Targeting racism in maternity ward
Counties team up to highlight toll on women, kids
During her first pregnancy two years ago, Vallejo resident Sharayah Alexander told her doctor she had Graves’ disease, an autoimmune disorder affecting the thyroid, only to be told she was mistaken and her concerns dismissed, she said.
Richmond resident Anisha Johnson lost her 16monthold son in 2008 to a rare and poorly understood disease called sudden unexplained death in childhood. When she delivered her second child a year later, a social worker asked her if she was equipped to take care of her baby. Disoriented after giving birth, Johnson remembers thinking, “If they only looked at my medical record, they’d know he (her first child) was in day care when he unexpectedly passed away.”
Shales Hogan, a San Francisco resident, said her doctor ran drug tests every single time she went in for an inperson prenatal visit during the pandemic. The single mother said the experience left her feeling judged.
Like many Black women who have brought or are bringing life into the world, Alexander, Johnson and Hogan say they’re all too familiar with racial bias in the examining room. Now, the Bay Area counties they live in and two others are highlighting the direct medical toll that racism has on Black mothers and their newborn children.
Alameda, Contra Costa, San Francisco, Santa Clara and Solano counties on Thursday announced Deliver Birth Justice, a public awareness campaign to combat disproportionately high mortality rates for expectant Black women and their babies.
Nationally, about 700 women die each year during pregnancy or in the year after, with Black women three times more likely than white women to die from pregnancyrelated causes, according to the U.S. Centers for Disease Control and Prevention.
The national rate parallels the regional one: According to the California Department of Public Health, Black moms in the Bay Area are three to four times as likely to die from childbirth than their white counter
parts, and Black babies are two to three times more likely to be born too soon or too small, or to die before their first birthday. The CDC cites a number of reasons for the racial birth disparities, including underlying health conditions, variations in health care, implicit bias and structural racism, the latter two which can cause higher levels of stress.
While some stress is a normal part of pregnancy, racisminduced stress has a detrimental impact on expectant Black mothers and their infants, explained Natalie Berbick, a public health program specialist with Contra Costa County, which is part of the regional partnership.
“Racism has real impacts on health,” Berbick said. “It can cause all sorts of birth complications, but it lingers even after that. Which is why we need to think beyond just clinical care and ensure Black moms are set up for success with income and housing stability, and education.”
Part education and part policy campaign, Deliver Birth Justice hopes to improve pregnant Black women’s access to safe housing, nutritious food and reliable public transportation. But the awareness part takes direct aim at the medical system, with antibias training to be recommended for health professionals, new systems for reporting and addressing incidents of racism, and new partnerships with doulas and midwives.
Disrupting structural racism will mean going outside the hospital, said Dr. Zea Malawa, the perinatal equity medical director of the San Francisco Department of Public Health, which is also part of the campaign.
“It’s about housing stability and income security and a host of other factors that need the same level of care and thought if we are seriously trying to make the lives of
“Racism ... can cause all sorts of birth complications, but it lingers even after that.”
Natalie Berbick, public health program specialist with Contra Costa County
Black moms better,” she told The Chronicle.
Deliver Birth Justice falls under the state public health department’s Perinatal Equity Initiative, an effort started in 2018 to identify best practices in addressing persistent health inequities, which have only been exacerbated by the pandemic.
The campaign also comes amid growing acknowledgment of racism as a public health crisis, something that has already been declared in Michigan, Ohio and Wisconsin. While California has yet to take that step, despite urging by health advocates, San Francisco did launch a basic income pilot program for expectant Black and Pacific Islander women in September.
The U.S. has the highest maternal mortality rate among developed nations. The nation also has a relatively high infant mortality rate, with 5.7 deaths per 1,000 live births, according to the CDC. Black babies had an infant mortality rate in 2018 of 10.8 deaths per 1,000 live births, compared with a rate of 4.6 for white babies.
The disparities for Black moms cut across socioeconomic, education and class lines. A highprofile example came in September 2017, when tennis champion Serena Williams publicly shared her own experience of not being listened to after giving birth. The winner of 23 Grand Slam titles said she suffered a blood clot in her lung that was almost missed when her doctors and nurses initially dismissed her request for a CT scan and blood thinners.
For too long, health care professionals have assumed the higher mortality rates for Black women and their children are due to behavior rather than the external factors causing them, Malawa said.
“Black women are too often robbed of their autonomy in making decisions for themselves during pregnancies; they are not listened to and they are undermined,” Malawa said. “This can be lethal for some of us, and it needs to stop.”
Alexander, the Vallejo mom, said the medical appointments leading up to her daughter’s birth in 2019 left her feeling unheard and exasperated as she tried to tell her obstetrician about her hyperthyroidism condition.
“I remember feeling so deflated after that ordeal. I was not being listened to and was pretty much accused of lying,” Alexander said. “The experience affected my mental health and my prenatal health. I ended up switching doctors. But the point is, I shouldn’t have had to do that.”