Black mothers are disproportionately dying during childbirth (Photo credit: Andrae Ricketts on Unsplash)
America is in the throes of a maternal healthcare crisis. Maternal deaths in the United States have been on the rise since 1990. Now, between 700 and 900 new and expectant mothers die every year, according to the Centers for Disease Control and Prevention. The risk is even greater for pregnant Black and Indigenous people, who are dying at a rate of 3.3 times and 2.5 times greater than whites, respectively, and the majority of these deaths are preventable. There isn’t a single reason why pregnant people, especially pregnant people of color, are dying, but Serena Williams’s near-death experience in September 2017 illuminated the impact of racism and sexism on expectant and laboring parents.
One day after Williams gave birth to Alexis Olympia Ohanian, Jr., she forced an unbelieving nurse to conduct a CT scan for possible blood clots and was rushed into surgery to treat a pulmonary embolism. Williams’s horrific experience is common for expecting parents of color, something author and professor Tressie McMillan Cottom hauntingly explored in her 2019 book Thick: And Other Essays. McMillan Cottom’s daughter died shortly after birth because nurses and doctors dismissed her early labor pains. “Like millions of women of color, especially Black women, the healthcare machine could not imagine me as competent and so it neglected and ignored me until I was incompetent,” she writes, before adding, “When the medical profession systematically denies the existence of Black women’s pain, underdiagnoses our pain, refuses to alleviate or treat our pain, healthcare marks us as incompetent bureaucratic subjects. Then it serves us accordingly.”
For Black people and people of color with fewer resources than Williams and McMillan Cottom, death is becoming an expected outcome of giving birth. Dani McClain, who has been reporting on race and reproductive health for years, knows how high the stakes are for pregnant Black women, so when she became pregnant three years ago, she asked other Black mothers for guidance and advice on how to survive pregnancy, raise joyful Black children, and protect themselves and their babies from harm. McClain’s powerful April 2019 book, We Live for the We: The Political Power of Black Motherhood, is a wellspring of anecdotes, research, and recommendations to help new Black parents navigate difficult terrain.
We Live for the We comes as a number of high-profile politicians, including Elizabeth Warren, Kamala Harris, Corey Booker, and Ayanna Pressley, have taken up the fight against maternal mortality. Booker and Pressley recently introduced the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES) Act to lower maternal mortality by providing care for a year after childbirth; connecting expectant parents to women’s healthcare providers, primary care physicians, and doulas; and extending full Medicaid coverage to new mothers rather than only to those who are pregnant. More is sure to come, and McClain plans to continue her work at the frontlines, using her own experiences to shape our understanding of this dire issue.
We Live for the We discusses “mothering as an action or a verb instead of a state of being.” Can you expand more on the idea of “revolutionary mothering?”
Revolutionary Mothering: Love on the Front Lines is the title of a [20OK16] book that’s coedited by China Martens, Mai’a Williams, and Alexis Pauline Gumbs. I reviewed that book for The Nation a few years ago, and I borrowed [the] idea of mothering as a verb rather than motherhood as the state of being because I love the way that book’s editors talked about mothering as an action that can be done by any range of people, not necessarily just the biological parent who considers herself a mother. You can talk about aunties mothering, grandparents mothering, gender-nonconforming people—parents who don’t necessarily identify with the word “mother”—engaging in the act.
I don’t use the word “revolution” much in my book, but I do talk about the politics of mothering. A lot of people hear [the] word “politics” and their mind immediately goes to electoral politics. I touch on mothers engaging in electoral politics in the final chapter of the book, but for the most part, I’m talking about the politics of our everyday choices: deciding who we want around us when we give birth. Do we want to have a Black doula, midwife or [ob-gyn] next to us, and how might their presence affect our birth outcomes and our experience of labor and birth? How do we decide [which school to] send our children to, given that so many of us are navigating segregated schools? How [do] we talk to our children about sex, consent, and bodily autonomy? I’m trying to encourage this expansive understanding of politics.
You’ve spent a good portion of your journalism career reporting on and writing about police violence, reproductive justice, and the ongoing impact of racism. Has that work influenced your approach to parenting?
At the end of 2012 I started reporting on reproductive rights. Early [on] in that process, I was checking out how other people approach that beat, and I saw that people typically cover access to abortion and contraception. But I was quickly introduced to the reproductive-justice framework by Black women like Monica Simpson at SisterSong [and] Reneé Bracey Sherman, and a lot of Native sisters and Latinas. Young Women United [and] California Latinas for Reproductive Justice were sharing information with me about reproductive justice, which argues that we have a human right to have a child, to not have a child, and to parent the children that we have in safe and healthy environments. [That] really opened up possibilities for me [as] I thought about how to construct [my] beat.
Earlier in my career, I was an education reporter for the Milwaukee Journal Sentinel. I still occasionally report on schools as a freelancer. I have reported on criminal-justice issues. And the way that this has influenced me as I’ve become a parent [is] really the motivating question in my book. I thought a lot about the range of political [and] social-justice questions [and] the campaigns I had covered, and I started wondering: How do people bring their politics and their values into family life? I was wondering how I was going to do it for my own child. I realized I’ve been covering these issues for so long [that] I know all these people as sources, [but] I’ve never asked them about their parenting.
I’ve known dream hampton for many years [and] I admire [her work] as a writer [and] cultural organizer. I had met her child before, but I had never asked her about her experience of mothering. I’ve known Monifa Bandele, cofounder of the Malcolm X Grassroots Movement and a vice president of Moms Rising, for a long time. I’ve interviewed her for stories and I also knew she and her husband are [parenting] teenage girls, but I had never talked to them about their parenting. I decided to tap into that network of sources and ask these people about [bringing] their politics into family life.
Your book functions as a handbook for Black parents who want to create a community that will uplift and support their children. How have you created that village? What are the first steps for other Black parents who want to do the same?
Community is a kind of thread throughout [the book]. I’m searching for a community that feels right for myself and my child. Chapter five takes this question head on: How do I find the right community for myself and my daughter? I’ve spent a lot of my adult life living in the Bay Area and New York City. Now I live in my hometown—Cincinnati, Ohio—and I’m looking at friends and people I know who live in the Bay [Area] or in New York who have access to childcare co-ops: Little Maroons has an African-centered curriculum; Rice and Beans is a preschool cooperative in Oakland; [and] Abundant Beginnings is [a] summer and after-school program in Oakland that is led by Black women.
These progressive cities where I’ve lived [have] all these institutions and [this] infrastructure that parents have set up in the past couple of decades. I can get really envious, and I think: If we moved back to New York or the Bay, I’d have access to communities that already have all this stuff set up. But I spend a good amount of time in [the book] on belonging—something that I’ve learned about in Detroit. This is not considered a progressive bubble; I live in the Midwest. We have Detroit Summer, an intergenerational program that was created in the ’90s, at a time when a lot of resources and people [were] fleeing the city of Detroit. Detroit Summer [was] really interested in showing love for Detroit, helping young people in Detroit see what was good about their city, and [helping them] feel pride in their city through media projects that engaged them in community gardening, mural projects, and interviewing elders so that they learn about Detroit’s history.
I value the conversation in the book around Detroit because you don’t have to go to these highly sought-after cities. It just takes a commitment to creating what you want. If you don’t have the institutions, the schools, the Saturday programs, [and] the sports leagues that you want, then it’s on you to create [them]. You have to have deep trust with people. You have to really get to know people before you embark on some big project. That’s the stage that I’m in now. I’m building my friendships, strengthening my friendships, [and] trying to create meaningful relationships with people.
You recently wrote an article for Time magazine about protecting your daughter’s joy and not allowing fear to guide your parenting. How can Black parents follow that blueprint?
It’s not easy. When you become responsible for guiding a young person through this world, there are a lot of reasons to have some anxiety. The stakes are pretty high. But for Black parents, we have added layers of things to be afraid about, [like] state violence. When we see 12-year-old Tamir Rice being killed within seconds of a police officer arriving on the scene [because he’s] holding a toy gun. When we hear the story of Jordan Davis, 17 years old, killed by a white man who is annoyed by the music that Jordan and his friends are playing at a gas station. Aiyana Stanley-Jones is another example I give in that Time piece: gunned down in her home, asleep on the couch with her grandmother because the police are raiding her home in search of a neighbor. There are lots of reasons for us to fear for our children’s safety.
I wouldn’t say that it’s a mandate. As I shared my fears with [the] Black parents I interviewed for the book, they all encouraged being honest with our children about how they need to conduct themselves to try to stay safe, but also not making our kids feel like they can control things. They can’t control a racist police officer. They can’t control some enraged vigilante who decides he’s going to take the law into his own hands. In that piece I share the story of Kim Tabari, a mom in Southern California who watched a friend of hers—another mother of a Black teenager—really shelter her child after that child got involved in a scuffle on a bus. Kim told me [that’s the] moment she decided that [wasn’t going to be her]. [She wanted] to orient toward joy with [her] child.
I found a lot of value in that story because I want to have fun with my daughter. She’s a source of a lot of joy and light in my life, and I want to cultivate that in her and help her understand how to find her own happiness [and] not be too bogged down in fear. I want her to enjoy the simple things in life: taking a walk, stopping to smell some flowers, [and] dancing in our kitchen. Of course we want to have fun with our children, and we want to engage in joyful practices with them. As long as we’re teaching them the basics and setting some explicit limits—teaching them what they can do, how they should behave—then why not just spend most of our time enjoying them and enjoying our time together?
America has one of the highest maternal mortality rates in the world. Black mothers are 243 percent more likely than white mothers to die from pregnancy- or childbirth-related complications. How did we get to this point?
My research has pointed to a couple of different things, [including] racism in our healthcare system. There’s a 2016 University of Virginia study that found that about half of the white medical students and residents surveyed held at least one false belief about biological differences between Black and white people, [such as] Black people’s nerve endings [being] less sensitive than white people. That is bananas. We need to think about our pregnancies and births being attended by people who don’t understand us and fully see us as human beings.
I remember when Serena Williams came forward with her birth story. She was telling her doctors, “I have a history of blood clots,” and there was a question about whether or not she was really being listened to. That’s often what you hear in these tragic stories about people dying during birth or the immediate postpartum period. They’re trying to tell their doctor that they’re experiencing symptoms. They’re trying to tell nurses that something doesn’t feel right, and they’re not being listened to. We have racism in our medical system, and there needs to be a lot of training around helping people recognize and deal with their implicit bias.
But the other thing that I found through my research was the physiological impact of racism—the stressors of dealing with microaggressions and the impact of structural racism on a daily basis. This researcher, Arline Geronimus, talks about what she calls “weathering,” the ways in which our bodies as Black women are just worn down. Our cortisol levels are too high; our stress hormones are reflecting what we’re dealing with on an everyday basis. And of course if our bodies are essentially aging more quickly than white people’s bodies because they’re not sharing these burdens, that’s something else we have to think about [in pregnancy] and giving birth. Our bodies have undergone a lot of stress just by surviving. I think this issue of implicit biases is the one that feels perhaps the most actionable, right? If we train doctors and train medical professionals, hopefully we can get somewhere.
I spend a lot of time in my chapter on pregnancy and birth talking to Black birth workers because I’m curious about what happens if you take that racism out of the equation. I interviewed Anayah Sangodele-Ayoka, a midwife in Washington, D.C., about cultural congruence and how Black families line up to try to work with her. They have open houses at the clinic where she works, where all the midwives introduce themselves and talk about their practices. At the end, Black families line up to work with her because they feel that they’re going to be listened to and cared for in a different way.
A lot of insurance companies don’t cover home births, so it’s often not an option to have a doula or a midwife unless you’re able to pay for it out of your own pocket.
In Ohio, home births are alegal: They’re not illegal, but if you choose to have one, you’re operating outside of the legal structure and taking on all risks yourself. A lot of people use a midwife in a hospital setting or [use] freestanding birth centers where midwives also work, but you’re absolutely right about insurance coverage. I talked to doulas [for the book]. They don’t get reimbursed by insurance companies. I know [there’s] a campaign underway in different states where people are [arguing that] low-income people should have their doula care covered. This is where we start to get into the policy battles around putting low-income people on equal footing with wealthier families that get to have the kind of births that they want.
We have to cultivate joy; that’s the only way we’re going to survive and thrive.
Senators Cory Booker and Ayanna Pressley introduced a bill to address maternal mortality. Elizabeth Warren and Kamala Harris have both made combating maternal mortality part of their campaign platforms. Lena Waithe narrated a PSA about maternal mortality. Why is this issue generating so much attention right now?
I wrote a [March 2017] cover story for The Nation [titled] “What It’s Like to Be Black and Pregnant When You Know How Dangerous That Can Be.” It was my experience of being pregnant interwoven with these interviews that I’d done with Black birth workers. That story became the foundation for the first chapter of my book.
In the past two years we’ve had a beautiful New York Times magazine cover story by Linda Villarosa about the Black maternal health crisis. NPR and ProPublica partnered up to do a series [about it]. Why now? I think that we’re finally admitting that America doesn’t have a maternal health crisis: Black America does. Black women are dying, and it’s not our fault. There’s finally some attention being paid to the fact that we’re receiving negligent care. There’s [also] a willingness to address what can be done to get Black families the care that they deserve. It’s interesting, watching people coming up with different policy proposals and thinking through what might help.
There’s a big aspect [of this issue that’s] about hospitals having to report out what’s happening, and not chalking these deaths up to something else. [Hospitals need to] get really granular about exactly what happened if [a person] dies [during childbirth]. We need to know what exactly was done. I don’t know how you train racism out of someone, but there are efforts to figure that out so that medical professionals are able to give the care that Black families need.
On my recent book tour, I kept hearing young Black women saying over and over again, “I’m scared. All the coverage that I’m reading makes me afraid to get pregnant and give birth because I’m not sure that I’m going to make it.” I’ve really been holding that close to my heart and thinking about my responsibility as a journalist: It really speaks to how important it is that we tell these stories with care and compassion, and really think about the impact they could have. It’s wonderful that the Black maternal health crisis is getting attention, but if the impact is that it’s making Black women second-guess whether they want to reproduce, that’s something to grapple with.
What are the greatest lessons you’ve learned about yourself through becoming a mom to a Black daughter?
Becoming a parent has really put my perfectionism in check. There are so many things that I want to get right. I want to choose the right preschool for her. I want to choose the right place for us to live so that her lead levels don’t read high when we go to the doctor, so there are plenty of places to play outside and friends for her to make in our neighborhood. I want to make the right decisions when I go to the grocery store to help with her body and her brain development. I need to make decisions about childcare and who [it is] okay for her to be with when I’m working. I’ve learned that I have to trust my instincts.
That’s something that I got from a lot of the conversations I had with the mothers and grandmothers I interviewed. We just do our best, trust in the resiliency of our children, and keep it moving. I’ve learned the importance of play, the importance of having fun, and the importance of not letting news events and the constant barrage of tragedy break me down and break us down as a family. We have to cultivate joy; that’s the only way we’re going to survive and thrive.
