The Washington Post
Black maternal mortality may worsen post-roe. A film shows the effects.
In “Aftershock,” a new documentary streaming on Hulu that spotlights the Black maternal mortality crisis in America, Felicia Ellis, a pregnant Black woman in Oklahoma, makes a chilling analogy as she prepares for childbirth.
“A Black woman having a baby is like a Black man at a traffic stop with the police,” Ellis says. “You have to really pay attention to what’s going on every step of the way.”
Indeed, the United States has the highest maternal mortality rate of all industrialized nations, with 23.8 deaths per 100,000 live births, and Black women are three times more likely to die than White women during or after pregnancy, according to 2020 data from the Centers for Disease Control and Prevention. Most pregnancy-related deaths are preventable, and the racial disparities result from structural racism and implicit bias, along with underlying chronic conditions and disparities in access to quality health care, the CDC reports.
After the Supreme Court’s decision to overturn Roe v. Wade last month, public health experts say those rates are likely to get worse. A study published last year in the journal Demography estimated that a nationwide abortion ban would increase pregnancy-related deaths by 21 percent over time, and by 33 percent over time for Black people.
“Aftershock,” which premiered at the Sundance Film Festival this year and was co-directed by Paula Eiselt and Tonya Lewis Lee, primarily follows the families of two young Black women who died after giving birth in New York City only six months apart: Shamony Makeba Gibson, 30, died of a pulmonary embolism in October 2019 two weeks after giving birth to her son, Khari, at Brooklyn’s Woodhull Hospital, and Amber Rose Isaac, 26, died in April 2020 after an emergency C-section to give birth to her son, Elias, at the Montefiore Medical Center in the Bronx.
The film’s focus on the victims’ families shows the “aftershock” of maternal mortality, Eiselt said: “There are ripple effects . . . to, of course, the fathers, to the family, to the community and to the country.”
The film also charts the history of how Black women have been mistreated in U.S. health care and highlights efforts — stemming from midwives, doulas and birthing centers — to reduce racial disparities in maternal mortality and give pregnant people more agency in their birth experiences.
The Washington Post recently talked with Eiselt and Lewis Lee about making the film and how maternal health care in the United States needs to improve.
This interview has been lightly edited for length and clarity.
Q: We’re now almost a month
out from the Dobbs decision. Experts have said that maternal mortality rates will probably worsen in light of state abortion bans, and maternal mortality rates are highest in states where abortion bans have already taken effect. What kind of added resonance do you think the film takes on in this new reality?
Paula Eiselt: When we talk about maternal health, maternal health is abortion care is health care — it’s all one conversation. A lot of time, unfortunately, it gets bifurcated: We talk about birth, and we talk about abortion as if they’re two completely separate things, but as we know, they’re so intertwined.
It’s a human right to choose whether or not to carry a pregnancy, and if one chooses to carry that pregnancy, it’s a human right to not only survive but to have a safe and dignified birth, and none of those things are happening in this country.
Q: Based on the research you conducted in making this film, what do you think lawmakers in states with abortion bans need to do to reduce maternal mortality?
Tonya Lewis Lee: Overall maternal health care, overall women’s health care, needs to be just generally improved. I do think that, as we talk about in the film, the integration of midwives into women’s health care, for example . . . would help a great deal in outcomes across the board. Midwives are not there just to catch babies; they can help a woman throughout her life cycle.
I think, in general, communication with health-care providers, between health-care providers, is another one — really listening to women, seeing and hearing them. As Dr. Neel Shah says in the film, it’s not a luxury, it’s the key to saving lives.
Q: The film also delves into the history of how doctors have systemically mistreated Black women in the American healthcare system. Why is this history important to understand where we are now?
Eiselt: The historical part was something we absolutely had to have in there, because the maternal mortality crisis didn’t just pop up out of nowhere — it’s part of a historical continuum that has devalued and dehumanized Black women from 1619, since the times of slavery. And that has continued post-slavery, with the turn of the 20th century, when White men came and really took over the profession of birthing and eradicated midwifery. And that was a racist campaign — it was really geared toward Black midwives.
That eradication of [Black] midwives, and that stigma, that was a very successful marketing campaign, because you talk about midwives today and people are like, ‘ You’re crazy,’ or ‘You’re gonna die, your baby’s gonna die, they’re not professional, you need to be in the hospital, they don’t know what they’re doing.’ They’re so stigmatized, and that racist campaign affected, of course, not just the Black midwives and the communities they were serving, but our entire country . . . because we don’t have integrated midwifery because of that, and that’s where we went off the tracks.
Some hospitals, depending on the state, are welcoming to midwives, but not many, and they don’t have the same privileges as doctors. . . . So our system is completely different, and it’s because of that history that is told in our film, that’s how we got here. And if we don’t know how we got here, we don’t know how to fix it.
Q: The film also follows Felicia Ellis, a Black woman in Oklahoma who gives birth in a birthing center. Why was it important to show her journey?
Eiselt: It really shows the promise of what birthing can be when a woman is empowered, when they’re in control of their choices, when they have choices.
When we first met Felicia, she was going to have a hospital birth. At about 35 weeks, she decided that, you know what, she wants to [give] birth in a birthing center. She made that pivot, she switched, and we were like, ‘We’re with you, we’re going to follow that.’ . . . She chose that new path, she had an amazing doula, and she had this beautiful, empowering birth.
We really wanted to show what real birth and labor could be [in the film]. It’s a long scene, you’re really there with [Felicia]. We wanted to reclaim that, because it’s not something the media shows you, in terms of how we are in birth. It was very important to really sit there for those minutes and be with her, even though it could be uncomfortable for viewers who have not seen that before. It was so important to show what it’s really like and how magical it could be, if that’s what you choose.
Q: Why do you think this crisis hasn’t yet galvanized Americans in the way that police brutality against Black people has in the last few years? Do you think the tide is turning?
Lewis Lee: I think part of the reason why, for example, police brutality gets more attention is that people are filming [police encounters]. People have cameras, they can see what’s happening.
With Black women in particular in the health-care system, often [something] happens and we may talk about it amongst ourselves, and then we question ourselves about something that’s a broader issue. What’s so wonderful about this film is that it is allowing people to be validated. . . . So many people have birth trauma stories. They may have survived it, but a doctor didn’t listen, someone didn’t pay attention, you had to demand something, you were treated in such a way, dismissed, talked down to as a woman.
I think maybe the tide is changing. People will be more open now to sharing their stories, not feel that they’re responsible for what’s happening to them, and understand that they are a part of a system.