advocating for black maternal health

In honor of Women’s History month and to further shed light on how we as society can help Black Maternal Health, we have partnered with NBEC (National Birth Equity Collaborative).

For the duration of the month, 10% of sales from the LÍLLÉlight carrier line will be donated to the foundation. We were able to spend some time with the founder, Dr. Joia Crear-Perry, and bring questions asked by the LÍLLÉbaby fan base.

I’d like to hear her perspective on how to talk to those people who don’t believe race or racism could be a factor in a black woman or infant’s mortality. For example, I live in Alabama. You really don’t want to be a black woman giving birth here, but a lot of people here aren’t educated about black maternal health or even know or believe that black women die in childbirth at a much higher rate than white women. My husband was actually shocked when I told him this (he believes me, FYI) because unless you’re a passionate member of the birthing community it just isn’t discussed. Can you tell that I am a passionate member of the birthing community?

Dr. Joia Crear-Perry: We don’t have to look much farther than the statistics to prove this point. In the wealthiest nation on earth, moms are dying at the highest rate in the developed world – and the rate is rising. For as dire as the situation is for all women and birthing people, the crisis is most severe for Black moms, who are dying at 3 to 4 times the rate of their white counterparts. While racism occurs on three levels, it is institutionalized racism that upholds the structures, policies, practices, and norms that drive differential access to goods, services, and opportunities — and is shaping social determinants of health.

Some of the ways we can identify and unpack unintentional bias, how it impacts on our work (including a test anyone can take to determine their own bias) and find strategies to decrease bias, include:

● Stereotype replacement

● Thinking of counter-stereotypic examples

● Individualizing instead of generalizing

● Perspective taking/”Walking in their shoes”

● Increasing opportunities for contact and relationship

Some work you can do as advocates and allies includes:

● Listen First — center families’ experiences for best use of resources and greatest impact

● Develop and invest in community engagement for participatory policymaking

● Have courageous conversations about race and racism and build listening skills

How does NBEC work with individual states?

Dr. Joia Crear-Perry: NBEC has created a community-informed theoretical model in the creation and testing of a participatory patient-reported experience metric (PREM) of mistreatment and discrimination in childbirth. Toward this end, we work closely with CBOs, nationally, to utilize the PREM in systems accountability, quality improvement, patient advocacy, and interprofessional education.

In 2021, we are expanding our grassroots initiatives to pilot programmatic public education initiatives in four communities: Prince George’s County, MD; Chicago, IL; St. Louis, MO; and Tulsa, OK. Further, our participation in the Respectful Maternity Care Collaborative (funded by Patient-Centered Outcomes

Research Institute) is training local stakeholders in fostering safe spaces in which to do this work with Black birthing people.

As a woman of color, where and how can I reach NBEC and understand my birthing rights?

Dr. Joia Crear-Perry: NBEC has a wealth of resources available at birthequity.org. We invite you to engage with us on all social media platforms @birthequity.

What is “Momnibus Act of 2020” and how can I participate?

Dr. Joia Crear-Perry: The Momnibus Act of 2020 is comprehensive legislation to address every dimension of the Black maternal health crisis in America. Reintroduced in 2021, Momnibus legislation: Each of the twelve titles of the Momnibus was introduced as a standalone bill by a Member of the Black Maternal Health Caucus. A summary of each of those bills can be found here.

Momnibus support: The Momnibus is endorsed by more than 190 organizations, listed here. Quotes in support of the legislation can be found here.

To learn more about the Momnibus legislation and its twelve titles, please join our Momnius Webinar + Live Twitter Chat (birthequity.org/bmhw2021/) during Black Maternal Health Week (Wednesday, April 14^th) where we will hold a webinar diving into the details of the Momnibus and a subsequent live Twitter chat where Black Maternal Health Policymakers and experts will provide real-time feedback via the NBEC account – twitter.com/BirthEquity

How can one help spread awareness about NBEC. Besides monetary donation?

Dr. Joia Crear-Perry: We invite you to engage with us on all social media platforms @birthequity

What other foundations / nonprofits do you work with that one can connect?

Dr. Joia Crear-Perry: Consider connecting with our organizational partners such as the Black Mamas Matter Alliance (BMMA). Together, we are planning and promoting Black Maternal Health Week 2021. This will be a week of awareness, activism, and community building intended to deepen the national conversation about Black maternal health in the US, amplify community-driven policy, research, and care solutions, center the voices of Black Mamas, women, families, and stakeholders, provide a national platform for Black-led entities and efforts on maternal health, birth and reproductive justice and enhance community organizing on Black maternal health. Learn more at birthequity.org/bmhw2021

How can I find out what my birthing rights are?

Dr. Joia Crear-Perry: Due to COVID-19, birthing services are shifting. Organizations such as the National Association to Advance Black Birth have launched a Black Birthing Bill of Rights.

To learn more click here or follow the hashtag #advancingblackbirth on social media.

Why is the death rate during childbirth for black mothers higher?

Dr. Joia Crear-Perry: As a Black mother, I cannot buy or educate my way out of dying at 3 to 4 times the rate of a White mother in the United States. The inequity in maternal mortality rates persists regardless of our income or education status. A White woman with less than a high school education has a better chance to live in childbirth than a Black woman with a college degree. Health data for Indigenous and Native American populations is less reported, yet frequently mirrors this inequity. The legacy of a hierarchy of human value based on the color of our skin continues to cause differences in health outcomes, including maternal mortality. Racism is the risk factor – not Black skin, not Race. Race is a social and political construct.

Maternal mortality extends beyond the period of pregnancy or birth. Nine months of prenatal care cannot counter underlying social determinants of health inequities in housing, political participation, transportation, education, food, environmental conditions, and economic security; all of which have racism, classism, and gender oppression as their root causes. We have data that shows that a Black woman who initiates prenatal care in the first trimester has a worse outcome in birth than a White woman with late or no prenatal care. Currently we do not have access to maternity care that is culturally congruent. Lack of workforce diversity and provider shortages are a direct consequence of policies created in these halls that date back to the 1921 SheppardTowner Act among others. This Act provided matching funds to states for prenatal and children’s health centers. Although the act had positive effects—like increasing funds to health care—it discouraged the practice of midwifery, particularly Black midwifery, and portrayed midwives as too uneducated and unclean to direct births. All midwives soon saw a decrease in activity, but Black midwives were especially targeted by Sheppard-Towner.

Consequently, they lost their positions as birth leaders and became “birth assistants.”

Good maternal health outcomes depend upon implementation of all sexual and reproductive rights, from comprehensive sexual education to access to all forms of birth control and safety from Intimate Partner Violence. We know that Medicaid Expansion protecting the ACA, Domestic Violence prevention and mental health parity laws are critical to ensuring that Maternal Mortality rates improve across our great nation. We have data that shows that

this investment in states through Medicaid Expansion, saves money and lives. Even if women are insured, coverage of sexual and reproductive health services is too often not comprehensive. Receiving the full range of reproductive options ensures safe healthy births for moms and babies.

These are a few of the reasons why the death rate during childbirth for Black mothers is higher.

What other factors affect a pregnant woman of color?

Dr. Joia Crear-Perry: There are many policy solutions available to improve the economic and workplace gender discrimination that negatively impact birth outcomes. Two weeks after delivery, the uterus is shrinking to its normal size, there is frequent bleeding, and the organs are finding
their original placement. Nearly 1 in 4 mothers are returning to work earlier than that to make up for lost wages at jobs that do not guarantee time to pump breastmilk, nor provide a storage cooler to ensure it is safe for ingestion. Breastfeeding is protective for both the mother and the infant’s mental and emotional health.

Many workers do not have access to paid leave to take care of an infant, an elder, a sick family member, or their own needs- like weekly high risk prenatal appointments. Black women with family caregiving responsibilities are estimated to spend 41% of their annual income on expenses related to caregiving, in contrast, white caregivers spend pprox.. 14% of

annual income on caregiving expenses.

Caregiving includes childcare costs, which are further exacerbate the income inequality experienced by families of color. We need protections and supports in paid leave and childcare to bolster any advancements made in healthcare or payment systems for maternal health care. Private insurance and payment systems are responsible for maternal health outcomes, as well.

What other risks are higher for black mothers and their babies? Infant mortality, communicable diseases, unsafe infant care practices, lower breastfed rates, lower birth rates?

Dr. Joia Crear-Perry: Yes. All of the above.

How do we get more women of color to talk about and take responsibility for their reproductive rights? Rather than just accept what is given to them?

Dr. Joia Crear-Perry: Celebrities like Beyoncé and Serena Willams have spoken out publicly about how they did take responsibility for their reproductive rights and were simply not believed.

We are creating structures to support Black women so that their voices are heard. We approach health care as a team effort—personal expertise is crucial.