We Need to Move the Needle on Black Reproductive Health. Like, Yesterday.

Reproductive Health Social and Racial Justice

“Can’t wait to write a tell all about my experience during my last two trimesters dealing with incompetent doctors at Montefiore [Hospital].”

On April 17, 2020, Amber Rose Isaac logged into her Twitter account and aired her grievances for the last time. Just four days later, she died of childbirth complications from a severely delayed diagnosis while receiving an emergency c-section. Her baby, Elias, survived the traumatic procedure. But why did Amber, only 26, have to die for Elias to live? Why was her light extinguished in the process of bringing a new light into the world?

Across the Black American community, stories like Amber’s are not as unusual as they should be. The Centers for Disease Control and Prevention (2022) reports that Black women are three times more likely to die of pregnancy-related complications than their White counterparts, a statistic that has not budged for several years. Some of the most cited causes of this harrowing divide include the increased likelihood that Black women are uninsured or underinsured, as well as the reality that non-Hispanic Black women are significantly more likely to suffer from overweight and obesity than white women, increasing their susceptibility to a long and morbid laundry list of maternal health complications. Living in neighborhoods and towns that have historically faced residential racial segregation, disinvestment in their healthcare infrastructure, and food insecurity (which helps to explain stark racial differences in overweight, obesity, and resulting chronic illnesses) reduces the chances of Black mothers having positive – or survivable – birthing experiences. With this said, Black identity itself is perhaps the greatest risk factor of all.

Blackness, irrespective of education level and socioeconomic status, brings with it increased risks of medical racism, missed and delayed diagnoses, and discrimination-induced stress, from prenatal to postpartum care. Modern medicine still needs to adjust its sensitivity towards the ways societal ills imprint themselves on Black women’s bodies, and more effort must be made to work with Black women’s communities to develop culturally sustaining care plans that minimize physical and emotional trauma. Does an expecting Black mother have access to a food system that will offer adequate, long-term nourishment to her and her baby? What about access to reliable transportation to and from prenatal appointments? At the appointments themselves, does this mother receive educational materials and instructions that use dignified and easily understandable language? During the birthing process, will she be surrounded by people who are in tune with her unique articulations of discomfort? Will her primary care team administer the proper screenings for postpartum depression in the months following childbirth, and is her community then equipped to provide necessary support in the instance of a mental health crisis?

And what about birthing Black people who are not women? Are clinicians and communities trained to ensure that their birthing experiences are as medically sound, discrimination-free, life affirming, and gender conscious as everyone else’s?
These questions have yet to be fully answered in mainstream research and practice for one reason: America has a lingering habit of dismissing Black women’s pain – of perceiving and treating Black women’s bodies as fundamentally different from white women’s bodies. For more generations than are countable, Black women have been socially conditioned to be independent and strong, to be stalwarts in their work of building and sustaining so many facets of American society while estranging themselves from their own hurt. The idea that Black women are wired for resilience is why women like Amber Rose Isaac are dismissed as “pestering” when they share their anxieties about not feeling normal.

Why women like Shamony Gibson are asked whether they are abusing drugs when they begin complaining of chest pains (she soon died of a pregnancy-induced pulmonary embolism).

And why women like Kira Dixon Johnson are left waiting hours for proper post-caesarean aftercare because it is assumed that they will be “alright” until their doctors can get to them (Kira bled out while still on the operating table, waiting for her doctor to follow up with her).

Thus, Black women’s loved ones, clinical care teams, and allies should invest in healthcare systems that are dedicated to exploring, highlighting, and healing the various contours of Black women’s pain. At the individual level, this means challenging the Strong Black Woman trope in households and workplaces, taking care to validate Black women’s concerns, and remove undue stressors that take physical tolls. Beyond community spaces, medical professionals must do their due diligence – yes, beyond existing training curricula – to grasp how past and current realities of food, housing, and economic inequity shape how birthing Black people access and present themselves in clinical spaces. Policymakers at local and federal levels can further allocate funding and attention to efforts that are dedicated to changing these realities, To know which efforts merit such advocacy, policymakers would be prudent to look toward the storytellers, culture bearers, cultural brokers, and seasoned mobilizers within the communities they serve. Among this group, I’d bet good money that you will find legions of Black women. And I can assure you that these Black women know best what it looks like to protect, preserve, and honor the lives of other Black women.

History has proven time and again that when a Black woman uses her voice – when she signals that something is amiss – we should listen. With respect to America’s Black maternal mortality epidemic, listening might just save a few lives.

Special thanks to guest author MacKenzie Isaac for highlighting this important issue in honor of Black History Month. MacKenzie (Kenzie) Isaac is an emerging health educator, aspiring social epidemiologist, and lifelong freedom-dreamer. She is currently attending the University of Oxford on a Rhodes Scholarship. After completing her Master’s degree in Modelling for Global Health, she will remain at Oxford to complete her doctorate in Population Health. Her research primarily explores how to mobilize youth and their communities to enhance adolescent mental health, and her doctoral work will focus on the design, implementation, and evaluation of a cross-cultural disordered eating prevention and management program for adolescents of the Black Diaspora. Beyond her studies, Kenzie loves singing gospel music, playing board games with friends, daydreaming about retiring into beekeeping, and figuring out how to keep her plants alive. If you’d ever like to discuss youth advocacy, particularly within the realm of health promotion, please don’t hesitate to send her a message at [email protected]. She would love to hear from you!


Further Reading:
Centers for Disease Control and Prevention – Working Together to Reduce Black Maternal Mortality

Center on Budget and Policy Priorities – Closing the Coverage Gap Would Improve Black Maternal Health

The Tennessean – How We Can Lower Maternal Mortality Rates for Black Women

Kaiser Family Foundation – Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them

The Gerontologist (Thomas et al., 2022) – Superwoman Schema, Racial Identity, and Cellular Aging Among African American Women

Essence – New York Woman Dies During Childbirth Days After Tweeting Concerns About Hospital Care

The Guardian – “You Are Not Being Heard”: The Devastating Black Maternal Mortality Crisis in the U.S.

Parents – Charles Johnson’s Loss Launched a Maternal Health Revolution

Greater Good Science Center (University of California, Berkeley) – How the “Strong Black Woman” Identity Both Helps and Hurts

Link to Original FB Post