The Week after Black Maternal Health Week: The Struggle Continues
by Jamarah Amani
April 21, 2019
So many names to lift up. #sayhername
All of these Black women have been slaughtered by this system in various ways. Police brutality, medical neglect and the stress of racism. According to the Honorable Malcom X, the most disrespected, unprotected and neglected person in America is the Black woman. When we talk about Black maternal mortality, we are talking about the conditions, policies and points of access that affect the quality of life for Black mamas and parents. Power disparities are the differences in the distribution of power among various identity groups. Power disparities relate directly to health disparities. A responsible discussion of health disparities compels us to consider the societal factors that determine Black folks’ experience on a daily basis that have a profound impact on health outcomes. When we analyze health disparities, we are counting the number of deaths that are impacted by the social determinants of health. We are saying that the lives of our people matter enough to end racism now. We are saying Black Mamas Matter, Black Babies Matter, Black Parents Matter, Black Lives Matter.
Last week, we commemorated the 2nd annual Black Maternal Health Week which was founded by Black Mamas Matter Alliance in 2018 to deepen the national conversation about Black maternal health in the US and center the voices of Black Mamas, women, families, and stakeholders. We also witnessed the release of the epic live concert documentary “Homecoming” by Black mama and performer Beyoncé in which she detailed her own struggles with pregnancy complications. Beyoncé summed it by identifying the problem and the solution for Black mamas:
The problem: “Black women often feel underestimated.”
The solution: “To create safe space where none of us feel marginalized.”
The events and media coverage for Black Maternal Health Week 2019 #BMHW19 were a great step toward reaching our goals of improving health for Black mamas and parents. Here are some highlights:
Congressional briefing on Black Maternal Health Caucus highlights
(*The doctor in this story is quoted as saying Black maternal mortality is genetic which is not true)
Intersectionality: Transgender, Young and Undocumented Parents
Black birthing people with multiple marginalized identities (Race, Class, Gender, Sexuality, Age, Disability, Immigration status, etc) are inherently subjected to multiple forms of oppression. Identity and implicit bias affect the values, knowledge and perceptions in the way people access care. How Black people birth and parent will be impacted by the multiple layers of oppression that have to be navigated.
Non-binary and transmaculine birthing folks are often made completely invisible in the research, care and policies that are created to address health disparities. Black pregnant transgender people often face discrimination, violence and refusal of care. Often the assumption is that because someone is pregnant, they are a woman. This bias toward misgendering can create unsafe situations for transgender and non-binary parents. It is important to intentionally and specifically ask about and respect gender identity in all care and community settings.
“How are we reaching and taking care of Black transgender femme mamas and Black non-binary and transmasculine parents? How can we better include them in our work?” - Delmar Bauta, doula and lactation consultant
The portrayal of the irresponsible young Black mother is a trope in mainstream media that causes stigma and isolation. Young mamas and parents are often shamed for their decisions to conceive, birth and raise their children. This starts with an inadequate education system that does little to provide comprehensive sex education to children of all genders in school before the age of puberty. There is not enough care or resources built into the systems of health care, education or employment to support mothers and parents in general, but certainly for young parents there is more needed and less available. Young parents deserve dignity and respect. Certainly with the right support, existing gaps in education, employment and successful parenting can be closed.
Southern Birth Justice Network has established the Becky Sprouse Birth Grant for undocumented families because Medicaid does not provide perinatal coverage for pregnant people without resident or citizen status. This has a tremendous negative impact on the access to care and options available to undocumented pregnant people. As a result, undocumented pregnant people are the least likely to receive adequate prenatal care and intervention for potential complications. Consequently, there are higher rates of unintended pregnancy, pregnancy related risk factors and a lack of follow up care.
To improve outcomes for Black maternal and infant health, the social and economic solutions for improving health care outcomes must also be intersectional.
The Role of Doulas
“Doula care provides emotional, spiritual, physical and mental support,” says doula Carmen Antonetty. This is much needed because we live in a culture that often marginalizes Black birthing people. For many people, the traumas they have experienced in life rise to the surface while they are pregnant. It’s helpful to have a trusted professional help to process barriers that arise during the birth and postpartum time. Doulas are also advocates that help Black mamas and parents navigate a hostile health care system.
“Having a doula to have my back and stand up for me was really important — someone who can coach and give you peace of mind.” —Anaya Kendall, activist, mom of one son
Black women have higher primary c-section rates and higher complication rates, leading to higher mortality rates. Conversely, people delivering with out-of-hospital midwives have the highest vaginal delivery rates in the U.S. Research from The Birth Place Lab shows that states that integrate midwives into the health care system tend to have better outcomes for maternal and infant health. Breastfeeding/chestfeeding is a physiologic protection factor against postpartum complications. People who birth with midwives are 2-3 times more likely to breastfeed/chestfeed than those who birth with physicians.
The platform of midwifery care illustrated in the Black Midwives Model of care is healing, holistic and humanistic. Research shows the benefits of early and consistent prenatal care on outcomes, but that requires trust and access. Access to Black midwives helps to reduce some of the barriers and identify community based solutions to complex health issues. One Black midwife, who anonymously shared her data of zero low birth weight babies or maternal loss during a one year period, stated “It has to do with trust. The word on the street is, they can come in here, get a hug and a smile and receive quality care. That really matters for outcomes.” The training, licensing and insurance reimbursement of Black midwives is paramount to improving access to this type of care.
Taking Care of Ourselves
For Black mamas surviving in a system that does not uphold the inherent dignity and value of Black lives, it is vital that Black mamas claim the power over their own lives, unapologetically creating space for radical self care. Self-care involves creating a plan to improve one’s own health and well-being. It can be taking a mental health day from work to avoid racist microagressions, changing healthcare providers or speaking up to get more respect, getting a prenatal massage, going for a walk in the fresh air or having a conversation about boundaries with a partner. Self-care can take many forms depending on the needs and circumstances of one’s life.
The point of self-care is for Black mamas and parents to put themselves first in a system that often puts Black women, non-binary and transgender people last. Black folks are often in survival mode, but a person’s life matters more than their job or anything else that is stressing them.
As a society, we have a responsibility have to uphold Black mamas’ and parents’ rights to self-care, quality health care and community care in order to create “a world where Black mamas have the rights, respect, and resources to thrive before, during, and after pregnancy.” (Black Mamas Matter Alliance)
1”Who Taught You to Hate Yourself?” by Malcolm X, May 5, 1962
2 Study by the National Center for Transgender Equality and the National Gay and Lesbian Task Force. October 2010.
3 “Outcomes of Care for 16,924 Planned Home Births in the United States. https://onlinelibrary.wiley.com/doi/full/10.1111/jmwh.12172
4 Midwifery linked to better birth outcomes in state-by-state “report card”.
5 Chestfeeding is a gender neutral term that includes everyone who lactates to feed a baby. https://www.lllusa.org/wp-content/uploads/2018/08/Joint-Statement-on-use-of-the-term-Chestfeeding.pdf
6 Association between Breastfeeding Duration and Type of Birth Attendant. 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852850/
7 Black Midwives Care: 21 Points for Optimal Health Care for Black Mamas and Parents by Jamarah Amani for National Black Midwives Alliance
8 Promoting Access to Prenatal Care. https://kaiserfamilyfoundation.files.wordpress.com/2003/05/3333-promoting-access-to-prenatal-care-issue-brief.pdf
Jamarah Amani is a mother, midwife and community organizer in Miami, Florida. To reach her and support her work, visit www.southernbirthjustice.org