As moms, pregnancy and childbirth is a magical and also, complicated time. We look forward to meeting our child, but also want to be sure we’re making the best decisions, along with our healthcare provider, to get them here as safely as possible. Black moms (as well as American Indian and Alaskan Native) also face a greater risk for themselves; they are 2 to 3 times as likely to die from pregnancy related causes as white moms. In an effort to understand this important issue, we reached out to one of the top experts on this subject, Dr. Alicia D. Bonaparte, an Associate Professor of Sociology at Pitzer College and co-editor of the anthology, Birthing Justice: Black Women, Pregnancy, and Childbirth, Here’s what she had to say about this troubling statistic:
Recent research is showing Black women are 2.5 times as likely to die due to pregnancy and childbirth than white women. What are the major reasons for this?
Institutional racism very much so is the root cause of most, if not all, health disparities among people of color and more specifically among Black women and it works conjointly with classism, ageism, ableism, and heterosexism as contributors to these cited statistics. These varied experiences of structurally-sanctioned oppression function as chronic stressors which impact the body physiologically.
So things like stress and other preexisting conditions are factors?
Stress, in general, causes an overproduction of cortisol which is linked to comorbid cardiovascular diseases (CVD) including hypertension and diabetes. These comorbid diseases set up a stage for potential pregnancy and birthing complications. Additionally, doctors and other health care practitioners persist in the belief that Black birthing people are always high risk patients without early interventions prior to the birthing setting.
In essence, Black women are prejudged and thus treated differently than other patients?
Black women are labeled and judged to the point that they consistently lag behind their White counterparts (despite class and age) in access to early interventions such as testing for CVD. These judgments also lay the groundwork for iatrophobia (fear of doctors) which directly impacts the types of healthcare experiences Black women experience over their entire life course.
Dr. Alicia D. Bonaparte
Can you share any stories from your research/practice that illustrate these preconceptions?
What are some ways this important discrepancy can be improved?
In [the book I contributed to] we detail how birthing justice activists strategize and their contributions to addressing birthing inequities. Alliances between OB/GYN’s and birthing justice activist organizations is one way that vaginal birth after C-section (VBAC) activism can actually happen. Medical insurance companies should move towards further legitimizing rather than delegitimizing midwifery as a safe form of reproductive healthcare since midwives perform more than just birthing work so that Black women can have other practitioner options. Additionally, one segment of the Black birthing population that is overlooked are birthing parents currently incarcerated. Attention should be placed towards embracing abolitionist work geared towards liberating birthing parents from the prison-industrial complex as well as regulating birthing within prisons so that no birthing parent experiences being shackled while birthing and after the birthing experience. Another critical aspect is changing the way medical schooling addresses reproductive healthcare. Many textbooks still do not properly provide images of the vulva or the female reproductive system as a whole. And, because obstetrics is a surgical discipline, there is a primary focus on surgical interventions as a form of quickly addressing potential problems/issues when sometimes allowing the body to do what it does naturally in giving birth is the better option.
If any moms want to become advocates for their fellow moms, how can they help?
Using your voice and truly understanding what allyship entails are crucial for advocacy. Oftentimes, people assume allyship simply means stating, “I’m here with you” when what it actually entails is actions beyond words. So, when noticing that injustices are happening in birthing settings, speaking up about them is critical and using whatever privileges (e.g. race, class) you have in order to address the injustice. Educating yourself about how and why Black women suffer irreparable harm in reproductive health encounters is vital. So I would highly recommend beginning with reading Chinyere and I’s anthology, “Birthing Justice: Black Women, Pregnancy, and Childbirth” (Routledge), learning and supporting the work of birthing justice advocates such as the Bay-Area based Black Women Birthing Justice (https://www.blackwomenbirthingjustice.org/) and D.C.-based Mamatoto Village (https://www.mamatotovillage.org/, and lastly, developing self-awareness which is a life-long work. It’s one thing to notice something happening to a birthing parent; it’s a completely different thing to examine yourself and see if your silence is a form of complicity. Looking deeply to see if your inaction is because you’re afraid of repercussions if you speak up; or, your inaction is because you’re unsure of what to say.
What advice would you give Black moms reading this who might not feel like their concerns are being heard by their doctor?
One salient option is to change providers if at all possible. No Black mother should feel that she must be subjected to a negative experience with providers in order to birth their child(ren). Additionally, I would suggest looking at Jennie Joseph’s the JJWay for inspiration (https://commonsensechildbirth.org/jjway/). One of its major proponents is the necessity of a community of support beyond just a partner or family members. Instead, you’ll have a team of individuals (e.g. community members, a doula, a sister circle, midwife) who support your birthing experience and affirm the birthing plans that you’ve decided upon. So, if you’re feeling unheard, you’ll have a wall of support that can affirm why you made certain decisions and/or are asking for particular actions from your doctor. This support is necessary when considering how Black women are subjected to increasing numbers of unnecessary cesarean sections; these C-section rates are often linked to subtle and overt forms of doctors’ coercion. I reference Chinyere’s birth story again because this is what she did and her actions led to the successful and healthy birth of her daughter within a community of support.
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