To Thrive, Not Just Survive: The Crisis of Black Maternity
In the summer of 2020, the global resurgence of the Black Lives Matter movement dominated both headlines and social media alike. However, this grassroots mission has been active for years, and the systemic racism it's been fighting against has been prevalent for centuries longer. The tragic murders of George Floyd, Breonna Taylor, and countless others – at the hands of U.S police officers – brought the conversation to the forefront of our global consciousness. While the focus was initially on the issues surrounding police brutality, it created a space for important, wider conversations on race. It also shone a light on systemic racism and its potent undercurrent across every facet of society – including reproductive health.
This is America
In the USA, it’s evident that much needs to be done to improve reproductive healthcare - especially for women of color. Data released earlier this year by the NCHS revealed that 658 women died from complications related to pregnancy or childbirth in 2018. An already shocking situation, this also gives the United States one of the highest maternal mortality rates among all developed countries. However, black mothers were dramatically (and disproportionately) represented in these statistics. The data showed that black mothers were 2.5 times more at risk of pregnancy-related deaths, proving that black people are not only dying at the hands of police but of healthcare providers.
Though many people try to write this statistic off as a socio-economic issue, it is merely rhetoric created to shift responsibility away from the people in power. If this was simply down to an issue of access or wealth, why have Beyoncé Knowles and Serena Wiliams – two of the most powerful black women in the world – reported a similar lack of care and understanding when it came to their own birthing experience?
From pregnancy to breastfeeding, it’s undeniable that a serious level of systemic racism is at play when it comes to black motherhood and maternal health. “This issue runs deep and is extremely complex," says Doula and Fitness Educator, Rachel Nicks. She recently wrote a piece for Elvie on the low breastfeeding rates among black mothers and its roots in American history. “To understand it, we must look at the history of oppression and exploitation of the black female body. Black women were raped, used as wet nurses, and had cesareans performed on them without anesthesia. It was believed they did not feel pain the same way that white women did.” Worryingly, this dangerous myth continues to exist in the present day, with 50% of white healthcare professionals believing that black people have a higher pain threshold than their white counterparts.
The danger of fear
Pain is our body's way of telling us that something's wrong. If black women’s pain is so often underestimated by disbelieving healthcare professionals, it’s no wonder they are more likely to experience complications. “Black women were not – and still are not – listened to, and many are afraid to even speak up because of fear,” says Rachel. “The lack of respect and trust between black women and their care providers has a direct link to the increased mortality rates amongst black women and high infant mortality rates in the black community.”
Rachel’s work as a doula allows her to witness women at their most powerful – and most vulnerable. She has seen firsthand how fear of a risky birth can affect a mother-to-be.“The majority of women of color are aware of the racial disparities in reproductive healthcare, which causes them to have a lot of fear,” Rachel explains. “That fear can interrupt the progress of her labor. Birth is all about hormones. You want women to produce oxytocin so they can dilate. But if they feel fear, they're producing the antithesis, which is adrenaline, which prevents dilation. Unfortunately, many women spend their labor afraid they will not leave alive. This must change now.”
The landscape in the UK
However, it’s important to remember that this is definitely not a U.S-centric issue. Reproductive healthcare in the UK is also plagued by systemic racism - and black women are losing their lives because of it. The comparative maternal mortality statistics in Britain are even more shocking than in America. British black women are 5 times more likely to die during childbirth and their babies are more likely to be still born.
London-based doula and sex educator Zachi Brewster believes that these statistics are largely down to a combination of a racists system and an unwillingness to prioritise much needed change. ‘This is the frightening reality of birthing as a black woman in the UK today. These figures are not due to a medical or genetic predisposition, but are a direct result of systemic racism as well as the implicit bias and lack of cultural competency of healthcare professionals.’
Commenting on the 2013 study on Experiencing maternity care: the care received and perceptions of women from different ethnic groups (Henderson et al 2013), she goes on to say: ‘Although these are results from 7 years ago, not much has changed. Compared to white women, black (and Asian women) still feel like they are spoken down to, not treated with kindness or respect or sufficiently involved in decisions about their own care.
Last year, the UK Government was under pressure from a petition that demanded funding changes to ensure the safety of black mothers giving birth. This petition failed. After not meeting its target, it was then shelved to prioritize the last-minute general election. However, it's since been revived and now has over 180,000 signatures. Now, the Government is obliged to address this issue in Parliament.
Together for change
Whilst news like the petition are a positive step in the right direction, it’s not enough. It’s imperative that we keep the conversation going, continue campaigning for change, and keep educating ourselves. This should not be an issue that only gains traction in the face of tragedy or during Black History Month. It’s also not a fight for change that should rest on the shoulders of black women.
“All women must come together to create change. There is no other way. “ says Rachel. “We cannot rely on the oppressed population to create change when they are not the ones who caused the oppression - nor are they the ones with the power or financial resources to dismantle and rebuild the systems that were consciously put in place for them not to be equitably served.”
Zachi agrees that intersectional allyship is an integral part of progress in this area. “Studies are great but if we don’t build a plan to address the results then nothing changes. Systems needs to change, and white people addressing their biases and supporting and actioning anti-racist policies and behaviours both personally and professionally is what will bring about the biggest changes.” she explains. “Only once we start to address the disparities and build solutions for those most at risk of poor care - especially black women, members of the LGBTQ+ community and people with disabilities - then we can start to build a better healthcare system for all.”
What can you do?
For any progress to be made we need to take action and keep the conversation going - both off and online. Here are some ways you can be a proactive ally and support causes doing incredible work in this space.
Educate yourself on the history and current situation
Knowledge is power and having a deeper understanding of the historical and current landscape impacting black people will help you reflect on what you can do better, and also give you the confidence to challenge others. There are many powerful books out there including ‘Women, Race and Class’ by Angela Davis and Candice Brathwaite’s ‘I Am Not Your Baby Mother’ which is an insightful look at Black British motherhood. The Decolonising Contraception community has an extensive and comprehensive reading list that we would highly recommend investigating.
Call out microaggressions and challenge behaviour
In order to see change on a societal level, it has to start within our own bubble - both professionally and personally. We need to understand the vast spectrum of racism and hold ourselves and others accountable for our actions and words.
Amplify the voices of black doctors and wellness practitioners
There are some amazing black reproductive health experts, who offer inclusive and culturally sensitive advice - which is something we often lack in mainstream media. Follow, share and amplify their voices. We love midwives The Vagina Chronicles, Sumi’s Touch and Crimson Fig and doulas Zachi Brewster, Rachel Nicks and Erin Doulight.
Donate to important causes
There are many amazing charities working to dismantle systemic racism and support those affected by it. If you would like to donate to one that specifically focuses on black maternal health, we highly recommend supporting Black Mammas Matter and Mamatoto Village.