Want to Solve the Maternal Health Care Crisis? Listen to Black Birth Workers

Want to Solve the Maternal Health Care Crisis? Listen to Black Birth Workers

Want to Solve the Maternal Health Care Crisis? Listen to Black Birth Workers

“We are the solutions. We need more investment. And the way that we practice birthing, pregnancy, and reproductive health care in our overarching wellness—this is the way to go.”

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April Valentine arrived at Centinela Hospital in Inglewood, Calif., on January 9 to give birth. Valentine, 31, had selected Centinela because she would be under the care of a Black woman physician. In the weeks leading up to her delivery, she had written on an affirmation board messages like “I will not have any complications” and “I will have a healthy baby girl,” The LAist reported in February. But she died the day after giving birth, via an emergency C-section. She never got the chance to meet her daughter.

Centinela Hospital is now under investigation by the state’s health department for improperly caring for Valentine, whose family says that her concerns about leg pain were ignored and that she was denied access to her doula. Her boyfriend, Nigha Robertson, testified before the Los Angeles County Board of Supervisors that after Valentine stopped breathing, “I’m the only one who touched her. I’m the one who did CPR. Nobody touched her, we screamed and begged for help…. They just let her lay there and die.”

Too many women in this country have died while pregnant or shortly after giving birth, and Black women like Valentine—who, according to the Centers for Disease Control and Prevention, face the highest rates of maternal death—are at particular risk. Now, new data from the CDC shows that in 2021, the number of maternal deaths across all racial groups increased by a shocking 40 percent. This follows the public health agency’s announcement that four out of five maternal deaths between 2017 and 2019 were preventable.

By themselves, these numbers are disgraceful. Combine them with the Supreme Court’s overturning of Roe v. Wade, and four-alarm-fire bells should be ringing. Pregnancy and childbirth have only become more dangerous in recent years. Now, medical providers in many states have even fewer tools with which to protect the health of pregnant people. And just as the anti-abortion movement has reached the height of its influence over essential health care, health care facilities are shuttering at a rapid pace. Between 2015 and 2019, at least 89 obstetric units closed in rural hospitals nationwide, in areas where patients face a heightened risk of pregnancy-related complications. In March of this year, Bonner General Health in North Idaho announced it was ending its childbirth services, citing concerns about the legislature continuing “to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care.” Anti-abortion legislation wasn’t the only reason for this response. As the Idaho Statesman’s Editorial Board explained, anti-vaccination proposals threaten to criminalize other forms of care as well.

It is impossible to overstate the impact these closures have on local communities, who are already suffering from an underfunded and under-resourced public health system that, when it comes to childbirth, lets too many parents fall through the cracks. When I spoke to Angela D. Aina, cofounding executive director of the Black Mamas Matter Alliance (BMMA), about the new data, she made it clear that the problem of maternal deaths is a maternal health care crisis. “Health care systems and ob-gyns by themselves, they don’t do a lot of work when it comes to wraparound services,” said Aina. Indeed, over half of the maternal deaths between 2017 and 2019 occurred after the patients had left the hospital, between seven days and a year after giving birth. After I gave birth, it was only thanks to my doula, whom I paid for out of pocket, that I felt I had appropriate support.

We need legislation that helps to expand the number of midwives, particularly Black midwives of all licensure,” Aina said. “We need more birth centers; we need more states to be friendly to home births and other birthing options. We need doulas, [and] more perinatal workers at the local level,” adding that it’s essential that more support translates to more boots on the ground. “Philanthropy is throwing billions of dollars [at] apps and technology. But for the folks in rural areas, the folks in local communities, an app is not going to help stop hemorrhage. An app is not going to pick up on the fact that we got a postpartum mama who just gave birth three weeks ago and now her legs are swelling.”

Although it is true that the Covid-19 pandemic exacerbated the maternal health care crisis, our country has a far longer history of putting pregnant people at risk. Starting in the mid-1800s, experienced midwives, who were largely immigrant or Black women, were pushed out of their profession by a white, male medical establishment that wanted to standardize the field of obstetrics and gynecology. Through the newly established American Medical Association, which at the time did not allow women or Black physicians to be members, the medical community sought to phase out midwifery care under 19th-century abortion laws that made some of their services criminal. The consequences were dire. From 1900 to 1930, the country’s maternal mortality rate was at its highest.

Over a century later, the United States’ maternal health outcomes are still far worse than those of its peers in the developed world. And we see maternal health disparities even in countries, like the UK, with universal health care systems. The failure of medical systems to address institutional racism has made pregnancy deadlier for Black women. When doctors neglect to do a thorough examination in response to their patients’ complaints because of their implicit bias against people of color, people die or suffer serious complications.

Even knowing that historical context, this moment in particular feels really heavy. That’s exactly why BMMA is focusing this year’s Black Maternal Health Week, April 11-17, on the theme, “Our Bodies Belong to Us: Restoring Black Autonomy and Joy!” Aina told me that it was really important to the community-based groups that are part of the alliance that they not center “the doom and the gloom” after the right tried to “knock us down by taking away Roe v. Wade and the protections around abortion care.” The birth justice and reproductive justice movements have long called for a more expansive framework beyond abortion and contraception that centers “our practice, our traditions, and our culture around pregnancy, birth, and bodily autonomy.” 

So with this year’s theme, “that is us signaling out to everybody else who has concerns, who are scared about these statistics. It breaks my heart when I hear from young women and young people, especially Black folks who are like, I’m scared to get pregnant. I’m scared to do this.” 

Aina wants them to know, “The power is in your hands. You do have autonomy over your body. You can enter pregnancy, you can plan your family how you want and how you see fit, according to your values and your cultural practices.” That shift in focus, Aina says, is the key to how we fight back against these systemic injustices. “And that’s really at the core of why we wanted to uplift and speak power into this scene. And, with that, showcase the beauty of the work that we’re doing and the beauty of Black women and Black-led… maternal and reproductive health care work, to say first and foremost, we exist. We are the solutions. We need more investment. And the way that we practice birthing, pregnancy, and reproductive health care in our overarching wellness, this is the way to go. This is how we combat these issues.”

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