WHEN NNEKA ROOM she was pregnant with her third child, she had a symptom of pre-eclampsia, a serious complication of pregnancy, but her doctor never detected it. Hall sensed that her daughter was hiccuping and worried that something was wrong, but the doctor told him that she was having a recurrence of depression due to her husband’s separation from her.
“My son told me that something was wrong. He was reiterating it and no one was listening to me,” Hall said.
His daughter was born dead.
Unfortunately, Hall’s experience of feeling like her doctor wasn’t listening to her is not unusual for black women during pregnancy and childbirth. Hall said she has spoken with African-American doctors who have physically moved from one emergency room to another where her colleagues work to offer treatment for postpartum preeclampsia, because she didn’t take her patients seriously.
And black women’s pregnancy and childbirth outcomes are much worse than their white counterparts. In Massachusetts, a black woman is nearly twice as likely to die from a pregnancy-related cause as a white woman. Black women are 70 percent more likely than white women to have serious health consequences related to pregnancy and childbirth.
The legislatively formed Task Force on Racial Inequalities in Maternal Health recently released a 74-page report exploring why these disparities exist and what can be done about them. Two commission members, state Rep. Liz Miranda, a Roxbury Democrat, and Hall, founder of Quietly United in Loss Together Corporation, spoke at this week’s meeting. codecast about the report
The report concluded that there is no single cause of inequities in maternal health. There are factors related to the health system, families, communities, racism and poverty.
For example, the use of a doula, a trained person who can help a woman through labor non-medically, can improve birth outcomes. But doulas cost between $800 and $2,000 and are not covered by insurance.
However, Miranda said that resources alone cannot explain the disparities, although money and insurance are a factor in accessing care. She noted that her Cape Verdean sister gave birth to a 21-week-old baby who did not survive after a doctor downplayed her symptoms. But black tennis star Serena Williams had her own near-death experience with childbirth and had to personally insist on tests after hospital staff seemed unconcerned.
“Childbirth is the only space where it doesn’t matter how much education you have, where you live, what your socioeconomic level is. Black women continue to die at two to three times the rate of white women across the country and even here in Massachusetts.,Miranda said. “There is a lot of structural and systemic racism, age discrimination and gender issues between black and white women,” Miranda said. “The other things that make it difficult to give birth as a black person giving birth is the wear and tear on black people. We are stressed. The greatest income inequality. We live in historically segregated communities.”
Miranda said many women, particularly women like the non-English speaking immigrants she represents, don’t know what resources are available to them. “There is a lack of cultural competency, there is a lack of a prenatal workforce that is diverse and has the linguistic ability to help our diverse communities in Roxbury, Dorchester, Mattapan, Hyde Park,” she said.
Hall said there are volunteer doula programs in hospitals, midwives who accept payment plans and state home visiting programs, but people don’t know about them. “I have given birth in the Commonwealth four times,” said Hall. “I first heard about the home visiting program that is available through the Massachusetts Department of Health to anyone when I was working as a contractor for the Massachusetts Department of Public Health..”
The Health Care Financing Committee recently sent for review, or legislatively killed, two bills that would have established a regulated and licensed system of professional midwives, while requiring midwives to be covered by insurance and paid the same amount than other medical providers for the same services. Currently, Massachusetts is one of the few states that does not recognize a national certification for midwives, making it difficult for women to obtain midwifery care.
Miranda, who is running for state Senate, said the lack of progress on several bills related to maternal health indicates a need to increase the representation of women and people of color in the Legislature. She hopes that, either this session or the next, there will be an appetite to pass a blanket “childbirth justice” bill. “This is not a situation that we can choose or choose which intervention we are going to do now,” Miranda said. “Speaking as a black woman, saying black women are dying twice as often as white women, but Massachusetts is better, doesn’t do me justice..”
“I, for one, am not giving up on Black women, Indigenous women and women of color, because I know that if we work to improve their birth outcomes, we will improve outcomes for everyone,” Miranda said. “And that’s the most important. We can get to zero. We can save mothers, we can save couples, and we can save babies in Massachusetts if we get focused and focused and let black and brown women lead this space.”