Black women are dying — during pregnancy, delivery and the postpartum period after childbirth. According to the Centers for Disease Control and Prevention, Black women are three times more likely to die from pregnancy complications than white women.
Frankie Robertson of Baton Rouge could have been one of the statistics.
When Robertson’s son turned 1, Alton Sterling was killed by police in Baton Rouge. The former head of a nonprofit, Robertson became an activist. She started a Moms of Black Boys United chapter in Baton Rouge and helped support the infrastructure for the national organization.
During this time Robertson says she felt stressed, overwhelmed and having panic attacks. She was diagnosed with depression two months before she learned she was pregnant with her daughter.
“I didn’t really know how depression could be a contributing factor to preterm birth and really be dangerous for your pregnancy,” Robertson said.
Her care team wasn’t that helpful, she said.
“The team there, they handed me a piece of paper with a bunch of therapists and stuff, and that was the extent of my observation,” Robertson said. “There wasn’t a question about, ‘Well, what’s happening in your life?’”
During her pregnancy, Robertson, founder of The Amandla Group, a social justice consulting firm, was diagnosed with high blood pressure and gestational diabetes. She was also dealing with a large amount of stress at her job.
Robertson’s daughter was born premature, three months early. According to the Centers for Disease Control and Prevention, in 2021, the rate of preterm births among Black women was nearly 50% higher than that for white or Hispanic women.
“When I talk about my total birth experience, it’s not just about what happened in the delivery room for me,” Robertson said, “it’s about my care team being able to understand and relate [to] what life is like for me as a Black woman and what types of things in my environment and my day-to-day helped shape my pregnancy outcomes.”
Robertson sought out the work of Fleda Mask Jackson, a renowned child and maternal health scholar who has studied the underlying causes of the high Black maternal mortality rate. In an interview with Atlanta’s 11 Alive in 2019, Jackson talked about how racism wears down the body and can lead to cardiovascular disease, hypertension, depression and preterm babies and low birth weight. She calls it weathering.
“Weathering really captures the accumulation of stressors,” Jackson said in the interview. We think about something being beaten down and just hammered and hammered on. Eventually they’ll break down, they’re weathered and that imbalance begins to wear and tear on the system.”
Jackson’s studies found that well-educated Black women are at a higher risk of pregnancy-related deaths and complications than uneducated, unemployed and uninsured white women.
A similar study was done in California by Stanford University researchers.
“There’s something deeply wrong that in 2022, we can’t keep our moms alive,” Rep. Lauren Underwood (D-Illinois) said in the documentary, Birthing Justice, which takes a deep dive into Black maternal health.
“This is not a unique phenomenon for Black birthing people, but our rates are the worst.”
“Birthing Justice” looks at Black maternal health in California, Georgia and Washington, D.C., and those on the frontlines addressing the issue. The film notes that “it is more dangerous for women in the United States to give birth today than it was 30 years ago.”
Louisiana has the highest Black maternal mortality rate in the nation. There’s a clip in the film of Louisiana’s U.S. Sen. Bill Cassidy, a medical doctor, talking to Politico about maternal health. Cassidy said: “In Louisiana, about a third of our population is African American. African Americans have a higher incidence of maternal mortality. So if you correct our population for race, we’re not as much of an outlier as we otherwise appear.”
Some viewed Cassidy’s words as an illustration of implicit bias and believe it’s this kind of dismissal of African American women that has contributed to the Black maternal health problem.
Cassidy’s statement, “on its face tells you where we are as a state and the lack of care that’s given to Black lives, Black mothers, their babies, their families,” said Ashley Shelton, executive director of the Power Coalition for Equity and Justice, a group of grassroots organizations.
But there has been some progress on the policy front in Louisiana, Shelton said.
Last year, the coalition worked to get legislation passed that would make insurance cover post-perinatal mental health issues, including postpartum depression and other mood disorders, Shelton said.
“We have been able to work with many groups and people on the ground to actually move some policy change that we know is going to be helpful and critical,” Shelton said.
And this legislative session the coalition is working to get private insurance to cover the cost of a doula.
“It’s about trying to create a space where we are doing as much as we can for mothers and women that are in the process of giving birth and trying to also make sure that there is a health continuum that gives them the most options possible and the kind of options that we know save lives,” Shelton said. “There has to be some type of intervention that helps Black women make it through childbirth.”
But attitudes such as Cassidy’s don’t stop at the hospital door, said Inas-Khalidah Mahdi, vice president of equity center capacity building and director of training, praxis and evaluation at the National Birth Equity Collaborative. These attitudes show up in health care settings, in delivery rooms and during postpartum care.
“If your attitude towards a person is that person deserves a less dignified care experience, that’s going to come out in terms of the way that you’re interacting with them,” Mahdi said. “We know that Black women consistently report that their complaints are not heard, that their voices are suppressed, that concerns and symptoms that they report to their care providers are often neglected. And this medical neglect really doesn’t have any other basis other than racism.”
The collaborative is addressing the issue of Black maternal mortality on two fronts. The Patient Reported Experience Measure is a “first of its kind tool that will center Black birthing people’s experiences in the health care system.” The tool is a joint project with Johns Hopkins, Mahdi said.
The tool is a survey that focuses on the experiences of Black women in health care settings. It asks questions such as: Did you have moments in particular where you felt neglected? Did hospital staff call and check up on you? Did you feel a sense of caring? Were you referred for resources?
Another National Birth Equity Collaborative initiative is the birth equity assessment, which examines the gaps in the health care system that lead to inequity in treatment for marginalized communities.
The goal is to shift the culture inside health systems by taking a critical look at practices that negatively impact Black birthing people and then provide assistance to help guide health care providers to address them. “I think at the basic, most fundamental level is that in the United States and across other countries, we have the responsibility to protect human rights, and health is a human right,” Mahdi said.
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