Black Southerners deserve a better birth experience

Birth should be a joyful experience. But in America — which is among the most dangerous nations in the developed world in which to give birth and continues to see a rise in maternal death rates — pregnancy and birth are often extremely frightening. Especially for Black women in the South. 

One Black Southern woman who was on Medicaid during pregnancy told me she labored alone in a hospital room for hours, was attended by a medical student with little experience, and was never put on a fetal monitor. She lost her baby.   

Another woman, an Afro Latina, told a Federally Qualified Health Clinic — a place that is intentional about communicating in patients’ languages — that she encountered no one who spoke her language at a New Orleans birthing hospital when she was in labor for the first time recently. Alone because of COVID-19 protocols, she endured an emergency C-section without understanding what was happening or why.  

These personal stories matter. The latest CDC statistics, released last month, show Black women remain 3 times more likely than white women to die during pregnancy or childbirth or in the first year of their child’s life. 

It’s a national problem that’s worst in the South, where about half of Black women live. In our region, women face the highest vulnerability to poor pregnancy outcomes. With the exception of Virginia, not a single Southern state received a grade above an F or D from the March of Dimes’ for infant and maternal health last year.  

The South has such stark outcomes because of the combined impact of institutional racism and patriarchy. Concerned about the added isolation and barriers to care the pandemic has heaped on Southern women, several New Orleans organizations, led by Ashé Cultural Arts Center, have collected recent birth stories of primarily Black women. Unsurprisingly, they found the pandemic worsened participants’ pregnancy experiences. COVID-19 has stressed health care professionals and mothers alike to the breaking point.  

In Black women’s pregnancy and birth stories across the South, you will find common threads: health care professionals who didn’t know their names, look in their faces or talk to their partners, let alone support their births or listen to their concerns. You will also hear about lack of access to transportation, healthy food, prenatal care, mental health care, and stable housing — all necessary for a healthy pregnancy and birth. 

Black women’s birth stories don’t have to have tragic endings. My great-grandmother was a South Carolina midwife who safely delivered my father, aunties, and babies throughout her community. Decades later, I used a registered nurse midwife for my three births in Maryland. I had my last child at a birthing center covered by my health insurance, with no co-pay. Research shows these safe, affordable, very personal approaches, such as use of midwives and doulas and compensating them through insurance and Medicaid, can improve birth outcomes. But these options are not available in much of today’s South. 

We need a shared vision of a South where all women have a safe, healthy, affirming birth experience. At a White House event for Women’s History Month in March, I told President Biden about our work in the South to build the health, wealth and power of women and girls of color. He told me, “I understand how important your work is.” 

Local change is possible. In New Orleans, a Merck for Mothers’ Safer Childbirth Cities Initiative grant supports work to improve maternal health for Black birthing people. The Mama+ Health Policy Agenda tackles issues such as addressing social determinants that affect maternal health, extending Medicaid to one year after birth, diversifying and increasing the perinatal workforce, and improving telehealth. More cities and counties in the South should promote similar policies. 

Southern hospital systems should put in place the National Birth Equity Collaborative’s framework for providing pregnant and birthing people unbiased, equitable health care. 

Congress should pass the remaining bills included in the Black Maternal Health Momnibus Act of 2021, on which Mama+ is modeled — whether in a large legislative package or as stand-alone bills. More Southern states should take advantage of the new federal option to extend Medicaid coverage for pregnant women to 12 months after birth. 

Finally, health care providers and institutions and policymakers in the South and beyond must listen to Black women and Black grassroots advocates. Even a woman crying out in labor is saying something. She is asserting her humanity, her pain and her needs. How much better would the lives of Black women be if everyone listened? 

Carmen James Randolph is founding president and CEO of Women’s Foundation of the South, which supports BIPOC female entrepreneurs and BIPOC woman-led nonprofits working on issues that impact gender and racial justice across the South.