ICYMI: Town hall on Black maternal health

By ERA Coalition

January 20, 2022

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The ERA Coalition works with more than 300 state, federal, and grassroots partners to advance the cause of women’s equality in the United States, primarily through adding the Equal Rights Amendment to the Constitution and supporting states’ ongoing efforts to ratify the ERA.

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By Jenny Horn

Carol Jenkins, President & CEO of the Equal Rights Amendment Coalition & Fund For Women’s Equality, introduced this month’s town hall regarding Black Maternal Health. The need to look for solutions to the crisis of Black women and babies dying is only becoming more crucial as the already unprecedented rates of maternal mortality in the United States are rising. Jenkins thanked the Harnish Foundation and John J. Harnish for sponsoring the town hall, and formally opened the meeting by asserting that equality by definition must be available to everyone.

Rep. Lauren Underwood, co-chair of the Black Maternal Health Caucus

The first speaker in Wednesday’s town hall, Congresswoman Lauren Underwood (IL-14), thanked the ERA Coalition for hosting the town hall. Rep. Underwood, as co-founder and co-chair of the Black Maternal Health Caucus, explained that the United States has the highest maternal mortality rate of any high income country, and that this rate is 3-4 times higher amongst Black women compared to non-Hispanic white women. The crisis is unacceptable and only getting worse, especially as COVID-19 continues to sweep through communities, exacerbating the already increasingly-present health disparities Black women face in the U.S. today.

Rep. Underwood proclaimed that we need to take bold evidence-based action to solve this crisis, which can in part be accomplished through the passage of the Black Maternal Health Momnibus Act of 2021, as this act would provide necessary investments to save lives and close disparities. Rep. Underwood continued to discuss some of the progress already made towards improving maternal healthcare for Black women, including President Biden’s signing of the Protecting Moms Who Served Act back in November of 2021 at the White House, as well as Congress passing the Maternal Vaccination Act. She concluded her remarks on Wednesday by restating how vital and essential it is that we prioritize these investments that all women and families are counting on for their survival and livelihood.

The next speaker in Wednesday’s town hall was Linda Villarosa, an American author, journalist, educator, and contributing writer to the New York Times. Villarosa has a book coming out later this year, called “Under The Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation.” She has also worked with the Black Mamas Matter Alliance and has accrued over 15 years of public health experience. Villarosa began by recalling when her attention was first brought to the issue of maternal mortality rates in the United States, initially not believing the statistics showing the rates as obscenely high, given that the United States is a very wealthy and developed country with some of the most advancement technological and medical innovations in medicine in the world. After learning that these maternal mortality rates are 3-4 times higher amongst Black women, one of Villarosa’s peers explained that a Black woman with a master’s degree is still more likely to die from maternal complications than a white woman with an 8th grade education – having a master’s degree herself, this point stood out to Villarosa as significant.

She believes that in solving the crisis, energy can sometimes be channeled in the wrong direction or manner, as seen in California’s efforts to reduce maternal mortality rates. Villarosa explained that California has done some great work in trying to lower this rate, but has done so by changing what the processes were in the hospital itself during a maternal crisis. California created a toolkit to ensure better preparedness in case of an emergency, and this worked – maternal mortality rates in the state dropped by about 55%. However, the proportion and differences in higher maternal mortality rates amongst Black women remained the same. Villarosa clarified that you cannot doctor your way out of a situation created by racism – that this crisis is beyond the individual and not a problem of race, but of racism itself. In sum, a lens of equity is needed to zoom out to better address higher maternal mortality rates in Black women.

Breana Lipscomb, Senior Manager for Maternal Health & Rights at the Center for Reproductive Rights, spoke next regarding how geographic differences within the United States can contribute to the crisis, explaining that the rates we see in the South are often higher than anywhere else and the racial disparities are wider than anywhere else in the country, and with the least amount of political will to address these issues. Lipscomb gave the example of the more recent abortion bans in Texas and Mississippi, as states with greater abortion restrictions also tend to have the least number of maternal health supportive policies, and that to address this, we ned to fight to extend coverage, secure better paid leave, affordable child care, and other social safety net type programs. She described how it can be frustrating as an advocate and for the families who need this safe and respectful care to respond to these dilemmas. In addition to this, the South is currently seeing some of the worst provider shortages, with only half of the counties in Georgia having access to obstetrician care, as this care is already more difficult to come by in rural southern settings. Today, Lipscomb is fighting back against the notion that these issues are something we can just fix in clinical settings. Rather, she continues, we really have to look at the system as a whole and what structures are in place that have created these barriers when it comes to designing a safe outcome for a pregnancy.

Charles Johnson, founder of the non-profit organization created in memory of his late wife Kira’s honor, 4Kira4Moms, joined the conversation from the car, apologizing for his tardiness, pointing out that it served as a prime example of some of the difficulties families and single fathers face when affected by maternal mortality. Describing how he could have never imagined leaving the hospital without his wife after the birth of their second son, Johnson told the story of how after a routine C-section, Kira bled internally for more than 10 hours before medical staff at Cedars-Sinai intervened. He explained the negligence that ultimately led to Kira’s otherwise preventable death as a failure of humanity, and knew that while it was too late to save Kira herself, he would work tirelessly to ensure that other women would be able to go home safely with their healthy babies after giving birth. Johnson discussed 4Kira4Moms, and the importance of hearing real stories alongside studying the maternal mortality data in progressing toward more equitable healthcare for Black women and mothers.

Carol Jenkins then ushered the primary speakers for the town hall – Linda Villarosa, Breana Lipscomb, and Charles Johnson – into a structured discussion, first asking Villarosa about her thoughts regarding Johnson’s explanation of maternal health negligence as a failure of humanity. Villarosa explained that just that morning, she had gotten a note from a doctor saying “how dare you say I’m racist!”, clarifying that as a journalist, she isn’t saying that individual providers are racist, but rather there is something wrong with the system as a whole – a larger failure from system to humanity – when the lived experience of Black women in this country results in so much harm. She continued to describe the implicit bias that all individuals, doctors, nurses, and others alike have just from being raised in this country, and because medical staff don’t always know of their own implicit biases and often deal with patients that are very different from them racially, culturally, socioeconomically, etc, you get this conflict of people narrowing in, thinking of this crisis as an issue at a personal, individual level, which only further contributes to the failures of humanity in this regard.

Carol Jenkins then asked Breana Lipscomb to clarify what she saw happening from her position with the U.S. Maternal Health & Rights Initiative and the levels of the issues she’s seen in the country thus far. Lipscomb responded by first saying that most recently she’s seen a big push for implicit bias training, but that on its own is by no means comprehensive enough to make real change where it matters. She clarified that it is important for us to talk about the maternal health crisis as one component – it’s about the culture of the healthcare system, not just current practicing physicians – meaning, you can’t just attend one bias training course and be culturally competent. Lipscomb continued to advocate for a bill that would create a comprehensive roadmap of how to achieve maternal equity, the importance of Black women being able to see themselves in the care that they receive, and the need to diversify the workforce itself. Additionally today, she explained, we need to address the very real issues around access to vaccines (particularly during COVID-19), how climate change impacts health, and that we for too long have focused on data regarding what mothers themselves have or haven’t done, as opposed to what the materials, access, and care they are being restricted from. Essentially, Lipscomb proclaimed, we need a comprehensive approach to maternal health policy.

Charles Johnson continued the discussion by adding his perspective, stating that this is a crisis that is affecting families all over the country in ways that data just can’t quantify. He asserted that there is just no true substitution for a mother, and stressed the importance of fighting to ensure we protect and save mothers, while also providing support, resources, and relief to the families that do suffer from maternal loss firsthand – may it be counseling, financial support, access to case transparency, or otherwise. He concluded by agreeing with previous statements that a completely comprehensive approach would be the only adequate approach, explaining that it’s going to take advocates, survivors, and providers coming forward to the table to discuss these issues to really propel changes forward.

Carol Jenkins shifts gears in the discussion as she asks Linda Villarosa, regarding her new book coming out later this year, what she thinks about the idea that racism is killing people, and not necessarily the isolated incidents of violence and neglect, but rather the larger image and effects of racism itself. Villarosa, having studied and written about Black health for over 30 years, explained that racism, at every point, has blamed Black bodies for whatever disparities are being discussed at that point in time. For example, blaming the “different gentucs” of Black bodies for the higher rates and instances of COVID-19 in people who are Black is not a real matter of genetics, but a matter of blatant racism. Additionally, she explained, the maternal health crisis itself shows how things like education and access to healthcare will still result in poorer birth outcomes for Black mothers and infants, and these disparities go all the way back to Blakc body experimentation and treatment during slavery.

Pointing the conversation back to Breana Lipscomb, Carol Jenkins asked what exactly it is that she wants people to know about what they can do and what the steps are going forward to help resolve this crisis. Lipscomb outlined that we need a shift in how we deliver care, and how we talk about maternal mortality in the media and popular culture – if people see these issues portrayed on screen in their favorite TV shows, movies, reality shows and so on, that will resonate with people most deeply. This shift in how the issue is discussed has already begun, and stories shifting from blaming the mother to looking at the failures of the healthcare system will continue the momentum towards more progress. Additionally, Lipscomb stated, we need to keep the broader view and think about the comprehensive approach in a way that also includes and protectors providers like midwives and doulas, as their positions often act as an added layer of protection for vulnerable mothers – regardless, the access to these resources needs to become more widespread, and covered by insurance like medicaid and employer-sponsored insurance. Lipscomb concluded by exclaiming that in this regard, accessibility and availability of these protective layers is what matters.

Charles Johnson responded to Lipscomb’s remarks by first agreeing that media perceptions are absolutely critical in shaping public perceptions of the issue, adding that there is a need to refocus the humanization of the topic. Reiterating his earlier points, Johnson explained that centering the conversation around real individuals, families, victims, and survivors and through sharing these personal stories will help turn the corner of public conversation. He continued that this is not just a women’s health issue or a Black woman’s issue, but a human rights issue itself and we are failing women in their fundamental right to give safe births to healthy babies. He showed optimism in having seen a shift in consciousness and awareness surrounding the issue of maternal mortality in Black women, and that by working to increase public knowledge, we can put on the pressure that can eventually lead to actual policy. He concluded by giving the example of more recent popular documentaries outlining the issue and shedding light on personal stories, and how that’s already started more policy conversations around the country. Breana Lipscomb responded by agreeing, recalling hearing from her peers that when seeing a documentary about maternal mortality amongst Black women and disparities in maternal health treatment, many women didn’t even realize that what they had experienced while giving birth was wrong to begin with.

Carol Jenkins transitioned the discussion to a quick Q&A before a message from a final speaker. The questions and answers are outlined below:

Q: What is the role of sexism in this issue and how does it play out within this topic?

Breana Lipscomb: Sexism plays a role in that Black maternal health is an intersectional issue. Human rights violations are always amplified when facing intersectional problems like the one at hand, so we need to approach solutions from the intersectional standpoint. Women often fall to the bottom of the list in legislative corrections, and multiple classes of intersectionality – ableism, sexism, racism, classism – all contribute to the maternal health crisis in this case.

Carol Jenkins: At the ERA Coalition, it is exactly this kind of question and problem that we aim to answer and solve through the implementation of the Equal Rights Amendment in the U.S. Constitution! The ERA would allow for intersectional problems like the issue of Black maternal health to be protected from different intersectional identities.

Charles Johnson: From a man’s perspective, it’s been incredibly important to understand privilege when you have it yourself, practice allyship, and move forward in this space in such a way that amplifies women’s voices around me rather than just my own. Advocating as a man has gotten the word and story out more prominently, but from there, it’s essential to highlight the other women shouting the same information so as to provide equitable access from your own privileged standpoint.

Q: Could you discuss advocacy strategies to best address the lack of political will?

Breana Lipscomb: Unfortunately there are no hard and fast strategies, and we are constantly trying to adapt and see what might work. There is a state interest in protective legislation, and building off of what’s happening at the federal level within the state level can provide a great opportunity to leverage what the federal government is doing, as well as what other states are doing. We need to constantly leverage everything that’s happening within this issue’s space to progression’s benefit, and we need to support the community level organizations that are under-resourced and under-financed to maintain that community level support afloat alongside the larger policy work that’s being executed.

Rep. Alma Adams, co-chair of the Black Maternal Health Caucus

The final speaker in Wednesday’s town hall, Congresswoman Alma Adams (NC-12), is Rep. Lauren Underwood’s co-founder and co-chair of the Black Maternal Health Caucus. Rep. Adams reiterated that the maternal mortality rate is worse today than it was 25 years ago, and women from all walks of life are dying from preventable pregnancy and birth-related deaths. The overlooking of Black women within the realm of maternal healthcare, she proclaimed, stems from the implicit bias and racism, then resulting in a lower quality of care, and undermining Black women’s health endangers their lives and the lives of their infants. Rep. Adams further explained that the passage of the Black Maternal Health Momnibus Act of 2021 would intentionally center Black women’s health justice in the conversation surrounding maternal healthcare, and in working for justice and equity for Black mothers, the level of care for all mothers will be vastly improved.

Carol Jenkins concluded Wednesday’s town hall meeting by thanking all of the speakers for their valuable time, as well as the attendees for participating in a crucial sharing of knowledge, and invited everyone to continue the fight for equality on January 27th for the ERA Coalition’s Rally - Rise Up 4 ERA!