The State of Black Maternal Health
In our opening conversation, Stacey D. Stewart, president and CEO of March of Dimes, U.S. Rep. Alma Adams of North Carolina, and Tonya Lewis Lee, co-producer and co-director of the documentary Aftershock, discussed the current state of Black maternal health care and outcomes for Black women — which have actually gotten worse since the start of the pandemic. “We were already in a pretty dire situation with respect to the health of moms and babies, even prior to 2020,” said Stewart. “We are considered the most dangerous developed nation in the world in which to give birth, and that’s especially true for Black and brown women in this country.”
The statistics show that Black women are three times as likely as their white counterparts to die as a result of childbirth. According to Stewart, “In one year alone, we saw … maternal mortality rates increase by 18%, and significantly so for Black and brown women.”
The panel also talked about solutions. Adams noted that this week marks the fifth anniversary of the instituting of Black Maternal Health Week, a moment in which medical professionals, activists, and community organizers call national attention to the crisis. The Black Maternal Health Momnibus Act — a bill aimed at holistic improvements to health care for women and babies — also just celebrated the two-year anniversary of its introduction.
Lee talked about the important work of centering real families in discussions, as she did with her film. She also discussed the very personal aspects of this topic for her and many Black women. “My daughter, who is 27 years old, has a higher chance of dying from childbirth complications than I did when I birthed her, which is a disgrace.”
Pregnant and Undocumented
Capital B’s Atlanta Health Reporter Kenya Hunter sat down with Dr. Rachel Fabi of SUNY Upstate Medical University, and Sydelle O’Brien, an associate at the Black Alliance for Just Immigration, to discuss the compounding impact that an undocumented status can have on birth inequity for Black women. The pair talked about the chilling effect that fear of deportation, lack of access to health insurance, distrust in medical systems, and cultural and language barriers can have on women seeking care. The result is often worse outcomes for them and their children.
Fabi offered a single action she would like to see to improve the situation for undocumented women: the expansion of Medicaid coverage in all states, which would offer access to critical prenatal care to all women regardless of immigration status and decrease concerns over ability to pay.
In addition, she clarified that birthing centers and hospitals are a safe space where they do not risk medical deportation for seeking care.
For O’Brien’s part, she noted that maternal care that centers humanity and leads with compassion could have a radical impact. More cultural competency, hiring from immigrant communities, valuing different birthing practices, and improving interpreter resources could go a long way to making women feel truly cared for during a particularly vulnerable time.
Fighting Disparities in Postpartum Care
The postpartum period can be one of the most vulnerable, and yet most overlooked, moments when it comes to care for birthing individuals. The results, particularly for Black women, can be particularly dire. Health reporter Shefali Luthra of The 19th was joined by Jennie Joseph, certified midwife and founder and president of Commonsense Childbirth; Kathryn Hall-Trujillo, founder of Birthing Project USA and adjunct professor at Charles R. Drew University of Medicine; and Dr. Ndidiamaka Amutah-Onukagha, founder of MOTHER lab and assistant dean at Tufts University School of Medicine; to talk about the ways America struggles to serve Black women during the critical postpartum period.
Here’s a snippet of their conversation (this selection has been edited for clarity and length)
Shefali Luthra: I wanted to open this conversation just by getting the lay of the land of what’s behind these persistent and really profound discrepancies between Black women and white women when it comes to both postpartum care and outcomes. Dr. Amutah-Onukagha, can we start with you.
Dr. Ndidiamaka Amutah-Onukagha: We know that 63% of maternal deaths are preventable and that, honestly, the health care system is so fragmented and so racist inherently in its nature, that the needs, the priorities, the symptoms, the responsiveness to Black and brown birthing people, is not where it needs to be. This is why we see people slipping through the cracks. When you hear statistics like 90% of maternal deaths due to hemorrhage are preventable, then you’re wondering how is it that 9 out of 10 people that die from hemorrhage are dying in a country like the United States, in a country with the resources that we have, the technology, the excellent training of these clinicians. That tells you there’s more to the story than technology and medication and what we know to do clinically. There has to be something more. That’s where racism plays out. They call it implicit bias. I call it explicit racism.
Jennie Joseph: For me, I’ve been in the United States 32 years and I’m absolutely still horrified because there is no postpartum [care]. Postpartum barely exists. What frustrates me more than anything about our care system as far as postpartum, is that we have this little two-day window that families are supposed to manage, learn everything, and be ready for because after two days in a hospital environment, you’re tossed out. You’re on your own. You’re put back into the community where there are, really, no resources for you. The most upsetting and egregious part of our outcomes, our maternal morbidity, and mortality are that the majority of them take place in the postpartum. How ridiculous is that? We know where the problems lie and yet our efforts are going towards continually ignoring this phase for people.
Kathryn Hall-Trujillo: I’m based out of Cuba, which has mama-leave, daddy-leave, and grandparent-leave. And grandparents are considered the first supporters of a family and get the support and the training and education they need to be able to start at the family level, to be the one that’s eyeballing someone who has just had a baby and supporting them. In the sense we’re looking at pregnancy in a vacuum, we are developing it all by ourselves without looking at what the rest of the world is doing. I think it is really a detriment to us because we are behind every developed country in the world in the policies that drive the services that we get.
Amutah-Onukagha: The way that our system is set up, as we’re talking about the United States and how we operate in such a silo and a vacuum, and we are so tone-deaf to what’s happening in other parts of the world. There’re so many beautiful practices and beautiful things that are really beneficial to the family unit.
Joseph: There are things already in play, but what we haven’t achieved here in the United States, is an ability to take policy and transfer it into action. [That’s] an imperative if we are going to see any changes in our outcomes for Black and other marginalized folk. Here’s the problem: When we put these policies in place, we don’t have any providers, or we’re not willing to create the providers to carry this work forward. It is really strange when you think about it. The workforce is able to be developed, but we just keep choosing not to develop the workforce. We already have enough research that points out the impact and the value of doulas, community health workers, resource mothers, peer counselors. We don’t have any need for any more research before we move ahead.
Amutah-Onukagha: It’s not that we don’t know what to do. We have to put procedures in place that have teeth, that have resources attached to them. I don’t want to be in any more governing boards, or coalitions, or commissions, just for the purposes of showing up in the room and eating good food and talking to people that already understand the problem. We are here to move the work forward. While we’re here patting each other on the back with all our accolades, people are dying. We’re missing opportunities to save lives and to really interrupt how racism is showing up in the health care system
As the political landscape across the country shifts, women are facing drastic changes to reproductive health care access. Black women are among the most affected by these changes. Capital B CEO and co-founder Lauren Williams talked with Planned Parenthood CEO and President Alexis McGill Johnson about what the future holds. (This quote has been condensed for length and clarity.)
“What we see in a state like Texas, and many copycat bans across the country, is an effort not only to deny access to sexual and reproductive health care — after all, abortion is health care — but also the criminalization. The increased surveillance and the policing of the Black body is what we’ve been fighting for over 400 years. Our ability to make decisions about our own bodies becomes particularly acute for Black women. We have the Supreme Court, where we are awaiting a decision in a case called Dobbs v. Jackson Women’s Health, which is a 15-week ban [on abortion] in Mississippi. Again, that’s another state that’s predominantly Black, one where the health outcomes generally are incredibly poor, maternal health outcomes in particular are poor. Also, [it has implications for] outcomes for children and foster children in the state. And here you have a 15-week restriction that the Supreme Court has taken up. And the way they took it up goes directly to the heart of Roe: Who gets to make the decision [about abortion] pre-viability. And we know, if the court lets that law stand, it will create a ripple effect. We’re starting to see the number of restrictions being introduced across the country that will expedite the end of Roe in 26 states. We’re talking about 36 million people who could be impacted by this law, people who could become pregnant. At the center of that are Black women who disproportionately bear the brunt of relentless attacks, not just on access to abortion, but bodily autonomy. What we see people having to [do] in Texas and other states: having to secure child care, to secure resources, to secure days off from work, to travel out of state thousands of miles to get access to basic health care that they should be able to get in the state. We always know that when other communities have a cough, we have a full-on flu. I think that’s exactly what we are likely to see at this moment as we await the Supreme Court decision.” — Alexis McGill Johnson
Solutions for Surviving Pregnancy
In light of the dire statistics around maternal health, Sona Smith, the Birth Justice program officer at the Ms. Foundation for Women, and Dr. Fleda Mask Jackson, president and CEO of MAJAICA LLC, joined Capital B to discuss some of the potential solutions and resources available to birthing families.
Jackson noted that her years of research have centered the mental health experience of Black women — who, thanks to the intersection of gender and race, are predisposed to conditions like depression and anxiety. One of the most important resources that can help? Community. Jackson said that resources coming from the community as well as a broader commitment to birth equity provide significant benefits to women who are forced to face the multiple stressors of race, resources, health, and pregnancy all at once. Smith said that she, too, sees community and community-based resources as a tremendous contributor to better outcomes — but notes that often smaller, grassroots community organizations struggle to get the resources and funding to adequately address the needs of their communities. Solving that gap, they note, will be critical to bridging the divide in pregnancy disparities.
The Joys of Black Parenthood
Closing out the day, Simone Sebastian, editorial director of Capital B, talked to journalist and author Helena Andrews and Leah Wright Rigueur, author and historian at Brandeis University, about the many positive sides of being a Black mother even in the face of such difficult statistics and social uncertainty. Below, the pair share their most surprisingly joyful part of parenthood:
Helena Andrews: I think the joy that came at the beginning was just in being pregnant and being on this new journey. Especially as professional Black women, you’re just on this grind. It’s like checking it off the list. I did this, I did this, and now I’m pregnant. Just being in my pregnant body in and of itself was a joyful experience for me, even though my pregnancies very much aligned with a lot of the renewed attention — necessary attention — [ on the] Black maternal morbidity rate. That was happening literally as I was baking a child, and yet I still was able just to find a lot of joy in my body.
Leah Wright Rigueur: The moment that someone’s like, “Hey, your baby’s here, here you go.” I’ve written about this before; my reaction has always been laughter because it’s such a wonderful moment. It feels like a celebratory moment. And then the other thing that I think took a little bit of getting used to, that actually brings me so much joy, is the development of my children as individuals with their own likes, personalities, and independence. They’re so different from one another. And they’re so different from my husband and myself, that it has been just amazing to look at them and say, “Wow, you’re like your own little you. You have likes, you have dislikes.” So nobody really told me about that, about how these personalities come out so quickly. And I just feel very lucky to be entrusted with guiding them through the process of them discovering themselves. They’re going to do it on their own, but I just feel really incredibly fortunate that I get to watch them through that process.