Maternal deaths on rise because hospitals and doctors ignore safety measures.
High blood pressure took one mom’s life. Excessive bleeding left another with a hysterectomy. Would long-known safety practices have saved both?
Walbert Castillo, USA TODAY
Police violence and racism in general can be insidious threats to a Black woman’s reproductive health, damaging her own well-being and possibly even the DNA of her children, growing research shows.
Transgenerational trauma – defined as trauma that passes through generations – has long been documented in descendants of enslaved people, refugees and Holocaust survivors.
In the case of Black women who have witnessed the countless deaths and injuries of Black people at the hands of police, or been hurt themselves, their children may be unintentional genetic recipients of their wounds, both psychological and physiological. And in some cases, it’s making them think twice about having children.
“If you have a Black woman that already has this within her DNA and she’s experiencing community trauma, what is that doing to her body before she is even thinking about conceiving?” said She-Tara Smith, a Newton, Massachusetts birth and postpartum doula serving Greater Boston, also a mom of three. “Then you fast forward, not only is all of this trauma affecting her, now it’s affecting her baby.”
Police violence and brutality framed as a reproductive health issue encompasses its inherent, though often overlooked, impact on Black mothers. It affects their decision-making process whether to have children in the first place, and then psychologically – and likely physically – if they do.
“Weathering,” said Smith, is the accumulative effect on Black women from both micro- and macro-aggressions. In the case of Black reproductive health, “the womb is weathered and that causes huge systemic problems both for (parent) and baby.”
Black death: Why we need to talk more about the racial trauma
Witnessing or being part of such traumatic events, either directly or indirectly, can leave a permanent mark in lineage.
Some studies have linked racism to premature cell-aging in Black people. Evidence has also shown that trauma experienced by a mother during pregnancy can affect her child’s physical and emotional health.
“There are things that happened 100 years ago, 60 years ago, that are still affecting us now,” said Adriana Jean Louis, a birth and postpartum doula and midwife-in-training in Saugus, Massachusetts. “Not only socially, but in our DNA. This is the fabric that makes up our personhood.”
Those linking police violence to the reproductive justice movement also feel “the current climate of excessive force, harassment, and surveillance by law enforcement restricts (Black people’s) right to bear and raise children safely, free from an oppressive sense of peril that their offspring will be victimized or even killed prematurely at the hands of law enforcement,” said a study published in the Hastings Race and Poverty Law Journal.
But the impact of police violence on Black women and their reproductive health does not exist in a silo; rather, it’s part of larger historical systems at play in the United States that make Black women more susceptible to preterm labor and other complications, or worse, death during childbirth.
How police brutality, racism impacts Black maternal health
Maternal mortality rates for Black women in the U.S. are three to four times higher than those for white women, and infant mortality rates for Black babies are more than twice the rate of white babies, according to the Centers for Disease Control and Prevention.
Black mothers also have the highest rates of preterm birth nationwide – they’re more than 50% more likely to deliver a premature baby than white women.
Established research points to racism and related stress as drivers, transcending other factors such as socioeconomic status and education.
A 2020 study done by researchers in the University of California system found evidence that fatal police violence, when looked at as an isolated factor, affects the health of Black pregnant people living in communities where it occurs, and that it may play a role in inequities in preterm birth by race/ethnicity.
The potential for police violence can cause higher chronic stress levels in Black people, who are more likely to “internalize fatal police violence as an explicit threat to themselves and their families,” the physiological factors ultimately impacting pregnancy.
Using California birth and death records and the Fatal Encounters database from 2006 to 2015, the study’s findings suggest that exposure to fatal police violence during pregnancy is associated with a larger increased hazard of moderate preterm delivery among births to Black people.
Researchers found that when police killed a Black person in her own neighborhood, a Black mother’s risk of delivering her child between weeks 32 and 33 increased 81% with one dataset, and 35% with another.
Black newborn mortality rate: Black babies are more likely to survive when cared for by Black doctors, study finds
A new five-year study launched last month, funded by a $1.8 million grant from the National Institute of Child Health and Human Development, will survey a cohort of 200 Black women who were pregnant and living in Twin Cities, Minnesota and Baton Rouge, Louisiana during two incidents of high-profile police violence.
Rachel Hardeman, a University of Minnesota School of Public Health associate professor who is leading the study, plans to further probe the connection between racialized police violence and the occurrence of premature births and low birth weight among Black infants.
‘Watching the news is just not good for them’
Increased media attention to instances of police shootings and use of force has been a major stressor, and oftentimes a source of trauma, for Black parents or parents-to-be in New England and across the country.
“Watching the news is just not good for them,” Dashanna Hanlon, a birth and postpartum doula in Lowell, Massachusetts, said of her clients. “Having the George Floyd trial being ongoing, and although there was accountability, most of us don’t feel like there was justice. A lot of my clients haven’t chosen to find out the genders of their babies, and it’s because they’re nervous. What if I have a little Black boy?”
Jean Louis, who founded Doula Philosophy, said her clients are feeling the impact of “all of this access to video and images and sounds of brutalizing events in people’s lives, and the fact that these are people that look like us and could be our own children.”
That societal stress is in addition to the racism and discrimination that Black women historically face in health care. Many of Hanlon’s clients fear that they’ll “end up on the operating table” and not make it home, she said.
Seventy percent of her clients are Black, and this year, Hanlon noted, many of them have had early inductions, high blood pressure, “or generally stressful pregnancies.”
Without an ‘ounce of empathy’: Their stories show the dangers of being Black and pregnant
Both Hanlon and Jean Louis pointed to a huge uptick in Black families electing to give birth at home or at birth centers with Black doulas present, as an alternative to the potential risks presented by hospitals.
Hanlon herself is a mother to two biracial boys, so “it’s on my mind as a Black woman and as a doula who really tries to shepherd people through this journey in the most graceful way possible.”
Courtney Daniel, a Black mom in Portsmouth, New Hampshire, has three sons – ages 10, 13 and 14. It’s on her mind, too.
“I noticed a long time ago, before I even thought about having kids, what it would be like to bring a Black kid into this world,” she said. “I waited so long. I waited a while to become pregnant because I didn’t know if this was a climate I wanted to bring kids up in. It’s emotionally stressful, especially in these times.”
Daniel cited “constant scenarios that run through your head.”
“Praying no one knocks on your door, or that you’re that parent this time,” she said.
What are the solutions to improve Black maternal health outcomes?
That discussion is nothing new, emphasized Smith. In fact, it’s a broken record. But more people are talking about it following the racial injustice watershed of the last year, and the conversation now needs to steer towards solutions, she said.
“Race is not a risk factor, but racism is,” said Jean Louis. “So if we can address racism and address it in a very specific, targeted way by really making choices and efforts to combat the effects, we will find the solutions behind that. There will be positive effects.”
Black maternal health is a crisis nationally, and in New England, some wheels are in motion attempting to address it.
Maternal morbidity: US Health and Human Services unveils action plan to reduce racial disparities
In Massachusetts, the state Legislature recently passed a bill to create a maternal health commission, which will be tasked with finding ways to target and reduce racial disparities within the maternal health system. In doing so, it joined just upwards of a dozen states that have created similar commissions.
In Providence, Rhode Island last year, though not a solution that addresses the systemic problems in health care systems, the city set aside grants to pay doulas, non-medical trained companions before, during and after birth who are viewed as advocates to help offset the disparity in maternal health outcomes for Black women.
Pregnancy in Rhode Island: More perilous for Black women
The Maine state Legislature is currently probing the fact that Black women there are four times more likely to start prenatal care late, or not at all, a disparity tied with Texas for worst in the country, the Portland Press Herald recently reported.
“If we start by asking Black birthing people what their needs are and where their needs are not being met, they will tell you,” said Jean Louis. “There are no shades of grey.”
Last week ahead of Mother’s Day, the attorneys general of Massachusetts, Maine, Connecticut and Rhode Island joined a group of 22 attorneys general from across the country urging Congress to pass the Black Maternal Health Momnibus Act of 2021, a legislative package aimed at combatting the Black maternal mortality rate and increasing access to maternal and perinatal care.
If Black maternal halth is addressed, said Smith, then maternal health outcomes are lifted for all people.
Black families ‘persevere’ to have children, but they shouldn’t have to
Despite the ever-present realities of being Black in America, Hanlon said her clients – spanning from couples to single mothers – have chosen to proceed with their plans to conceive as a way to celebrate life and seize the joy they deserve. They’re persisting to bring a child into the world.
And yet, added Smith, the idea that Black women especially are required to have an indomitable spirit to do seemingly everyday things has its ramifications.
“Yes, Black women are resilient. Yes, we persevere through everything, but we also have to recognize in doing that, there’s consequences,” she said. “You can be strong and resilient and persevere, but you can also be left with all of these other issues as a result.”