Photo credit: LaToya Ruby Frazier for The New York Times


There’s been a ton of discussion in the birth world this month about Linda Villarosa’s excellent New York Times Magazine feature, and for good reason. It would be an understatement to say that this longform report is a compelling read. Framed by the heartbreaking personal story of one mother in New Orleans, Villarosa’s piece lays out the history of black maternal and infant mortality in the U.S. in fascinating, infuriating detail:

Black infants in America are now more than twice as likely to die as white infants — 11.3 per 1,000 black babies, compared with 4.9 per 1,000 white babies, according to the most recent government data — a racial disparity that is actually wider than in 1850, 15 years before the end of slavery, when most black women were considered chattel.

Yeah. I’ll give you a minute to read that again.

Methodically, Villarosa dismantles the myths and assumptions that have obstructed progress for black mothers and babies in the United States. She shows us how the research community continues to dig deeper to unravel the knot of causation:

Though it seemed radical 25 years ago, few in the field now dispute that the black-white disparity in the deaths of babies is related not to the genetics of race but to the lived experience of race in this country. In 2007, David and Collins published an even more thorough examination of race and infant mortality in The American Journal of Public Health, again dispelling the notion of some sort of gene that would predispose black women to preterm birth or low birth weight. To make sure the message of the research was crystal clear, David, a professor of pediatrics at the University of Illinois, Chicago, stated his hypothesis in media-friendly but blunt-force terms in interviews: “For black women,” he said, “something about growing up in America seems to be bad for your baby’s birth weight.”

With engaging prose, Villarosa surveys a broad range of past and current projects focused on making sense of the abysmal statistics. She shoots down the various shame/blame theories that have persisted over the years (no, the high rate of infant death for black women is not due to smoking, drinking, using drugs, being overweight, being too young, or being poor) and brings us up to speed on what the evidence says about the long term effects of systemic racism on black bodies:

The bone-deep accumulation of traumatizing life experiences and persistent insults that the [Black Women’s Health Study] pinpointed is not the sort of “lean in” stress relieved by meditation and “me time.” When a person is faced with a threat, the brain responds to the stress by releasing a flood of hormones, which allow the body to adapt and respond to the challenge. When stress is sustained, long-term exposure to stress hormones can lead to wear and tear on the cardiovascular, metabolic and immune systems, making the body vulnerable to illness and even early death.

If reading her story makes you weep with sorrow and rage, it’s supposed to. And yet, she also shows us glimmers of hope. Villarosa highlights the vital work of several groups working hands-on to create better birth outcomes for black families: SisterSong, the Birthmark Doula Collective, the By My Side Birth Support Program, and Sisters Keeper are among a nationwide network of organizations trying to bridge the gaps in healthcare.

Here in Portland, a city whose long-term sustainability centers on attracting and retaining non-white families from away, we have a few organizations working woman-to-woman to improve black maternal health; the Community Doula Birth Program supports births at low/no-cost and In Her Presence provides a variety of social support, to name two. But as Villarosa notes in her conclusion, very few doulas can earn a living solely from birth work, especially if they are trying to reach low-income populations, and doulas can’t change the game all on their own regardless. As a state and as a nation, we still have centuries of systemic oppression to overcome and repair.

There is a growing body of research demonstrating that maternal and infant health outcomes are better when mothers have good social support during pregnancy, birth, and postpartum recovery. For families with resources, that kind of help can be bought (and even then, Villarosa emphasizes, income and education are no protection against low birth weight for black babies.)

For the rest, for the majority, we need fundamental, structural change — in workplaces, healthcare, state law, insurance coverage, and social attitudes toward birth. We need medical professionals to listen to, and believe, black women. Prioritizing the health of black mothers and babies is prioritizing the health of our communities. Making space for women of color to connect with each other and with resources is a good start. Creating systems that pay birth workers a livable wage is even better. Improving the way doctors and nurses interact with women of color is better still. So how do we get there?

Now that we know better, let’s do better, Maine.

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