box that she received after his death in August 2019, Tuesday, Nov. 11, 2025, in Houston. (Douglas Sweet Jr./Capital B News)
For Black women in Harris County, Texas, which encompasses most of Houston, Ballard’s experience is heartbreakingly familiar.
Racial disparities in outcomes for pregnant mothers and their fetuses have long been established, but even against that backdrop, Harris County is an outlier. Home to nearly 5 million residents — one‑fifth of them Black — the county has in recent years reported maternal and infant mortality and maternal morbidity rates that at times exceeded both Texas and national averages.
A recent study by local public health officials found that from 2016 to 2020, the maternal mortality rate for Black women in Harris County was 83.4 per 100,000 live births — the highest in the nation. In 2020, the national rate for Black women was 55.3 per 100,000; for white women, it was 19.1.
The infant death rate for Black children in Harris County has been equally troubling. From 2016 to 2020, the rate was 11.66 per 1,000 births. Nationally, the infant death rate in 2020 was 5.4 deaths per 1,000 live births.
The severity of the crisis in Harris County has prompted public health officials, researchers, and advocacy groups to deepen their efforts to answer a pressing question: Why are more Black pregnant mothers and their babies dying in Harris County?
Experts say that formulating an answer to save Black lives means examining a constellation of issues: race and the enduring legacy of bias in Texas, inequitable health care access, delays in care, and systemic gaps in treatment.
Esohe Faith Ohuoba, a Houston-based obstetrician-gynecologist, said that it’s clear that multiple factors are to blame.
Ohuoba said much of the disparity stems from what researchers call the social determinants of health. “Things like access to quality care, financial stability, housing, education, and even the stress that comes from navigating systemic inequities,” she said. She added that the expansiveness of the state is another factor.
Ohuoba said a recurring issue is poor communication between physicians and their patients.
“It is important that we are listening to patients, answering their questions, and paying close attention to their symptoms,” she said. “That’s where the quality of care and communication from the health care team becomes critical. Was the patient heard? Were warning signs recognized, and was treatment timely?”
As of 2024, Black women are three times more likely to die a pregnancy-related death than white women, and more than 80% of these deaths are preventable, according to the Centers for Disease Control and Prevention.
“Often it’s about systemic gaps in communication, cultural awareness, and trust,” Ohuoba said. “But the result is the same: Women of color don’t always receive the same level of attention or intervention as others.”
To eradicate the crisis, she said, providers and the medical system must confront the root cause — racism.
Pain dismissed, symptoms ignored
Two years ago, when Rayna Reid Rayford was about seven months pregnant, she went to a Houston hospital with severe abdominal pain — and felt ignored by doctors who, she said, insisted she was simply dehydrated despite her drinking a gallon of water a day. That changed only when she encountered a Black physician and, coincidentally, had several relatives in town for her baby shower — all physicians — who advocated on her behalf.
Rayford was ultimately sent for an MRI, which revealed she had acute necrotizing appendicitis, a rare but severe complication of appendicitis that must be treated immediately. She was rushed into emergency surgery, recovered and delivered a healthy baby girl two months later.
“I’m here because I had five doctors in my waiting room. Not every woman has that,” Rayford said of her family of physicians who helped save her and her baby’s life. “Pregnancy is supposed to be a joyous time, but so many of my friends and Black women are terrified of pregnancy.”
Recent research has highlighted reports from Black women who say their pregnancy-related pain and discomfort are often ignored or dismissed by physicians, reflecting a broader pattern of medical racism rooted in the history of experimentation on enslaved people and reinforced in medical education and practice.
Those factors are not disputed by health officials in Harris County, who, in a report released last year on maternal and infant health in their community, acknowledged that in addition to access to quality health care, nutrition, and education, “prejudices against specific racial groups can also contribute to existing health disparities.”
County officials pointed to higher rates of diabetes, sexually transmitted diseases, and high blood pressure as factors that disproportionately worsen health outcomes for mothers and babies in certain racial and ethnic groups.
The maternal morbidity rates for Texas increased 24.5% from 2019 to 2024. The maternal morbidity rates in Harris County were not only higher than those in Texas each year, but they also increased by 34.7% during the same time frame, according to an analysis by Teresa Do, a fellow with the Media Innovation Group — an experiential learning project within the School of Journalism and Media at the University of Texas at Austin.
Local hospitals say that they are working to address the disparities in severe maternal morbidity, which includes unexpected outcomes of labor and delivery that can result in significant short- or long-term health consequences. In 2024, Memorial Hermann-Texas Medical Center, where Moriah Ballard delivered, recorded a severe maternal morbidity rate of about 250 cases per 10,000 deliveries, according to Do’s analysis.
A spokeswoman for Memorial Hermann Health System declined to discuss Ballard’s case in particular, or its protocols for managing preeclampsia and monitoring high‑risk patients in general.
“Memorial Hermann is committed to improving the health of the communities we serve, including women and children of all ages,” the spokeswoman wrote in an emailed statement. “One of our system’s key areas of focus is reducing and ultimately eliminating maternal mortality and morbidity.”
Memorial Hermann-Texas Medical Center is among four Harris County area hospitals that had some of the highest cases of severe maternal morbidity, upward of 100 cases per 10,000 deliveries.
The spokeswoman also highlighted some of Memorial Hermann’s current initiatives aimed at reducing maternal mortality and morbidity, including the establishment of its maternal health access committee in 2021, when county officials said the infant death rate decreased. The committee was created to understand severe maternal morbidity better and begin addressing its underlying causes before labor and delivery.
Memorial Hermann-Texas Medical Center is among four Harris County area hospitals that had some of the highest cases of severe maternal morbidity, upward of 100 cases per 10,000 deliveries, nearly every year from 2019 to 2024, according to Do’s analysis.
Each of those hospitals, including Texas Children’s Pavilion for Women, Harris Health Ben Taub Hospital, and the Woman’s Hospital of Texas, is housed within the Texas Medical Center and is a specialty institution that treats the most severe, complex, and high-risk cases from across Texas, the nation, and abroad.
The concentration of especially challenging cases in those hospitals may explain higher maternal morbidity rates compared with other facilities, a Texas Children’s Hospital representative said.
In 2019, the Texas Children’s Pavilion for Women recorded its highest rate of severe maternal morbidity — 203.7 cases per 10,000 deliveries, Do’s analysis shows. That year, the hospital also formed a quality‑assurance and performance‑improvement committee to review every case and identify opportunities for improvement, a spokesperson said.
Upon review, the hospital said it had implemented several quality‑improvement and patient‑safety measures for obstetric hemorrhage, including a safety bundle and in‑depth case reviews of adverse outcomes with a health‑equity focus.
“As a result of our targeted focus on respectful care, we eliminated racial disparities regarding SMM (severe maternal morbidity) related to hemorrhage. We have also developed quality improvement initiatives for obstetric hypertension that resulted in an improvement in our timeliness of treatment for hypertension,” a spokesperson said in a statement.
A false sense of security
In hindsight, Ballard said Houston’s concentration of high‑level hospitals gave her a false sense of security about her delivery, influencing her decision to transfer to Memorial Hermann–Texas Medical Center despite her worsening complications.
When she arrived on Aug. 8, 2019, expecting to deliver, she learned the plan had changed. Once there, she said, doctors told her that they hoped to stabilize her with medication and delay delivery, hoping to extend the pregnancy at least three more weeks — or when she would be 34 weeks pregnant — and improve the baby’s chances of survival. It became a race against time, balancing maternal risk and fetal development.
The American College of Obstetricians and Gynecologists recommends delivery at 34 weeks or later for patients with severe preeclampsia.
For patients with preeclampsia, Ohuoba said, treatment can range from low-dose aspirin to hospitalization, or in severe cases, early delivery, but the protocol depends on the severity of the condition.
Over the next two days, Ballard said, her pain had become excruciating, headaches ensued, her sight began deteriorating in her right eye, and her blood pressure spiked, at one point reaching 186/106. According to the American College of Obstetricians & Gynecologists, her symptoms signaled “severe features” of preeclampsia.
On Aug. 11, Ballard said she felt a burning sensation in her abdomen. She said that she repeatedly pressed her call light, but no one came.
Ballard said she felt her pleas were ignored.
“I remember telling God that I know you’re going to take me, but save my baby,” Ballard said. “I was ready. This is what happens to Black women. This is how you die. You’re dying, but you want your baby to survive.”
A Memorial Hermann Health System spokesperson said the hospital cannot comment on individual patients or their care, citing privacy laws.
“For all of our patients, we are committed to delivering safe, compassionate and high-quality care,” they wrote in a statement on Nov. 5.
Ballard said that she was given some Tylenol and that the chief nurse on her floor came to her room about two hours later.
It was then, after using a monitor, that Ballard said the nurse told her that she could not detect her son’s heartbeat. When a vaginal delivery attempt failed, Ballard was taken for an emergency C‑section, where her son was delivered stillborn.
Ballard said that she awoke from her C-section surgery experiencing blindness in one eye — a side effect of severe preeclampsia — and that an MRI revealed that an epidural needle inserted before the procedure had been left in her back and was undetected for two days.
Three days after her son’s death, Ballard said physicians told her they wished they had delivered sooner and communicated more clearly about her treatment plan, adding that the patient experience would be handled differently in the future.
Ballard, who has recently obtained her case file from the Medical Center, said that she grapples with many aspects of her treatment.
She questions everything, from why she wasn’t diagnosed with preeclampsia sooner, to the number of physicians’ visits she received while in the hospital, to the kind of medication she was given, to whether she should have simply given birth at her local hospital instead of choosing to be transferred to the Medical Center.
She also said that she has a lingering mistrust of physicians and still gets triggered when driving past the Texas Medical Center.
“When I’m in pain, it takes so much for me to go to the hospital because I do not trust anything at all,” Ballard said. “I just cannot pull myself out of that PTSD.”
Moriah Ballard goes through items from a storage box that holds items she saved following the lost of her infant son Denim during birth in August 2019, Tuesday, Nov. 11, 2025, in Houston. (Douglas Sweet Jr./Capital B News)
Moving the work forward
Rayna Reid Rayford has turned her pain, trauma, and grief into purpose by raising awareness and pushing for changes to promote health care equity for Black women.
That’s why she started her own nonprofit, Pregnant and Black, which aims to foster community and support among other Black expectant moms, connecting them with culturally competent care, health care advocates, and lifesaving resources through a mobile app set to launch on April 11 at the start of Black Maternal Health Week.
Another Black Houstonian, Kay Matthews, founded The Shades of Blue Project in September 2013, four months after delivering a stillborn child, to raise awareness about the correlation between infant loss and mental health.
“I was trying to get people to understand that, honestly, I was experiencing postpartum depression versus grief at the time,” Matthews said. “In reality, my grief was delayed.”
Advocates agree that efforts like those of Rayford and Matthews are a crucial next step in addressing racial disparities for African American mothers and their babies. It’s a step that depends on collaboration — health care organizations partnering with communities, listening to patient stories, and harnessing innovation and technology to ensure every mother receives equitable, compassionate care.
“When I’m in pain, it takes so much for me to go to the hospital because I do not trust anything at all. I just cannot pull myself out of that PTSD.”
Moriah Ballard
Angela Doyinsola Aina is the co-founder and executive director of the Black Mamas Matter Alliance, a Black women-led cross-sectoral alliance and advocacy organization best known for coining the phrase “Black Maternal Health Week,” which became a movement in 2016. She said that Houston has a “groundswell” of opportunity.
“It’s going to take more investment to allow the Black-led entities to take the helm and move the work forward,” she said. “We need funding.”
Harris County has received a significant amount of funding to address its Black maternal mortality and morbidity rate — roughly $9.1 million, which has funded programming for the county’s maternal and child health program, a five-year initiative that provides everything from one-on-one home support to prenatal and postpartum care assistance. From its launch in April 2023 to Sept. 30, the program has served 409 families, spokesperson Eduardo “Eddie” Miranda said.
Unfortunately, those resources were put in place too late to help Moriah Ballard. She and Denim’s father — the couple have since divorced — had done all the necessary preparation for their baby: buying clothes and onesies, planning a baby shower, and even purchasing a new home. Before, she said, their world collapsed.
“We were full-fledged, ready to go — we had just bought a four-bedroom house,” Ballard said, as she sifted through a tote bag of Denim’s belongings on a Tuesday evening in November — inside were hospital mementos like his diaper, blanket, and photographs, along with ultrasound images, a naming certificate, and the clothes and books they prepared.
Each year, she said, she pulls the tote out of storage on Aug. 11 and looks through its contents once again as a way of honoring Denim’s birthday.