Researchers and advocates for Black women’s maternal health have been sounding alarm bells for years. Their message reached critical mass at the start of 2018, when two back-to-back events propelled this issue into the media spotlight. First, the death of 27-year-old activist Erica Garner – daughter of Eric Garner, who was murdered by the NYPD – four months after the birth of her second child.
Rachel Cargle of the State of the Woman newsletter remarked at the time that Erica Garner “fought hard not only against a system of racial inequality within our justice system but she bore the weight that so many in the US do and that is being a woman of color in the healthcare system.”
Commentators looked to Erica’s asthma, trauma, class background and her status as a survivor of domestic violence as causal explanations for her death. Then, less than two weeks later, a profile of Serena Williams in Vogue revealed that she nearly died after giving birth to her daughter. After experiencing a shortness of breath that she believed was caused by a pulmonary embolism, Serena had to plead with doctors and nurses for the CT scan and heparin drip that ultimately saved her life.
Writing for Quartz, Annalisa Merelli commented that “even Serena Williams… is just another black woman when it comes to being heard in the maternity ward – and when it comes to being dismissed.”
Maternal mortality and morbidity are on the rise in the United States, to which the World Health Organization has assigned a higher maternal mortality ratio than Kazakhstan and Libya. On top of this, Black mothers are 243 percent more likely to die within a year of giving birth than white mothers. A 2016 publication by Black Mamas Matter identified poverty, quality of care, access to care and racial discrimination as causal factors of this disparity.
Last week, I attended a seminar hosted by the African American Policy Forum titled “From Birth Control to Death: Facing Black Women’s Maternal Mortality”. It was the final event in #HerDreamDeferred, a week of action on the status of Black women in Washington, DC. With a panel moderated by Kimberlé Crenshaw that included some of the top experts and activists from across the country, there was a lot of catching up to do.
Catholic Hospitals and Maternal Mortality
The failure of Catholic hospitals to provide adequate care for Black mothers was one of the biggest themes of the afternoon. Laurie Bertram Roberts, Executive Director of the Mississippi Reproductive Freedom Fund, started off by telling her own story. Roberts went into her local hospital with a discharge and was told she was having a miscarriage. Because of the existence of a fetal heartbeat, the hospital sent her home. She began hemorrhaging and returned to the hospital, where she received the surgery she needed to live.
Roberts was lucky, as was Tamesha Means, who went through a similar experience at a Catholic hospital in Michigan. As an Irish American and a recovering Catholic myself, I came into the seminar mindful that two days earlier, the Republic of Ireland had set a date (May 25) for a referendum on repealing a constitutional ban on abortion. The main driver towards this was the 2012 death of Savita Halappanavar, a 31-year-old dentist from India who suffered a sepsis-induced heart attack after her medical team first failed to diagnose a blood infection and then denied her abortion because of a presence of a fetal heartbeat – even though a miscarriage was inevitable. If the referendum passes, it will be celebrated as the beginning of a new era in Ireland for women’s rights. But that victory will always be tainted with its own original sin: the double disadvantage that Savita faced as a woman of color in a Catholic country.
How is it that in the 21st century, we still see reproductive justice constricted by religion? As Roberts put it, “If you don’t have autonomy over your own body, there’s no birth justice. It can’t be separated out”.
Kira Shepherd is the Director of the Racial Justice Program at Columbia Law. She gave an overview of Ethical and Religious Directives (ERDs) that restrict reproductive services in Catholic hospitals. The ban on sterilization procedures stuck out, considering the disproportionate rates of sterilization, often without consent, that were experienced by Black and Brown women after the procedure was introduced in the 20thcentury. Even as recently as 2010, California prisons were illegally sterilizing female inmates.
The unavailability of this procedure to women seeking care at religious hospitals adds insult to injustice, as women of color rely disproportionately on Catholic hospitals in comparison to white women. Shepherd spoke of a study in showing that while half of all women in New Jersey of reproductive age in the state are Black or Latinx, they represent an overwhelming 80% of births at Catholic hospital. That same study found that women of color accounted for 75% of births in Catholic hospitals in and 48% in non-Catholic hospitals in Maryland.
Many Catholic hospitals aren’t even advertised as such, meaning that women who enter them seeking care are often unaware of the restrictions on the type of care they can receive. According to Roberts, who had spoken about her own experience of nearly dying from her miscarriage, “I didn’t know it would be different in a Catholic hospital. I know so many women in my position who also don’t know. And then there’s being uninsured. Poor Black women internalize that this is the sort of trauma we have to take”.
The next speaker, Dr. Joia Crear-Perry, is the President of the National Birth Equity Collaborative. She revealed that the only Medicaid providers in some states are Catholic hospitals. “They are using us for profit”, she said. Roberts later cited statistics from the Mississippi state government showing that in some majority-Black areas like Jackson, 83% of mothers were receiving C-sections. The World Health Organization recommends a maximum rate of 15%. Mortality rates for Black women in the state are still 70% higher than white women.
Misogynoir in America’s Healthcare System
Misogynoir – a word that describes the intersecting experience of racism and sexism faced by Black women – also marks its presence in our healthcare system through a series of discriminatory and punitive policies and laws, along with the substandard level of care that they often receive due to provider bias. Even Black mothers who are college educated experience a higher maternal mortality rate than women of all other races who never finished school.
Jennie Joseph, midwife and CEO of The Birth Place, drew attention to the need for medical providers to receive antiracist training, citing a study that found a widespread belief among medical providers that Black people can endure higher thresholds of pain. “It’s about understanding the impact of your bias. Without looking at racism as part of it, we’re going in these circles where we’re not getting to solve the problem”. Joseph added that providers struggle as well, pointing to burnout, which “often overruns the good intentions that people bring to medical professions in the first place”. On top of this, providers who are Black women struggle to navigate the need to “have it all” as women of color.
The conversation turned towards how the War on Drugs has punished and incarcerated Black mothers. According to Dr. Perry, “Black women are judged more on what we’re putting into our bodies than what we’re putting into our communities”. The difference between the reporter-led witch hunt against “crack mothers” in the 1980s that was used as an excuse to escalate the War on Drugs with the more empathetic coverage of the effects of opiate abuse on white mothers today stands out.
Meanwhile, the rise of state laws that criminalize women who suffer miscarriages intersects with Black women’s poor access to birth control, abortion and other critical services to create a perfect storm. Aarin Michele Williams of National Advocates for Pregnant Women chimed in: “We’re helping people defend women who have abortions and women who have children at home. And if their home birth results in a miscarriage or stillbirth, they are prosecuted and robbed of their lives.”
Despite its in-depth evaluation of the intersecting oppressions faced by Black mothers in the United States, the panelists’ concluding mood was overwhelmingly positive and hopeful. Jennie Joseph, who runs a midwifery practice for Black mothers, said that this “is generational work we're going to have to do. We can start community-based work sooner than we can get any larger organizational to do anything besides a quick training." Roberts, who is part of the Black Mamas Matter Alliance, shared photographs of a new birthing center she was opening in Mississippi. “You can’t just show up for the Claire Huxtables of this world”, she said. “You’re either with mamas, or you’re against mamas.”
The Black Mamas Matter Alliance is preparing for #BlackMaternalHealthWeek starting next week. Click here for more information.