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Black Maternal Health care in 'crisis.' What's the solution?

A doctor uses a hand-held Doppler probe on a pregnant woman to measure the heartbeat of the fetus. (Rogelio V. Solis/AP)
A doctor uses a hand-held Doppler probe on a pregnant woman to measure the heartbeat of the fetus. (Rogelio V. Solis/AP)

It’s Black Maternal Health Week, a time to raise awareness about what the White House recently called a “crisis.” Black women in the U.S. are three times more likely to die from pregnancy-related complications than white women. Experts point to systemic racism and inequities as the cause.

Story after story tells of Black women who experience discomfort or tell their provider that something doesn’t feel right, only to have their concerns brushed aside. Many end up dying as a result.

“Because of slavery, because of Jim Crow, Black people have not been able to pass down assets across generations and thus access the kinds of spaces and resources that are needed to have healthy pregnancies,” says University of Wisconsin-Madison associate professor Tiffany Green.

4 questions with Tiffany Green

How do both systemic and individual experiences contribute to the problem and solutions?

“My bias is really to think about not individual actions, but the structures that make them possible. I will say that we know that Black birthing people experience less autonomy and less support during labor. There is some evidence that having a support person can help to mitigate experiences of obstetric racism. But really, that’s not a systemic solution.”

There’s a doctor working to measure racism in obstetrics through a pilot program at hospitals. What might she find out?

“I certainly can’t speak for her excellent work, but what her work is really defined by is a desire to center the communities that we serve, not to tell black birthing people what their challenges are, but to go to them and ask them so that we can find community-centered solutions.”

Tell us about the effort in California to standardize how providers address postpartum hemorrhaging.

“We know that some things do work. And one of the things that has worked is California doing a quality improvement initiative to standardize the way that hospitals tackle postpartum hemorrhaging. And we know that that had a disproportionate effect on black birthing people, and it helped to narrow racial disparities in that outcome.

“I think it shows that when we ensure that people are getting equitable care, we can move the needle on some of these outcomes.”

How is a project in Washington helping provide access to resources for Black birthing people?

“We know that people are coming into care and they have social needs that are not being addressed. There are people that are at risk of being unhoused, people that are food insecure, people that have problems with intimate partner violence. 

“This program… connects them with community-based organizations that can meet their needs as well as provides them with a doula if they would like one. And at the end of the day, it’s one of the solutions that I think will hopefully help. But at the end of the day, systems have to be accountable for the way that they treat their patients, and that is a long, hard journey.”

What advice do you have for someone who is Black and pregnant and looking for resources?

“I always say it’s not the responsibility of patients to do this. But the reality is, I have been that Black birthing person. I think the key really is finding a provider that you can trust. And I know that’s not accessible to everybody. I happen to have had a Black obstetrician that I trusted to do right by me and my babies, but that’s not accessible to everyone. 

“In the short term, making sure that you understand what’s being done to you, making sure why, asking questions is important. If you need to, having a support person there. But at the end of the day, solving this problem means that we address the fundamental inequities in society that range far beyond medical systems and have everything to do with inequitable social conditions.”


Jill Ryan produced and edited this interview for broadcast with Todd MundtGrace Griffin adapted it for the web.

This article was originally published on WBUR.org.

Copyright 2023 NPR. To see more, visit https://www.npr.org.

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