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A few weeks ago, I spent an hour speaking to a high school Women’s History Class in a place where that sort of thing still is considered acceptable. The walls of the classroom were covered in timelines, images of icons from around the world, and the posted projects of students — handwritten 3×5 cards detailing their own perspectives on current events given the historical context provided in this room. It was hot in there, but we closed the windows against the sound of a lawn mower making neat turns on the turf outside. I had been invited to talk with these students about a topic they had no idea was taboo — the maternal mortality gap for Black women in the United States.
For years, our nation has ranked poorly when it comes to the survival of women bringing new life into the world. Compared to other high-income nations, the United States ranks dead last — and when you isolate the maternal mortality rate of Black women in the United States compared to those nations, the difference is stark. As a country of innovators we pride ourselves on health care advancements, but the accessibility and delivery of that care is drastically different for different patients. The most recent data shows improvement — the maternal mortality rate demonstrated decreases for every demographic of women in the United States except Black women. Controlling for education, controlling for income, and controlling for access to health care, Black women are three times more likely to die due to preventable causes related to childbirth. Our inability to come to terms with and solve these very obvious inequities has led to thousands of preventable deaths — and now, we’re not supposed to talk about it.
I write about this issue every year for Black Maternal Health Week. Never before have I encountered so many dead links, so many “this page no longer exists” errors, from organizations that relied on federal funds to perform advocacy and research activities and from websites that belong to government agencies directly. What does it look like to continue pushing for health equity during the war on Diversity, Equity, and Inclusion?
Dr. Karen A. Scott, MD, MPH, FACOG is a pioneering obstetrician-gynecologist and public health expert dedicated to addressing the urgent crisis of Black maternal health inequity. Dr. Scott has built a framework that seeks to transform maternal health care. The issue as she sees it:
“Hospitals in the U.S. do not routinely keep Black women, girls, and gender expansive people and their loved ones safe during pregnancy, labor, birth and postpartum.”
Dr. Scott developed the first valid tool in existence created to identify and define obstetric racism as an adverse medical event. This tool, called the PREM-OB scale, measures the impact of racism, kinship, and humanity on maternal health experiences.
These words taken at face value may be challenging to understand from a lay perspective, and for someone who may read them without access to the clinical experience of a Black person in this country. I will do my best to provide some context.
Black women and birthing people are questioned as to the status of the father of their children, or assumptions are made that the father will not be part of the process, whether or not the individual giving birth happens to be married. Whether or not the father is present. “Is dad in the picture?” Assumptions are made about our health insurance coverage. “Can I see your Medicaid card?” (when we have private or employer coverage.) Off color commentary made as we seek medical attention. (Anecdotally, I once had a nurse call my child an “oopsie” as she was jabbing a needle into my vein to place an IV bag.)
We often face dismissal of our concerns, requests, care plans, and need for enough time to consider the outcomes of medical decisions. Unconscious bias means those charged with our care struggle with our capacity for autonomy and comprehension. Decisions about what medications and treatments we receive are in the hands of people who do not consider us capable, autonomous, worthy human beings. We are not listened to when we describe our pain. We are not prescribed medication in the same way as our white counterparts.
Again, I write about this topic every year.
It is deeply personal to me, as a Black woman who has nearly lost her life to preventable causes related to childbirth twice. As a person who has done advocacy work within this space for years. As someone who has conducted countless interviews, sat in on story gathering sessions and met with lawmakers who care enough to work toward change.
Every year, right about here in my column, when I explain that the reason Black women are not surviving the process of becoming a mother is due to the care they receive, not due to some inherent quality associated with their race, someone pulls out their laptop or their phone to send me a strongly worded letter.
If the intention of whatever correspondence you may be contemplating at this very moment is to scold me and prove that no one in the medical field is racist or a person who has implicit bias, I assure you, your perception of your experiences do not disprove decades of data. That’s the thing about data — when you mine it correctly, it reveals the trends you can’t see from your own narrow window. That’s what makes it powerful. That’s why they want to redact it from the record. Remove it from the institutions of education. The game isn’t quite as fun when it’s so obviously rigged.
The high school Women’s History class was stunned when I told them that where I come from, it is very unlikely I would be welcomed to speak to a class of students about historical racial inequity and its contemporary outcomes in the United States.
“What do you mean?” a wide-eyed sophomore pressed.
“I mean, they consider talking about the fact that we are more likely to die during childbirth due to racism a ‘divisive topic’. It would therefore be considered unlawful by the State of Iowa. Now, they want to make it unlawful everywhere.”
“How is it divisive to say that we want to live?”
“How indeed,” I replied.
I wish that I had something more reassuring to tell her as the current administration cuts funding from Historically Black Colleges and Universities. As they work to silence public health researchers, journalists, and educators. As Black Lives Matter is scraped from the concrete in our nation’s capital. I wish that we didn’t have to reiterate again and again to our children, to our youth, to ourselves that our lives have value because WE say they have value, and that our value does not rely on any political agenda.
What I said to them instead was this –
“I’m here to talk to you today about creating a life of purpose on your own terms. You don’t need anyone’s permission to change the world.”
Sofia DeMartino is a Gazette editorial fellow. sofia.demartino@thegazette.com