Labor nurse and midwife Demetrice Smith delivered babies for a living. A community-health advocate in New Orleans, she taught expectant African-American moms how to have a healthy pregnancy and baby, warning them of the stubborn and silent epidemic in the black community: high infant- and maternal-mortality rates.
So in 2006, when 27-year-old Smith, who is black herself, found out she was expecting her first child, a girl she’d name Tristin, she was elated and confident about her pregnancy. “I would have a beautiful birth without complications, with my husband by my side,” she recalls thinking. Her trusted colleagues lined up to help her with the delivery, even picking out her favorite birthing suite at the hospital where she worked.
Little did she know that she would experience the very same tragedy she had tried so hard to prevent for her clients. Inexplicably, she went into labor early and delivered little Tristin at just 25 weeks. Weighing only 1 pound, 8 ounces, Tristin never left the neonatalintensive-care unit, succumbing six weeks later to a bacterial infection that had made her tiny intestines disintegrate.
Heartbroken and depressed, Smith was unable to return to work in obstetrics and sought therapy to help her cope with her devastating loss. “I did everything I was supposed to do,” she says. “I went to my doctor visits. I took my vitamins. I worked out.” She can still recall the total number of hours she was able to hold her baby girl before she died: six..
Each year, about 23,000 infants in the United States die before their first birthday—and black babies are more than twice as likely to die as white babies. Equally grim is the increasing number of African-American women who die due to pregnancy-related causes. The U.S. has the highest maternal-mortality rate of all industrialized countries in the world—and the rate for black women has climbed to a staggering 43.5 deaths per 100,000 live births, compared with 12.7 deaths for white women and 14.4 deaths for women of other races, according to the Centers for Disease Control and Prevention (CDC).
“It’s a disgrace,” says Paula Braveman, M.D., professor of family and community medicine and the director of the Center on Social Disparities in Health at the University of California, San Francisco. She and state officials have grappled with the fact that the black infantmortality rate in California is 9.4 deaths per 1,000 births—a dramatic difference from the white rate of 3.9 deaths and one of the nation’s largest racial gaps.
Experts agree that the solutions for this alarming disparity cannot be reached by doctors and nurses alone. The problem will require a seismic shift in society in order to empower and protect black women long before they become pregnant.
Confronting a Medical Reality
Public-health experts can’t fully explain why black women and babies are dying more than others. Conventional wisdom has pointed to poverty or to a lack of education or access to quality health care as some of the culprits. “But the situation is more complicated than that, and those factors don’t explain why highly educated black women also have poor outcomes,” says Parents advisor Laura Riley, M.D., director of labor and delivery at Massachusetts General Hospital, in Boston, where she specializes in high-risk pregnancies.
The fact is, affluent and educated black women are more likely to lose their newborn than uneducated white women who’ve had little or no prenatal care. Black women suffer the highest infant and maternal-mortality rates across the board, according to the CDC. “Researchers have had to broaden their scope in searching for answers,” Dr. Riley says. And a growing number of experts are reaching a far more complex conclusion that is chained to our country’s complicated history with racism.
“It is absolutely plausible, scientifically, that the chronic stress of being treated unfairly or viewed unjustly because of one’s race—or even just worrying that this may occur—could cause physiological changes in a woman’s body that can in turn put her infant at a disadvantage,” Dr. Braveman explains. Research has shown, for example, that ongoing stress can lead to inflammation throughout the body and is likely to weaken one’s immune system in a way that can potentially affect offspring. Doctors refer to this overall effect as “allostatic load,” which causes a breakdown of the body’s health-preserving mechanisms. A study in Journal of the National Medical Association found that black men and women have higher allostatic load scores that whites, which has led to an increase in premature death from chronic diseases.
Being on the receiving end of racism can have a powerful impact: Black men have the lowest life expectancy of any race or ethnicity in the United States. And while white women have the highest rate of getting cancer, black women are far more likely to die from cancer than any other group. The ever-present stress caused by racial bias and its legacy of discrimination over generations is becoming the most likely underlying offender for these disparities.
Creating a New Support System
In recent years, mostly women-led organizations across the nation have been fighting for better birth outcomes for African-American women. While the country continues to struggle with the specter of racism, experts agree that optimizing a woman’s health before, during, and after pregnancy is crucial for good birth outcomes. These groups are focused on what they can do now.
Monica Simpson, executive director of SisterSong Women of Color Reproductive Justice Collective, helped form the Black Mamas Matter Alliance in Atlanta in 2015. The alliance draws from a mix of political, social, and health experts to highlight the plight of black women’s reproductive health in the South. “Racism has many legs and tentacles that are both wide-reaching and deeppiercing,” Simpson says. “Unfortunately, pregnant black women are not immune.”
Take Monique Woodford-Breaux, 38, a married mother of three who is a health educator for the San Francisco Department of Public Health. She vividly remembers visiting the doctor’s office to complain of stomach pains before her first child (Nala, now 7) was born. “During a routine blood workup, the nurse gave me a pregnancy test and came back and said, ‘Oh, I’m sorry—you’re pregnant,’ ” she recalls. “But I was thrilled by the news and said, ‘My husband will be so happy!’ ” The nurse’s response was incredulous: “Oh, you’re married?”
This initial exchange set a negative tone for every prenatal visit that followed. Woodford-Breaux says she felt immense pressure to quickly establish herself with everyone on staff, making sure they knew she was indeed a college-educated, married woman. “No matter what degree, no matter what job, no matter what good we do in this world, it always comes down to ‘Oh, you’re still having one of those babies,’ ” she says.
Woodford-Breaux already had a working relationship with the Black Infant Health program, which is dedicated to improving AfricanAmerican infant and maternal health in California, having previously partnered with the program on her job. After Nala was born, she was able to benefit from their encouragement and support firsthand, and would again throughout her next two pregnancies.
The kinds of microaggressions like the one Woodford-Breaux experienced in the doctor’s office that day are ubiquitous among the women whom Jenée Johnson, the program’s director, meets. That’s why the center focuses on building women up by connecting them with needed services, developing stress-reducing strategies, and offering self-affirming group sessions. The program celebrates black women—even if the outside world does not. “Black women bear a unique burden,” says Johnson. “So we place an emphasis on mindfulness, empowerment, resilience, and self-love.”
Similarly, Chanel Porchia-Albert started a program for young girls at Ancient Song Doula Services, in Brooklyn. The 12-week course, called Soul of a Sister, shows girls between ages 12 and 24 how to establish healthy lifestyle habits with frank discussions about sex and taking care of their bodies. “When it comes to birthing and reproductive health, we as a community don’t talk openly about it,” says PorchiaAlbert. “Typically, young women of color don’t have a place where they feel comfortable enough to be able to ask questions and know that it is a nonjudgmental space.”
Focus: HOPE, a 50-year-old institution in Detroit, is also dedicated to overcoming racism and poverty by providing education and training. It recently started a program that teaches women to become doulas for their neighbors, giving them a job skill with more financial stability. So far, the organization has trained and hired doulas who have helped more than 120 mothers during the delivery of their babies. “This is precisely what can help stem the tide of trauma,” says Debbie Fisher, a program director. “Having someone on your side who has been through some of the same experiences—and can help you navigate the bureaucracy of childbirth and give you the tools to advocate on your own behalf—can make all the difference.”
On the national level, Nurse-Family Partnership pairs low-income women who are pregnant with their first child with a free nurse who supports them during their pregnancy and until their child’s second birthday. The nurse visits about every other week and helps mothers have a healthy pregnancy and successful transition to motherhood. “I was just hoping to get someone who I could talk to and who wouldn’t judge me,” says Mahogany Scott, 22, of Lumberton, North Carolina. What she got was so much more: Her nurse, Stephanie Chavis, helped her overcome massive swelling in her limbs during pregnancy after a series of visits determined that the former high-school basketball player was drinking only sodium-heavy sports drinks for hydration.
After her baby was born, Scott suffered from postpartum depression, feeling isolated and helpless about how to care for herself and her infant son. “Stephanie was always there for me, like my own personal psychologist,” she says. “Anything that I needed—physically or mentally—Stephanie was just a phone call away.”
Focusing on Resilience
Still, programs like these would not have had an impact on the short life of tiny Tristin. Demetrice Smith did everything she was supposed to do and nevertheless had a tragic birth outcome. Every chance she gets, she talks about her story of anger, sadness, and confusion to her patients who have experienced a loss. Infant mortality is a reality for many black women, she says, but it doesn’t have to define their lives or be accepted.
It took time, but Smith was able to bounce back from her experience. She returned to work part-time and went on to have three healthy children: Trinity, 9; Taelyn, 7; and Trebor Jr., 3. But she will never forget Tristin. “Just being black in America puts you at a higher risk of losing your life or your baby,” she laments. “Racism—whether it is blaring in our face or under the covers—has always been here and may always be. Until we can get past that, we just have to focus on loving ourselves.”
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