The following article is a transcription from the 2019 Black Maternal Health Caucus testimony from Jennie Joseph, a 2019 Healthy Communities Fellow. Jennie Joseph is the Executive Director of her own non-profit corporation, Commonsense Childbirth Inc., and the founder of the National Perinatal Task Force, a grassroots organization whose mission is the elimination of racial disparities in maternal child health in the USA. The Black Maternal Health Caucus was founded in order to improve black maternal health outcomes in the United States Jennie Joseph brought in her own experience as a Midwife of nearly 40 years, supporting and advocating for women and newborn babies to push for greater health equity. Please find the full speech below.
It’s 2019. We have a perinatal problem. Perinatal means ‘around birth’ – not just pregnancy but the entire life course of health before, during, after, and in-between babies, for people of childbearing age. The United States’ maternal mortality and morbidity ranking – death or poor health of mothers due to pregnancy, birth or postpartum, – is beyond shameful and cannot stand. As a British-trained midwife, living and working in the United States for the past 30 years I am embarrassed that America has allowed the rate of mothers dying to not only increase, but more egregiously, let the disparity between Black and White women widen. We are responsible when hundreds of these deaths, and tens of thousands of ‘near deaths’ every year are preventable.
We have the resources, we have the review boards, we have the data, we even have the safety drills and protocols – we just don’t seem to have the will. This is not a new crisis; this has been happening for decades and Black women in particular have suffered disproportionately. Across this country, in areas that I call ‘Materno-toxic Zones’ – areas where you yourself surely wouldn’t want to be if you were pregnant, breastfeeding or parenting young children, people are faced with the grim reality that they are totally unsupported and at-risk for their health and their life due to the social determinants of health – conditions where they live, work, and play.
Worse yet is the even more insidious ‘pop-up toxicity’, which in my opinion is the reason why all Black women, regardless of socio-economics, education, health insurance status or celebrity, are physically and mentally at-risk of a poor birth outcome because of someone else’s perception of who they are, based on their race. Perinatal pop-up toxicity is the term I use to describe what happened to Serena Williams after the birth of her baby, while still in the hospital – could you be in any safer place? Her story supports what countless women have been saying and experiencing for decades – that due to racism, classism, sexism, and institutional and personal biases – Black women are treated differently, not listened to, not believed, and certainly not trusted. And that behavior, that way of being, is not only condoned in institutions and organizations on an everyday basis, but is lethal, in the USA today.
Of the 700+ maternal deaths annually and the 60,000+ who nearly died, how many women are suffering daily from disability, depression, anxiety, PTSD, or shame – how many families? Women don’t readily share their stories, or their pain. Too many women are suffering but Black women particularly carry the extra burden of trying to just ‘survive while Black’ let alone thrive, throughout their reproductive years. Therefore, we must consider Maternal Justice and Reproductive Justice as a means to right these wrongs. This is not just a physiological dilemma – we cannot continue to ‘blame and shame’ the women – it is not their propensity for high blood pressure, or obesity, or weak cervixes that won’t hold a baby in, no… it is the systemic and structural inequities, the responses, or lack thereof, the barriers, the obstacles and the materno-toxicity itself that leads to these conditions that are not conducive or supportive for full health, agency and self-determination during the perinatal period.
My organization Commonsense Childbirth Inc. houses the National Perinatal Task Force and we propose the creation of national Healthy Black Women Goals to be set by the Black Maternal Health Caucus every 10 years until we achieve real and concrete health equity. Towards fulfilment on those Healthy Black Women Goals for 2030 we strongly urge support for the following –
- Access to Safety: Ensure access to, and invest in community-based and Black-led organizations, providers and advocates offering culturally safe health navigation, health education, health literacy, psychosocial support, and integrated community resources and referrals for ALL communities in Materno-toxic Zones.
- Access to Quality Clinical and Behavioral Health Care: Deploy professional and paraprofessional perinatal teams to urban and rural areas of critical maternal health care shortage to establish maternity medical homes or clinics, level one birthing facilities run by midwives, and interdisciplinary telemedicine/telehealth collaboration and support services.
- Workforce Development: Align investment in human resources for a healthcare workforce keeping the current and future needs of the population and healthcare systems in mind. Support programs to diversify, strengthen and build a pipeline to perinatal health service careers, while creating access through training to entry-level jobs and entrepreneurial opportunities in communities of need.
We have a perinatal public health problem and Black women and babies are dying because of it. Black maternal health disparities will not change, lives will not be saved, nor will we achieve equity until we insist on structural and institutional competency based on racial, social, maternal and reproductive justice.