August 24, 2022. Duke Medium. By Camille Robinson.
There is a Black maternal and infant health crisis plaguing the United States of America.
It’s so easy for us to passively consume this issue, be unphased or even numb because we see this problem on TV, a post on Instagram or in a news story. However, this is not a problem that can continue to be ignored. Black women and infants are struggling to live and thrive during one of the most magical moments in life, and this is an emergency not only across the country, but right in our backyard in North Carolina.
North Carolina ranks 30th in the country in terms of maternal mortality rates and received a grade of D, again, on the 2021 March of Dimes report card, whose purpose is to address indicators that affect maternal and infant health in addition to highlighting each state’s progress toward health equity among all races and ethnicities.
In North Carolina, Black women are two and a half times more likely to die of pregnancy related complications regardless of education or socioeconomic status, indicating that implicit bias, racism, and discrimination are key factors. These factors hit close to home when 40 year-old Tomeka Issac, a Black woman, nearly died and tragically lost her son Jace in Pineville, North Carolina. She suffered from HELLP syndrome; however, knowing her risk factors, her doctors never took any urine samples her entire pregnancy. And when her son died, the staff didn’t empathize or provide comfort, instead they gave her the bad news and moved on. This story is too often the face of Black women in medicine.
This story — and so many others that I have heard and seen first-hand — was my motivation for co-founding the Black Maternal Health Equity Initiative at Duke University School of Medicine, a program which supports Black women with high-risk pregnancies to help address racial disparities in maternal health outcomes. We decided that we could no longer sit on the sidelines; we had to create a space for Black women to feel supported and heard. Our program pairs Black women receiving care at Duke High Risk Obstetrics Clinic with medical students who are trained through our program to identify personalized maternal health goals, assist in navigating the healthcare system and connect their patients to community resources. Many of our patients have said they wished a program like ours existed sooner. During my time working with Black women in our program, these are some of the things I’ve heard which continue to challenge me.
“I’ve had terrible experiences with my past pregnancies. This is the first time where I felt like someone was listening to me.”
“They let me go earlier than I wanted from the hospital. Thank you for checking in to see how I am feeling.”
“I feel like I am a burden to the care team. Thank you for reassuring me that my concerns are valid.”
These direct quotes should be a reminder of the work that lies ahead for us to ensure that Black women are being treated fairly, getting the same level of care as others, and being heard.
Luckily, NC legislators agree and are hitting the pavement running with efforts to improve Black maternal outcomes and find solutions to combat the root of this pressing issue. If passed, the Black Maternal Health Momnibus Act includes funding for the Social Determinants of Maternal Health Task Force, the creation of a Maternal Mortality Prevention Grant Program and implementing an evidence-based implicit bias training program for health care professionals involved in perinatal care. This is just the beginning, so what else can be done?
Keep up with the policies that affect Black maternal outcomes in North Carolina
There have been many policies presented, suggested and turned down that if passed, would greatly increase access to care, provide additional support and facilitate closing the gap of maternal racial disparities across North Carolina. For instance, with Medicaid expansion, Black women of childbearing age would have increased insurance access, increasing their ability to utilize health services. Another important topic is doula expansion. Doulas are expensive, but evidence suggests doulas are vital components to the birthing process and decrease risk factors associated with maternal mortality. Getting insurance to cover the costs of doula services would help the lives of so many Black women across the state.
Get out and vote!
Voting is an essential component to this entire picture. Who we vote for translates into the laws that are passed, and ultimately, how our lives are affected on a local, state, and national level. Do your research, ask questions, call your local legislators, go to your next city council meeting, become active in your community. These are just a few of the ingredients to the recipe of change for Black women.
Check your own biases
We all have them, but what’s important is recognizing them and working to actively check them. Before you speak or complete an action, ask yourself “Do I have any preconceived notions?” “Am I providing the same level of services?” “How would this make someone feel?”
For healthcare providers: “Am I providing the same level of care?” “Am I listening to my patients’ concerns?”
Seek other perspectives from people you trust. Apologize when you’re wrong or have offended someone. Remember that we aren’t perfect and that we will make mistakes, but if we all work towards this common goal, nothing but positive outcomes will result.
It all comes down to saving lives. In one of the most powerful and resourceful countries in the world, Black women should be receiving the best care. Black women matter. Their lives should be valued and together we can make a change.
Camille Robinson is a fourth-year medical student at Duke School of Medicine and was a 2021–22 NC Schweitzer Fellow.