Awareness of the United States’ abysmal statistics on black maternal mortality has been growing – in large part thanks to Democratic presidential candidates’ focus on the issue. Last week, Sen. Elizabeth Warren rolled out a plan to offer “bonus” funds to hospitals that reduce their rates of maternal mortality among black women – and to penalize those that don’t confront the problem. And, earlier this month, Sen. Kamala Harris led the charge to introduce a Senate resolution designating April 11-17 as Black Maternal Health Week, and 50 House Democrats joined to form the Black Maternal Health Caucus.
All the attention to the problem is necessary and justified, but as a black woman who’s five months along in my pregnancy, it brings unwelcome reminders of the risks to me and my baby. That’s a dark thought to intrude upon an otherwise joyful time, but whenever I read the news or scroll through Twitter, it’s inescapable.
Being pregnant already brings with it a familiar array of anxieties and discomforts, but knowledge of the dismal state of maternal health for women like me is yet one more burden I must bear.
So, how does this manifest on a day-to-day basis? At the same time I’m trying to remember which kinds of fish contain too much mercury, I’m also wondering if I need to memorize the symptoms of a pulmonary embolism in case I need to advocate for myself – the way Serena Williams did, as she suffered the life-threatening postpartum complication.
While I’m searching Amazon for the best prenatal workout videos to accommodate my growing bump, I’m also spending hours trying to research which obstetricians and hospitals have better outcomes for black women to figure out where I should deliver. Since this kind of data is difficult to find, and hospitals can decline to respond to surveys on the issue, I’ve instead found myself sifting through anecdotal stories from local mothers in Facebook groups and on pregnancy forums.
And, as I’m mulling over whether my husband and I need to shell out for a double stroller with a 2-year-old and an infant on the way, I’m also planning for the considerable expense of hiring a doula who can help facilitate a smoother birth.
My fears aren’t abstract. I’m an only child because my own mother nearly died from complications arising from my birth, and the statistics haven’t improved much since then. The United States is one of only 13 countries in the world where the maternal mortality rate is worse today than it was 25 years ago, and, according to the Centers for Disease Control, black women are three to four times more likely than white women to die from pregnancy or childbirth-related causes – including infections after birth, pre-eclampsia and eclampsia (high blood pressure), and severe postpartum bleeding.
Studies show that health care providers are as infected with racial bias as any other cohort in American society, routinely underestimating and undertreating black patients’ pain and failing to take our symptoms seriously. And though I’m fortunate to have health insurance and access to high-quality medical facilities when far too many black women do not, the risks to black mothers and babies persist across income and education levels.
Given those realities, to be black and pregnant at this moment is to feel caught uncomfortably in an in-between space – after society has recognized the breadth of the problem, but before large-scale reforms to address it are implemented.
The expectation that black women will resort to self-help when systemic change is slow in coming is a familiar one for those of us in marginalized groups: While the gender pay gap persists, women are told to lean in and learn to negotiate to make up the difference; as racial gaps in education continue to defy large-scale efforts toward improvement, black children are taught they need to be “twice as good” to get ahead in the world.
On the issue of black maternal health, groups like the Black Mamas Matter Alliance, an advocacy and research organization focused on black maternal health, rights and justice, have stepped up not only to call for large-scale policy reforms, but also to do work with a more immediate impact, such as offering trainings for clinicians, midwives, doulas and other maternal care service providers on how to provide respectful, holistic care to black mothers.
I’ve also tried to help other black women in my own small way. As one of the first of my friends to have a baby, during and after my first pregnancy I wrote and shared with them an informal guide on everything from managing pregnancy symptoms and birth preparation tips, to perspectives on engaging a doula and postpartum self-care. The animating force behind my work was the knowledge that until necessary systemic reforms are put into place, black women have to fend for ourselves – and for each other.
But I shouldn’t have to do all that just to give my friends and our babies the chance to survive and thrive in the world. At such a vulnerable, exhausting and hopefully joyful time in our lives – one when we’re constantly admonished to avoid stress – black mothers should be able to trust that we can lean on others, especially medical providers, to assist in our care.
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So, while it’s heartening to see politicians and others beginning to recognize the significance and urgency of black maternal health issues, it’s imperative that the solutions we look toward include long-term systemic fixes, but also shorter-term stopgap measures that can help black women whose pregnancies will have begun and ended before the next presidential election comes around. That might mean funding grants to allow more women to afford better prenatal care and hiring doulas to help them navigate the system – or providing increased data and transparency on which care providers and institutions are safest for black women right now.
With those kinds of immediate reforms, policymakers could begin to lighten some of the mental and logistical burden on black mothers-to-be who are carrying so much already.