Community-based solutions can address racial disparities in maternal health
By Elizabeth Dawes Gay
Recent media coverage, including ProPublica’s Lost Mothers series, highlights the crisis of maternal health in the United States — a place where maternal mortality has been rising for all women even as it declines in most other parts of the world. It’s an issue that Every Mother Counts has been dedicated to educating the public on since 2010. Every Mother Counts launched a documentary series in 2015, Giving Birth in America to take a deeper look at the contributing factors that have been driving up the maternal morality ratio in the country for the past twenty years.
A deeper dive into the data uncovers one of the many issues– the problem of racial disparities in maternal health. Black women like Erica Garner, a Black Lives Matter activist and mother who died of a heart attack shortly after giving birth at the age of 27, aren’t alone. Black women like Serena Williams, pro tennis player and international celebrity who was initially dismissed by her providers when she told them something was wrong, aren’t alone.
Here in the United States, Black women are over three times more likely than white women to die from pregnancy-related causes and twice as likely to experience severe maternal morbidities such as hemorrhage, infection, eclampsia (extremely high blood pressure), heart conditions (like Erica Garner), and blood clots (like Serena Williams). Black women are also more likely to experience preterm birth and give birth to low-birth weight infants.
Evidence shows that these disparities don’t happen by accident. They are closely connected to the experience of living while Black in America. Racism in the US and in the American health care setting has a harmful effect on health, and Black moms pay for it with their lives.
The data is clear that racism harms Black moms. What’s less clear is what anyone is doing about it.
Activists, advocates, funders, care providers, non-profits, and other concerned stakeholders across the US are doing what they can in their respective fields to make a difference. Every Mother Counts is supporting community-based organizations to educate, empower, and engage women to advocate for better maternal health and goes beyond raising awareness to invest in proven, community-focused solutions.
One such solution was developed by Jennie Joseph, midwife and founder of Commonsense Childbirth in Orange County, Florida. Grant support from Every Mother Counts helps Commonsense Childbirth provide high quality prenatal and postnatal care, birth services, and education for low-income mothers, many of whom have nowhere else to turn. Over one third of Jennie’s clientele are Black women, and all her patients benefit from The JJ Way® comprehensive maternity care model. The Easy Access Clinic model that Jennie developed is based on four cornerstones — access, connection, knowledge, and empowerment — to provide high quality, culturally-congruent, and patient-centered care. No one is ever turned away from care and staff connect their clients to other public or private services they might need to ensure their complete wellbeing, including helping them navigate a complex, bureaucratic Medicaid system. Additionally, the client’s family and other supporters are encouraged to be part of the woman’s prenatal, childbirth, and postpartum experience.
According to a 2017 analysis, Black women who received care at a Commonsense Childbirth Easy Access Clinic were less likely to give birth prematurely than other women of the same race in Orange County, in Florida, and in the nation. The rates of low birthweight infants among Black women receiving care through Commonsense Childbirth was only slightly higher than white women in the state of Florida (8.6% vs. 7.2%). Additionally, the rates of preterm birth were lower among these Black women than white women in the state of Florida (8.6% vs 9%). This evidence demonstrates that high-quality, culturally-appropriate care that responds to the entirety of client needs can reduce racial disparities in at least some types of pregnancy outcomes.
Commonsense Childbirth isn’t alone in their work to improve maternal health. Giving Birth in America: New York featured Ancient Song Doula Services, a Brooklyn, New York-based service and training organization committed to lowering maternal and infant mortality. Support from Every Mother Counts helped the organization provide comprehensive doula care, nutrition and cooking classes, and group support for low-income expecting moms.
Both Commonsense Childbirth and Ancient Song Doula Services are community-focused, community-based, culturally appropriate solutions, striving and succeeding at overcoming the effects of racism to improve Black maternal and infant health outcomes. Many more of these small but powerful community-based programs exist, but few have the resources they need to reach the numbers of women who would benefit from their services. We need to raise the profile of these exemplary programs and help bring them to scale.